"hospital_name","last_updated_on","version","location_name","hospital_address","type_2_npi","license_number|MD","To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","attester_name"
"The Johns Hopkins Hospital","2026-04-01","3.0.0","The Johns Hopkins Hospital","600 North  Wolfe Street, Baltimore, MD 21287","1578597993","30034","true","Ed Beranek"
"description","code|1","code|1|type","code|2","code|2|type","code|3","code|3|type","billing_class","setting","drug_unit_of_measurement","drug_type_of_measurement","modifiers","standard_charge|gross","standard_charge|discounted_cash","payer_name","plan_name","standard_charge|negotiated_dollar","standard_charge|negotiated_percentage","standard_charge|negotiated_algorithm","median_amount","10th_percentile","90th_percentile","count","standard_charge|methodology","standard_charge|min","standard_charge|max","additional_generic_notes"
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","13449.74","13427.16","21557.39","1 through 10","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","12767.33","12767.33","12767.33","1 through 10","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","13427.14","11538.33","13544.36","19","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","12395.02","12395.02","12395.02","1 through 10","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2836.51","1936.63","12596.06","26","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","13427.14","12255.17","13533.05","13","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","12273.13","12273.13","12273.13","1 through 10","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","13498.54","13498.54","13498.54","1 through 10","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12063.88","12063.88","12063.88","1 through 10","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","13533.05","13533.05","13533.05","1 through 10","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12193.56","12193.56","12916.61","1 through 10","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","12050.26","12050.26","12175.59","1 through 10","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","13564.16","13041.07","13671.15","1 through 10","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","13427.16","13427.16","13427.16","1 through 10","percent of total billed charges","","",""
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 21 ($1901-$2000)","1521","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12098.14","2555.76","13262.2","1 through 10","percent of total billed charges","","",""
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","8532.01","8532.01","10266.84","1 through 10","percent of total billed charges","","",""
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","8464.38","5028.72","10916.95","16","percent of total billed charges","","",""
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8531.44","7721.33","16770.01","11","percent of total billed charges","","",""
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","10291.95","9399.61","18524.84","1 through 10","percent of total billed charges","","",""
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","10294.39","10294.39","18380.32","1 through 10","percent of total billed charges","","",""
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7103.81","6425.71","8364.61","1 through 10","percent of total billed charges","","",""
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9273.26","9273.26","9299.18","1 through 10","percent of total billed charges","","",""
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","15022.15","15022.15","16959.26","1 through 10","percent of total billed charges","","",""
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10976.25","8807.3","17898.58","1 through 10","percent of total billed charges","","",""
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","10730.72","10320.74","15977","1 through 10","percent of total billed charges","","",""
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 22 ($2001-$2500)","1522","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","21867.53","21867.53","21867.53","1 through 10","percent of total billed charges","","",""
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","18050.15","18050.15","18050.15","1 through 10","percent of total billed charges","","",""
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"New Technology - Level 39 ($15,001-$20,000)","1576","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","26260.92","26260.92","26260.92","1 through 10","percent of total billed charges","","",""
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","16280.97","16280.97","16280.97","1 through 10","percent of total billed charges","","",""
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","26230.41","26230.41","26230.41","1 through 10","percent of total billed charges","","",""
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","23608.43","23608.43","23608.43","1 through 10","percent of total billed charges","","",""
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","23339.7","23339.7","23339.7","1 through 10","percent of total billed charges","","",""
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","22270.61","22270.61","22270.61","1 through 10","percent of total billed charges","","",""
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","22695.74","22695.74","22695.74","1 through 10","percent of total billed charges","","",""
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","17598.01","17598.01","17598.01","1 through 10","percent of total billed charges","","",""
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,I-125","2639","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10124.9","10124.9","10124.9","1 through 10","percent of total billed charges","","",""
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","11057.95","11057.95","11057.95","1 through 10","percent of total billed charges","","",""
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","11357.81","11357.81","11357.81","1 through 10","percent of total billed charges","","",""
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-stranded,P-103","2641","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","558.05","558.05","558.05","1 through 10","percent of total billed charges","","",""
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","6185.15","6185.15","6185.15","1 through 10","percent of total billed charges","","",""
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1329.32","1329.32","1329.32","1 through 10","percent of total billed charges","","",""
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","3822.19","3822.19","3822.19","1 through 10","percent of total billed charges","","",""
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Brachytx, non-str, HDR Ir-192","2646","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","143.11","80.19","574.44","11620","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","134.59","70.18","461.16","3618","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","314.39","178.26","653.1","1 through 10","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","123.99","61.33","380.15","403","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","143.25","78.25","574.58","22701","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","132.68","49.64","468.03","763","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","142.9","53.99","477.23","29081","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","146.68","81.77","414.78","48","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","142.9","74.58","618.95","15179","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","120.52","65.02","411.61","2665","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","141.95","68.05","516.59","8877","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","142.9","53.22","409.01","100","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","146.68","135.61","458.62","11","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","137.51","118.37","436.26","127","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","125.53","70.45","676.9","240","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","113.54","113.54","113.54","1 through 10","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","172.28","107.33","872.33","412","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","234.28","118.75","1639.66","962","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","105","38.09","295.36","59","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","128.39","82.7","407.35","6031","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","131.9","79.72","474.87","53","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","136.11","81.81","646.85","33","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","143.5","142.65","354.59","1 through 10","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","142.28","100","376.84","81","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","128.76","48.45","466.56","30292","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","132.45","113.35","401.03","210","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","121.88","54.39","488","2425","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","144.66","80.36","611.74","8035","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","142.91","94.9","510.17","4249","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","131.9","94.73","624.21","1 through 10","percent of total billed charges","","",""
"Clinic Visits and Related Services","5012","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","128.76","96.34","319.49","7352","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","235.33","120.3","628.27","36","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","131.44","116.44","255.86","16","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","192.61","123.79","1430.16","1 through 10","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","486.1","425.78","639.01","1 through 10","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","244.56","85.96","975.7","56","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","193.56","185.98","427.42","37","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","247.1","111.56","458.9","79","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","131.18","128.81","351.62","13","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","244.61","133.92","319.09","55","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","93.98","5.69","286.3","32","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","185.98","124.69","233.14","1 through 10","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","124.69","95.56","1031.84","1 through 10","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","256.33","182.96","626.33","1 through 10","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","232.63","209.3","407.78","554","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","233.29","209.9","293.7","728","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","236.21","105.68","375.81","206","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","131.18","107.35","241.44","45","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","244.63","116.73","274.97","38","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","256.35","243.84","272.26","13","percent of total billed charges","","",""
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Type A ED Visits","5021","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","233.29","219.41","410.02","440","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","575.82","435.28","3334.65","58","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","606.57","388.81","1472.2","18","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","342.84","233.13","461.64","1 through 10","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","452.54","452.54","452.54","1 through 10","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","521.44","213.21","2279.24","136","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","469.63","371.96","963.36","42","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","487.71","487.71","665.9","1 through 10","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","549.58","361.01","2221.43","198","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","543.39","412.7","1864.5","129","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","613.42","365.42","3306.76","1 through 10","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","361.88","357.16","620.63","13","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","487.97","237.98","1269.46","84","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","781.14","781.14","781.14","1 through 10","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","508.13","508.13","508.13","1 through 10","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","3532.03","477.05","3554.02","1 through 10","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","421.35","361.83","841.95","15","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","548.75","427.69","1861.41","19","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","465.26","244.56","652.34","493","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","300","300","300","1 through 10","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","442.48","220.4","816.79","1224","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","464.17","211.36","875.58","261","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","393.78","321.37","1219.48","63","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","494.96","200.04","2431.51","75","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","544.39","465.92","5743.32","14","percent of total billed charges","","",""
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Type A ED Visits","5022","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","245.25","220.4","678.74","449","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","884.2","623.91","2654.8","409","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1006.01","677.57","3754.41","120","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","870.95","499.48","2316.82","26","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","678.57","495.2","979.58","1 through 10","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","831.13","589.71","2190.01","54","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","868.99","592","2671.74","688","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","850.29","585.14","2548.32","968","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","1016.32","664.01","3311.19","21","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","931.1","643.98","2744.35","663","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","1018.4","609.16","2913.35","40","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","889.14","542.82","3027.92","63","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","862.01","501.24","2361.12","398","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","791.63","791.63","791.63","1 through 10","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","1877.19","1877.19","1877.19","1 through 10","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","1018.58","703.64","3322.81","12","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","814.15","596.65","2543.06","56","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","935.69","653.29","2823.38","98","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","1173.37","1173.37","1173.37","1 through 10","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","675.08","220.62","1312.84","1639","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","822.15","793.97","1650.82","1 through 10","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","657.01","641.33","878.92","1 through 10","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","700.42","221.24","1388.75","3958","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","729.88","243.29","1412.38","652","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","885.37","542.07","2500.72","185","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","800.45","244.71","2357.71","343","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","892.81","736.67","2630.03","88","percent of total billed charges","","",""
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Type A ED Visits","5023","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","630.83","230.98","1394.74","1587","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1722.7","1164.76","4369.76","553","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2022.13","1300.89","4738.35","188","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","1381.34","180.04","4078.83","49","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","863.11","399.89","1098.44","1 through 10","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1612.96","1184.06","4336.38","60","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1788.63","1202.9","4016.82","987","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","1777.11","1142.75","4374.61","39","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1729.47","1137.28","4202.1","1522","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1749.8","1210.95","3633.72","891","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","1608.62","1095.86","3700.48","76","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1775.27","1179.08","3677.23","74","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1750.94","1129.97","3573.53","560","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","976.54","976.54","3865.17","1 through 10","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","1403.34","1403.34","1864.9","1 through 10","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","2251.1","1808.41","5008.83","1 through 10","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","1840.28","1424.28","2765.9","12","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","1870.69","1130.28","3826.31","101","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","1723","1210.95","4185.28","123","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","1854.32","1645.1","3419.78","1 through 10","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","4325.58","4325.58","4325.58","1 through 10","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1315.56","269.05","3071.79","1707","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","2284.24","1333.01","3453.36","12","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","2815.14","933.59","9456.69","1 through 10","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1484.49","245.25","3147.69","3618","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1421.86","568.3","2804.32","626","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1776.41","1162.32","4234.53","257","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1559.94","579.33","3289.44","490","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1592.26","1280.97","4329.71","132","percent of total billed charges","","",""
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Type A ED Visits","5024","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1259.2","313.54","2902.78","1635","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2680.76","1928.37","4935.65","223","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","3045.53","2150.61","6267.92","69","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","2214.94","1836.58","2879.41","23","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","606.41","412.67","2272.69","1 through 10","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2837.92","2055.16","5423.52","328","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","2539.14","1847.13","5298.89","31","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","2958.63","2495.74","5272.88","1 through 10","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2911.09","1943.74","5443.84","510","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2940.48","2089.33","5636.13","266","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","2296.8","1765.44","4605.06","27","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2833.85","2154.22","5018.86","19","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2853.66","1963.44","5377.29","148","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","2483.18","2483.18","2483.18","1 through 10","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","2871.63","2871.63","2871.63","1 through 10","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","2396.54","2396.54","2396.54","1 through 10","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","2913.49","2559.52","5322.54","1 through 10","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","3198.04","2029.94","5724.8","57","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","3549.36","2129.82","5703.93","39","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","5931.56","5931.56","5931.56","1 through 10","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2395.87","440.95","4461.17","516","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","4009.16","2080.26","4124.12","1 through 10","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2595.67","1907.64","4459.94","1151","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","2467.93","1182.63","5631.23","211","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2659.45","1944.48","5099.99","104","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2755.84","1090.75","5816.05","182","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","3121.25","2106.3","5805.89","60","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","3360.44","3360.44","3360.44","1 through 10","percent of total billed charges","","",""
"Level 5 Type A ED Visits","5025","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2201.27","583.64","4352.96","552","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","318.55","140.02","636.24","86","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","331.52","147.86","653.43","25","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","326.09","142.74","751.7","152","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","187.37","187.37","187.37","1 through 10","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","326.43","109.9","722.1","170","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","355.37","144.93","840.47","170","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","278.47","278.47","278.47","1 through 10","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","304.67","135.66","639.26","52","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","354.47","174.13","846.64","118","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","875.85","875.85","875.85","1 through 10","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","892.67","306.86","1354.84","11","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","942.41","942.41","942.41","1 through 10","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","286.44","118.08","1408.01","44","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","320.52","156.82","1199.5","177","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","3975.73","3975.73","3975.73","1 through 10","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","294.59","136.93","603.82","17","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","322.07","157.58","767.97","52","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","472.08","248.76","691.78","53","percent of total billed charges","","",""
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Skin Procedures","5051","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","283.24","76.11","515.5","26","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","356.64","146.35","1355.02","115","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","335.21","49.71","582.97","34","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","207.93","207.93","207.93","1 through 10","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","370.01","174.04","1782.61","215","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","496.03","335.23","2243.59","1 through 10","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","368.46","136.61","2456.8","233","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","174.88","96.55","9516.34","1 through 10","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","369.98","295.06","3030","107","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","414.34","189.92","19904.37","20","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","316.98","115.43","962.44","89","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","185.15","140.51","312.54","12","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","47.37","47.37","47.37","1 through 10","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","550.47","550.47","1114.9","1 through 10","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","400.16","400.16","2531.07","1 through 10","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","319.77","141.06","2163.27","47","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","312.52","131.57","835.06","161","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","483.85","277.53","1919.37","13","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","377.53","313.4","3737.87","53","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","355.74","318.12","1116.62","28","percent of total billed charges","","",""
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Skin Procedures","5052","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","403.29","279.54","6716.44","47","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","966.89","87.03","1974.27","36","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","914.76","584","2035.69","11","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","944.83","944.83","944.83","1 through 10","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1206.98","139.24","2851.69","62","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1255.26","88.8","4712.73","66","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","888.37","94.2","2305.2","39","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","901.15","69.37","1574.34","27","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1187","383.66","3344.27","23","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","1476.69","1476.69","1476.69","1 through 10","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","746.15","746.15","746.15","1 through 10","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","4911.15","4911.15","4911.15","1 through 10","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","2037.26","1987.1","8995.13","1 through 10","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1649.8","29.2","11744.29","1 through 10","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","891.96","891.96","891.96","1 through 10","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","500.63","78.41","1567.93","31","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","17986.9","17986.9","17986.9","1 through 10","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1891.96","1139.2","2932.52","1 through 10","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1424.66","122.96","8093.77","20","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1422.89","784.92","4097.76","28","percent of total billed charges","","",""
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Skin Procedures","5053","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","3269.34","3123.14","5366.26","1 through 10","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2778.94","244.93","8487.61","32","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2620.79","451.34","3379.95","1 through 10","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","2431.45","2431.45","2431.45","1 through 10","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2548.37","345.4","6829.99","42","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","8672.31","8672.31","8672.31","1 through 10","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2039.56","313.4","7716.99","42","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2099.54","81.74","10641.59","30","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","4872.98","4872.98","11041.86","1 through 10","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2377.18","70.47","5211.05","1 through 10","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","3829.26","3829.26","3829.26","1 through 10","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","117.11","117.11","117.11","1 through 10","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2768.43","1094.9","8624.2","1 through 10","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2625.05","207.94","9668.34","29","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","5803.16","5803.16","5803.16","1 through 10","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","3457.03","3083.82","11817.52","1 through 10","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3168.22","171.95","11037.78","19","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","2781.5","2232.98","6820.4","14","percent of total billed charges","","",""
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Skin Procedures","5054","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","5308.35","3009.95","12599.97","1 through 10","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","6678.14","2223.18","10762.11","1 through 10","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","5536.13","437.22","7189.28","1 through 10","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","3595.46","3595.46","3595.46","1 through 10","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","6201.41","2500.48","8105.59","26","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","7046.97","4011.4","9316.61","21","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","7534.9","4873.37","14426.67","16","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7410.99","5323.9","13422.57","1 through 10","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","6858.27","5713.59","9391.75","1 through 10","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","9272.5","9272.5","9272.5","1 through 10","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","6872.6","6872.6","6872.6","1 through 10","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6207.27","3506.11","16935.32","1 through 10","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","7908.57","6680.31","8887.12","12","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5975.31","5151.84","6857.81","1 through 10","percent of total billed charges","","",""
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Skin Procedures","5055","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","5947.19","3669.28","11265.36","1 through 10","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1245.28","687.35","4326.36","86","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","732.64","317.24","1622.55","21","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","754.56","754.56","754.56","1 through 10","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1101.01","527.25","3079.25","188","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1490.17","628.58","4470.58","174","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","970.29","300.8","1889.57","1 through 10","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1418.82","632.1","3443.94","113","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","2158.6","2158.6","2158.6","1 through 10","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1020.35","472.25","2911.97","57","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","738.98","411.52","1560.53","14","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","903.84","903.84","903.84","1 through 10","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1870.15","766.61","5830.18","22","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","954.88","954.88","954.88","1 through 10","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1354.53","661.72","4292.99","60","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1604.06","1604.06","1604.06","1 through 10","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","711.72","472.96","1623.3","17","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","996.65","360.75","3496.69","57","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1170","578.37","3380.87","49","percent of total billed charges","","",""
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Excision/ Biopsy/ Incision and Drainage","5071","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1141.81","631.01","4286.69","18","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2779.7","732.69","6377.5","145","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2909.95","1245.26","5680.36","47","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1845.82","1514.35","4515.45","1 through 10","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2980.98","898.09","5720.4","257","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","1855.14","890.75","5778.9","1 through 10","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2855.41","813.88","6530.83","311","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2945.34","974.62","6133.92","146","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2342.68","1629.7","3999.74","21","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2509.56","760.38","5527.07","133","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","3624.93","3624.93","3624.93","1 through 10","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","3899.9","3899.9","3899.9","1 through 10","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","870.2","870.2","870.2","1 through 10","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","1906.47","1906.47","1906.47","1 through 10","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","7232.91","7232.91","7232.91","1 through 10","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","6009.97","6009.97","22208.15","1 through 10","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","6228.65","1636.42","13354.15","22","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","4277.43","4277.43","4277.43","1 through 10","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3113.61","1231.28","6833.04","96","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2848.31","1560.74","6761.67","25","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3142","710.66","6768.58","97","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","2876.69","699.86","5398.82","50","percent of total billed charges","","",""
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Excision/ Biopsy/ Incision and Drainage","5072","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","3350.55","878.5","8101.06","39","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","6395.36","3513.98","16211.43","89","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","7828.22","4180.48","12816.56","38","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","13574.04","2930.77","24204.78","1 through 10","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","6066.38","2605.26","12392.14","167","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","4591.87","4544.83","7885.3","1 through 10","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6214.34","2574.23","14126.52","215","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","7154.16","3267.46","13708.43","123","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","1151.71","1151.71","1151.71","1 through 10","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","6978.62","4041.43","12301.4","30","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","8738.26","6048.39","17567.61","1 through 10","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","5184.03","5184.03","5184.03","1 through 10","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","5119.58","4217.01","7594.07","1 through 10","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","7410.01","4050.9","14066.7","20","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","7055.21","2089","12233.23","80","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","5261.01","3003.89","13455.27","18","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4996.67","2821.93","10485.86","86","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","6870.39","2728.75","12506.82","16","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","6307.74","763.79","13242.4","66","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5020.39","2272.62","11746.12","37","percent of total billed charges","","",""
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Excision/ Biopsy/ Incision and Drainage","5073","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","5506.45","3410.09","11597.79","34","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","9758.17","5125.97","14742.29","22","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","7800.65","6818.51","14019.86","1 through 10","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","3809.34","3809.34","3809.34","1 through 10","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","8713.77","4634.83","13927.14","49","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","7156.3","7156.3","19673.34","1 through 10","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6991.99","4989.65","13119.15","62","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","7750.75","4960.11","15089.38","18","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","7722.51","7722.51","7722.51","1 through 10","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","11948.69","8427.38","14716.24","1 through 10","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","6597.96","5235.7","11929.33","20","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","5027.17","5027.17","5027.17","1 through 10","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","7787.59","7787.59","7787.59","1 through 10","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12431.35","6176.56","13836.99","1 through 10","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6171.52","3831.63","10265.07","18","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","9120.17","9120.17","13501.18","1 through 10","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10535.93","5227.33","13584.18","18","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","8134.7","6163.56","9736.64","1 through 10","percent of total billed charges","","",""
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Breast/Lymphatic Surgery and Related Procedures","5091","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","7221.94","5537.72","11404.62","1 through 10","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","9528.07","3923","19235.87","19","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","10280.6","10146.21","23283.61","1 through 10","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","11135.83","5101.6","18603.21","57","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14015.96","8313.18","20656.61","58","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","12138.62","9359.19","21356.04","32","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","12097.44","12097.44","18330.42","1 through 10","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","10795.95","8380.09","20805.34","35","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","30754.89","30754.89","30754.89","1 through 10","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","8376.26","8376.26","10365.65","1 through 10","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11396.07","8376.34","15364.19","32","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","4238.43","4238.43","4238.43","1 through 10","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","12410","7552.86","14587.77","1 through 10","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","11992.39","4122.58","18531.59","16","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","13272.84","9798.37","20543.85","15","percent of total billed charges","","",""
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Breast/Lymphatic Surgery and Related Procedures","5092","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","11607.17","9042.77","19939.14","1 through 10","percent of total billed charges","","",""
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","12076.39","10384.47","20008.12","13","percent of total billed charges","","",""
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11644.78","8347.05","16593.35","12","percent of total billed charges","","",""
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","15597.84","12686.58","56513.13","1 through 10","percent of total billed charges","","",""
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","20520.57","14723.17","22534.37","1 through 10","percent of total billed charges","","",""
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","34687.81","34687.81","34687.81","1 through 10","percent of total billed charges","","",""
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","10257.1","10257.1","10257.1","1 through 10","percent of total billed charges","","",""
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10382.48","8415.74","35057.8","1 through 10","percent of total billed charges","","",""
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","12423.18","12423.18","12423.18","1 through 10","percent of total billed charges","","",""
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","14176.07","14176.07","14176.07","1 through 10","percent of total billed charges","","",""
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","17428.35","17428.35","17428.35","1 through 10","percent of total billed charges","","",""
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Breast/Lymphatic Surgery and Related Procedures","5093","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9231.69","9231.69","9231.69","1 through 10","percent of total billed charges","","",""
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","36392.84","36392.84","36392.84","1 through 10","percent of total billed charges","","",""
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","28088.43","10784.42","61424.56","1 through 10","percent of total billed charges","","",""
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","35950.93","29483.81","95944.13","1 through 10","percent of total billed charges","","",""
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","46895.91","22399.87","72993.55","1 through 10","percent of total billed charges","","",""
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","37265.5","13015.94","70150.55","1 through 10","percent of total billed charges","","",""
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","11680.83","11680.83","21054.71","1 through 10","percent of total billed charges","","",""
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11442.93","11442.93","16268.5","1 through 10","percent of total billed charges","","",""
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","49520.16","49520.16","49520.16","1 through 10","percent of total billed charges","","",""
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","22708.34","22708.34","26061.77","1 through 10","percent of total billed charges","","",""
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Breast/Lymphatic Surgery and Related Procedures","5094","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","36074.69","36074.69","36074.69","1 through 10","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","489.71","273.77","617.94","1 through 10","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1069.27","810.4","2637.25","1 through 10","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","539.8","539.8","539.8","1 through 10","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","165.11","110.07","1307.52","15","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","175.82","81.24","1968.31","19","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","573.01","357.36","1126.04","12","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","408.24","308.11","938.7","1 through 10","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","519.53","281.89","868.39","13","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","635.59","635.59","635.59","1 through 10","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","586.03","70.47","2220.56","1 through 10","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","396.02","78.41","1254.24","60","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","250.83","250.83","866.74","1 through 10","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","146.52","107.66","307.41","1 through 10","percent of total billed charges","","",""
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Strapping and Cast Application","5101","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","212.18","73.2","435.03","1 through 10","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","339.53","211.23","1166.28","13","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","284.18","284.18","284.18","1 through 10","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","435.34","122.03","819.61","31","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","175.82","87.11","860.51","21","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","341.22","169.56","632.52","25","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","437.89","437.89","484.82","1 through 10","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","526.36","526.36","526.36","1 through 10","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","460.24","460.24","460.24","1 through 10","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","324.74","94.09","619.35","55","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","144.66","144.66","144.66","1 through 10","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","176.6","176.6","176.6","1 through 10","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","610.78","398.63","638.63","1 through 10","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","799.06","680.14","6242.7","1 through 10","percent of total billed charges","","",""
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Strapping and Cast Application","5102","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","156.82","78.41","500.81","43","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1601.36","1601.36","6834.06","1 through 10","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","18922.84","10279.38","33748.49","1 through 10","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","4846.97","4846.97","4846.97","1 through 10","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9175.3","1692.46","26330.92","1 through 10","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","16998.19","16998.19","16998.19","1 through 10","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","11520.43","11520.43","11520.43","1 through 10","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","18420.13","18420.13","18420.13","1 through 10","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","21769.43","21769.43","21769.43","1 through 10","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","341.7","105.25","14414.58","1 through 10","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5242.41","5242.41","5242.41","1 through 10","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","15583.03","15583.03","15583.03","1 through 10","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","8808.49","8808.49","8808.49","1 through 10","percent of total billed charges","","",""
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Musculoskeletal Procedures","5111","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8445.39","8445.39","8445.39","1 through 10","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","10099.66","5024.4","11274.24","1 through 10","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1439.06","1439.06","1439.06","1 through 10","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","4352.61","2351.85","8494.11","11","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","3532.42","2789.39","5760.9","12","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","12682.91","12682.91","12682.91","1 through 10","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1574.21","1574.21","1574.21","1 through 10","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","3112.31","2957.72","6143.23","1 through 10","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","3811.01","3811.01","3811.01","1 through 10","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4395.33","3530.7","8889.19","1 through 10","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3499.35","1965.17","6369.22","16","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1000","1000","1000","1 through 10","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","7643.74","7643.74","8637.52","1 through 10","percent of total billed charges","","",""
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Musculoskeletal Procedures","5112","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12136.52","12136.52","12136.52","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","10601.45","5688.9","15885.01","15","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","6430.1","6430.1","6430.1","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","7307.92","5752.45","11768.69","29","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","12597.8","12597.8","12597.8","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8167.07","5524.19","12363.75","42","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","8545.64","6129.47","12494.05","12","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","13022.47","13022.47","13022.47","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","7128.72","6523.89","11794.5","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","9674.78","9674.78","9674.78","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","5568.33","5568.33","5568.33","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","16224.87","16224.87","30661.55","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","13400.92","13400.92","13400.92","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","31996.53","31996.53","31996.53","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","7975.31","3716.13","20821.37","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7076.63","4471.44","18146.63","32","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","6114.31","6114.31","6114.31","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","11995.4","11995.4","12190.84","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","11182.27","7164.43","19036.62","1 through 10","percent of total billed charges","","",""
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Musculoskeletal Procedures","5113","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8844.23","3340.73","12398.16","13","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","16333.87","9131.72","34882.47","34","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","22519.67","21394.68","22822.84","1 through 10","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","13395.66","7501.63","22691.56","65","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","10267.73","10267.73","10267.73","1 through 10","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13672.46","8237.69","26528.42","88","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","15160.94","6329.46","24103.84","51","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","18527.05","9825.04","49332.08","1 through 10","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","11772.51","6973.41","18629.14","23","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","23051.09","23051.09","23051.09","1 through 10","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","18609.78","18609.78","18609.78","1 through 10","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","6350","6350","31177","1 through 10","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12938.78","6486.52","20653.15","18","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","1200","1200","1200","1 through 10","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9895.08","5166.47","22798.6","44","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","6191.64","6118.26","6337.41","1 through 10","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","14394.24","11518.91","31015.99","1 through 10","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12671.08","7176.99","32615.01","32","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","12481.11","9269.02","24891.12","13","percent of total billed charges","","",""
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Musculoskeletal Procedures","5114","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12221.38","7699.17","20369.77","21","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","21165.12","15298.56","33100.1","13","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","22166.8","5295.02","32135.33","1 through 10","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","23498.27","12387.07","38954.52","29","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25171.48","11976.91","35853.92","48","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","21057.07","9166.47","44523.49","16","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","27691.54","19564.42","40144.23","12","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","21515.11","21515.11","21515.11","1 through 10","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","28613.13","28613.13","28613.13","1 through 10","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","10437.24","10437.24","10437.24","1 through 10","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11608.03","11608.03","40486.78","1 through 10","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15928.05","7011.04","25765.65","21","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","17286.63","14082.32","41249.45","1 through 10","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","30723.64","19947.8","39531.91","1 through 10","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","24880.21","16276.24","50094.61","1 through 10","percent of total billed charges","","",""
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Musculoskeletal Procedures","5115","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","11230.79","7069.1","26548.06","1 through 10","percent of total billed charges","","",""
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","45518.9","45518.9","64227.02","1 through 10","percent of total billed charges","","",""
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","820.6","820.6","820.6","1 through 10","percent of total billed charges","","",""
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","36707.06","36707.06","36707.06","1 through 10","percent of total billed charges","","",""
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","56021.16","56021.16","56021.16","1 through 10","percent of total billed charges","","",""
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","33578.55","24093.81","62241.04","1 through 10","percent of total billed charges","","",""
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","25985.36","25985.36","25985.36","1 through 10","percent of total billed charges","","",""
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","38541.87","38541.87","41002.29","1 through 10","percent of total billed charges","","",""
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","55403.07","55403.07","55403.07","1 through 10","percent of total billed charges","","",""
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Musculoskeletal Procedures","5116","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","16636.08","16636.08","16636.08","1 through 10","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","633.74","180.56","817.73","103","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","590.79","176.09","646.27","15","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","175.22","175.22","175.22","1 through 10","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","619.44","180.91","764.61","163","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","632.41","172.7","792.98","214","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","629.17","172.7","794.93","146","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","610.51","177.83","685.12","66","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","426.39","309.33","579.99","12","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","708.75","708.75","708.75","1 through 10","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","822.97","698.03","822.97","1 through 10","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","455.97","455.97","455.97","1 through 10","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","155.16","7.41","611.02","37","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","179.92","144.72","758.46","99","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","626.64","626.64","626.64","1 through 10","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","591.83","506.52","617.04","1 through 10","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","633.68","171.95","699.09","50","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","199.68","159.86","686.88","27","percent of total billed charges","","",""
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Airway Endoscopy","5151","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","587.95","144.72","628.95","37","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","886.27","817.77","1060.52","63","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","829.63","801.79","877.67","34","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","864.97","490.31","1007.08","1 through 10","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","920.82","798.46","949.84","116","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","922.95","800.45","947.71","100","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","931.26","838.97","1090.14","53","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","850.43","806.09","943.98","26","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","523.43","393.75","861.72","11","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","888.11","819.17","896.99","1 through 10","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","789.22","681.14","840.03","1 through 10","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","950.9","829.25","1147.79","1 through 10","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","839.92","767.04","959.66","73","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","721.79","524.11","782.53","1 through 10","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","932.37","819.04","1247.42","20","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","851.31","810.77","946.57","16","percent of total billed charges","","",""
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Airway Endoscopy","5152","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","831.6","831.6","831.6","1 through 10","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2218.16","837.45","6755.8","24","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2297.62","220.04","3854.56","12","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1972.65","1972.65","1972.65","1 through 10","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2347.44","259.42","4982.65","46","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2187.31","271.04","6685.47","56","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","458.64","155.3","6966.37","28","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2746.41","2476.26","4691.87","12","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","3494.75","2242.81","5225.54","1 through 10","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","3571.82","3571.82","3571.82","1 through 10","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","3196.72","3196.72","3196.72","1 through 10","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","5169.06","3586.98","8939.56","1 through 10","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2053.3","217.91","10699.95","22","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2793.04","2793.04","3584.79","1 through 10","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3115.65","167.63","7630.25","20","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1983.99","1647.4","6448.89","1 through 10","percent of total billed charges","","",""
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Airway Endoscopy","5153","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1799.73","127.31","8385.59","1 through 10","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","5547.09","4187.13","9660.14","47","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","5289.73","3522.98","9284.7","21","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5503.19","5503.19","5503.19","1 through 10","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","6252.36","3985.71","11077.6","94","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","9136.27","5995.19","11804.34","1 through 10","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","5936.5","4096.29","12362.71","99","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","5615.92","3696.84","11002.51","62","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","4138.86","4138.86","4138.86","1 through 10","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","6955.26","4231.13","10089.73","18","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","6617.66","3688.05","9610.3","22","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","6847.88","6847.88","6847.88","1 through 10","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","8010.56","8010.56","8010.56","1 through 10","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","9188.67","9188.67","9188.67","1 through 10","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","4956.3","3458.69","8838.16","1 through 10","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","7951.8","7951.8","7951.8","1 through 10","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","8738.03","4834.43","11719.26","14","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","5013.43","5013.43","5013.43","1 through 10","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5631.39","4321.15","10378.48","32","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5392.73","1121.65","9458.19","21","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","6999.83","3528.55","11940.88","47","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","7700.8","4880.75","13536.28","17","percent of total billed charges","","",""
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Airway Endoscopy","5154","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","4884.39","3744.56","11154.27","22","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","10918.97","7729.62","16925.29","1 through 10","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","14355.37","14355.37","14355.37","1 through 10","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","9003.79","9003.79","9003.79","1 through 10","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","12348.95","7945.39","21795.78","17","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","23434.9","23434.9","23434.9","1 through 10","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9526.67","6607.24","23598.07","30","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","19548.78","10765.36","28073.09","17","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","15125.55","15125.55","15125.55","1 through 10","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","16008.12","13051.26","22256.68","1 through 10","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","10802.2","10802.2","10802.2","1 through 10","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11997.36","11997.36","12981.16","1 through 10","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11726.97","6531.02","18841.13","1 through 10","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","8359.37","8359.37","8359.37","1 through 10","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","13596.47","7605.12","17321.89","11","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","11314.58","9470.77","35331.98","1 through 10","percent of total billed charges","","",""
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Airway Endoscopy","5155","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9485.56","7082.32","21911.74","1 through 10","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","4315.21","3747.61","8509.77","1 through 10","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5034.12","5034.12","5034.12","1 through 10","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","4521.49","208.58","9706.67","15","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6450.53","490","14204.42","24","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","7863.06","5651.36","9565.46","1 through 10","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","6189.08","6189.08","6189.08","1 through 10","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","3942.67","3942.67","3942.67","1 through 10","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","6128.61","5772.73","10417.38","1 through 10","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5925.1","2529","11795.1","20","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","8465.41","8465.41","8465.41","1 through 10","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3258.49","2528.48","8168.11","13","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","6433.38","3731.84","7915.72","1 through 10","percent of total billed charges","","",""
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ENT Procedures","5161","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6608.5","4161.39","12450.63","1 through 10","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1612.81","219.64","2244.32","1 through 10","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","214","199.33","214","1 through 10","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","443.44","229.47","1020.54","19","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","274.52","190.74","3864.99","29","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","385.39","142.9","950.85","22","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","6081.58","6081.58","6081.58","1 through 10","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","189.46","189.46","189.46","1 through 10","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","189.83","189.83","189.83","1 through 10","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","183.37","140.74","5055.06","1 through 10","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","410.52","171.04","4749.44","11","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1498.94","1498.94","1498.94","1 through 10","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","258.8","178.79","512.66","1 through 10","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","347.01","347.01","347.01","1 through 10","percent of total billed charges","","",""
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ENT Procedures","5162","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","3282.3","2034.15","6075.83","14","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","215.7","215.7","215.7","1 through 10","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","122.65","106.07","409.94","1 through 10","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2580.28","229.38","5006.39","18","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","233.44","54.88","233.44","1 through 10","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1862.92","229.01","5210.85","48","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2269.03","233.9","4412.75","26","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2529.11","2529.11","3037.14","1 through 10","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7698.27","7698.27","7698.27","1 through 10","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","439.2","439.2","439.2","1 through 10","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1960.7","1529.07","7826","1 through 10","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1630.51","220.82","4896.53","28","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5516.91","5516.91","5516.91","1 through 10","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1000","369.23","8072.8","1 through 10","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","3669.79","9.23","6675.4","1 through 10","percent of total billed charges","","",""
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 ENT Procedures","5163","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2237.64","219.6","7354.08","1 through 10","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","4154.43","2920.07","7934.15","17","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","9656.08","9656.08","9656.08","1 through 10","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","5759.21","2557.08","10882.71","52","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","3167.11","3167.11","3167.11","1 through 10","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","4897.62","392.9","9589.44","76","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","5563.85","2498.74","9191.16","28","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","5726.72","3932.25","10496.52","11","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7236.77","7236.77","7236.77","1 through 10","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","8696.9","8696.9","8696.9","1 through 10","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","3352.46","3352.46","3352.46","1 through 10","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","6642.37","6642.37","6642.37","1 through 10","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4865.06","203.28","8151.7","22","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4023.97","943.93","6325.8","38","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","10448.71","10448.71","10448.71","1 through 10","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2520.22","2520.22","2520.22","1 through 10","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","4645.34","3205.82","12449.66","27","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5448.58","3259.75","9799.36","1 through 10","percent of total billed charges","","",""
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 ENT Procedures","5164","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","5004.08","392.05","7630.25","11","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","10489.8","4084.39","21659.5","76","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","11680.46","7318.45","18405.32","1 through 10","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","11088.36","7532.71","15360.68","1 through 10","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","9917.66","4556.04","18933.81","148","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10173.29","4327.36","21435.27","205","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","13462.19","13462.19","13462.19","1 through 10","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","8536.85","4169.59","23408.99","117","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","9407.49","4328.28","18447.19","32","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7755.23","6256.12","16462.41","1 through 10","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","12965.84","12965.84","12965.84","1 through 10","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","15678.16","15678.16","15678.16","1 through 10","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","5163.32","3859.77","15463.84","39","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5666.33","3511.05","12571.48","121","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","9565.43","9565.43","9565.43","1 through 10","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","11228.59","6204.88","18807.47","11","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","9639.31","3680.72","21200.77","65","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","8355.32","4455.18","20132.32","27","percent of total billed charges","","",""
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 ENT Procedures","5165","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6745.88","4532.52","18198.77","52","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","56279.12","56279.12","68283.29","1 through 10","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","41346.23","37491.46","43181.18","1 through 10","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","43363.13","25018.94","60615.34","1 through 10","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","87552.8","40629.44","88272.44","1 through 10","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","44172.91","43709.74","47681.65","1 through 10","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","40614.03","40614.03","40614.03","1 through 10","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","37936.55","36092.89","52604.87","1 through 10","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","55867.5","55867.5","55867.5","1 through 10","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","39364.5","39364.5","43736.22","1 through 10","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","34308.94","34308.94","34308.94","1 through 10","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","40787.64","40787.64","46323.54","1 through 10","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","42663.11","42663.11","42663.11","1 through 10","percent of total billed charges","","",""
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cochlear Implant Procedure","5166","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","43859.27","43859.27","43859.27","1 through 10","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2905.91","2002.17","6074.73","12","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1549.02","1208.55","5231.33","1 through 10","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2358.22","1382.04","2975.08","21","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","2460.13","2460.13","2651.68","1 through 10","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2852.2","1775.76","3926.39","22","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","3637.1","2278.55","4100.74","11","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2507.39","2507.39","2507.39","1 through 10","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2835.63","2835.63","2835.63","1 through 10","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","2144.83","2144.83","13028.54","1 through 10","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","1964.78","1964.78","1964.78","1 through 10","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1502.96","1502.96","5104.4","1 through 10","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2563.9","1850.55","3088.94","15","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2100.59","1671.26","3200.18","1 through 10","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2583.22","1788.12","5071.1","1 through 10","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","2575.23","2575.23","2575.23","1 through 10","percent of total billed charges","","",""
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Vascular Procedures","5181","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2229.63","2229.04","2395.94","1 through 10","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2247.94","1138.13","4257.97","21","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2197.52","1833.29","3417.55","1 through 10","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","2230.23","2230.23","2230.23","1 through 10","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1972.43","1364.87","6587.69","29","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","27196.96","27196.96","27196.96","1 through 10","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1949.26","1060.02","5841.69","49","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2188.06","1412.07","5622.52","26","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1675.18","1675.18","3133.47","1 through 10","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2066.7","1669.13","3914.9","1 through 10","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","1009.87","1009.87","1009.87","1 through 10","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","1460.67","1158.21","2694.85","1 through 10","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2842.21","1265.93","6568.2","1 through 10","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3009.03","1406.37","8090.9","16","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1921.87","1420.4","2555.29","1 through 10","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2224.07","1053.85","4721.37","17","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","3193.45","3193.45","3193.45","1 through 10","percent of total billed charges","","",""
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Vascular Procedures","5182","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2974.65","1785.2","5047.92","1 through 10","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","3891.03","2335.51","16829.29","86","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","3107.13","2443.89","5471.47","28","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","4333.73","1646.31","4886.55","1 through 10","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","4234.8","2381.4","9045.07","129","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","3315.65","2173.54","3800.27","1 through 10","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","4244.8","2308.5","11363.68","192","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","4533","2548.13","12016.84","94","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","2953.54","2953.54","2953.54","1 through 10","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","3673.89","2323.81","5977.47","46","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","4087.49","2726.01","10518.68","22","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","5508.5","3802.11","5508.5","1 through 10","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","2849.91","2849.91","2849.91","1 through 10","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","1961.51","1668.45","13664.38","1 through 10","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","2899.68","2096.19","15733.78","28","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4667.47","2666.93","12722.91","24","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4899.45","2147.21","8991.38","98","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","3531.07","2315.43","5795.92","26","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","4840.22","2693.04","13362.77","46","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5227.41","2958.73","18846.11","17","percent of total billed charges","","",""
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Vascular Procedures","5183","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","3443.45","2170.28","7634.13","44","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","6234.33","3503.85","12609.26","47","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","6109.75","3255.23","8365.81","1 through 10","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","6647.02","4129.93","10080.48","57","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6413.19","3387.96","9896.96","71","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","5467.12","5467.12","8803.98","1 through 10","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","5934.79","3136.35","10160.41","40","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","6279.32","4969.32","9654.91","1 through 10","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","7686.41","3106.15","12138.73","1 through 10","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","7826.51","7826.51","7826.51","1 through 10","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","5128.94","4707.55","7725.14","1 through 10","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","8988.1","3990.35","10343.38","1 through 10","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6228.32","3239.51","9284.08","17","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5428.79","4374.61","11066.16","1 through 10","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","7009.16","3627.89","10427.28","23","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","7158.91","4138.78","12540.25","1 through 10","percent of total billed charges","","",""
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Vascular Procedures","5184","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6068.72","3383.45","11101.19","1 through 10","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2677.12","1426.32","7781.49","52","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2864.53","1951.33","6170.57","31","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","2178.11","2178.11","2178.11","1 through 10","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2842.9","1854.52","9483.62","81","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","2731.24","1473.13","5992.24","1 through 10","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2929.6","1917.14","15944.05","65","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2676.24","1712.6","6594.75","41","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","10685.44","10685.44","10685.44","1 through 10","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2811.48","1921.39","5252.25","14","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2009.63","770.29","5088.16","38","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","3420.61","2656.52","18788.87","13","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3174.19","1779.17","12556.29","39","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2743.67","1635.31","6381.18","18","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2517.15","1940.05","5786.37","25","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","3156.33","2005.36","7092.07","34","percent of total billed charges","","",""
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Endovascular Procedures","5191","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10960.56","2179.07","17349.67","12","percent of total billed charges","","",""
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","9767.24","9767.24","9767.24","1 through 10","percent of total billed charges","","",""
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","8744.78","8744.78","8744.78","1 through 10","percent of total billed charges","","",""
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","20063.33","20063.33","20063.33","1 through 10","percent of total billed charges","","",""
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","5043.76","5043.76","5043.76","1 through 10","percent of total billed charges","","",""
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","9147.44","9147.44","11630.6","1 through 10","percent of total billed charges","","",""
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11137.63","11137.63","11137.63","1 through 10","percent of total billed charges","","",""
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","19808.36","19808.36","19808.36","1 through 10","percent of total billed charges","","",""
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Endovascular Procedures","5192","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12418.25","12418.25","12418.25","1 through 10","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","11621.9","6336.96","29401.41","20","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","9856.18","7459.73","26761.97","19","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","10474.31","8005.38","18938.22","1 through 10","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","10769.81","6960.46","18390.12","47","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","12621.89","8264.87","19476.09","1 through 10","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","12811.02","8319.34","29060.57","37","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","10046.21","7215.53","24556.63","25","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","10206.54","8450.24","15867.59","1 through 10","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","8600.57","6017.56","22247.27","17","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","10244.54","10244.54","10244.54","1 through 10","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","14244.76","14244.76","14244.76","1 through 10","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","12607.39","12607.39","12607.39","1 through 10","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","7450.02","6790.33","21145.45","1 through 10","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9674.49","5749.02","25520.62","21","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","15145.39","9211.97","24645.93","1 through 10","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10379.22","7118.95","32971.96","24","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","15995.9","10598.41","26676.94","22","percent of total billed charges","","",""
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Endovascular Procedures","5193","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10902.38","9442.86","82931.67","1 through 10","percent of total billed charges","","",""
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","10872.12","10872.12","87910.84","1 through 10","percent of total billed charges","","",""
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","12364.31","12364.31","12364.31","1 through 10","percent of total billed charges","","",""
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","26381.72","18860.47","37669.52","1 through 10","percent of total billed charges","","",""
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","18536.22","18536.22","18536.22","1 through 10","percent of total billed charges","","",""
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","30617.56","15036.94","49312.31","11","percent of total billed charges","","",""
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","37894.27","37894.27","39379.75","1 through 10","percent of total billed charges","","",""
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","11950.35","11950.35","11950.35","1 through 10","percent of total billed charges","","",""
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","17607.05","17607.05","17607.05","1 through 10","percent of total billed charges","","",""
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16525.97","12846.01","22979.95","1 through 10","percent of total billed charges","","",""
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","42730.36","42730.36","42730.36","1 through 10","percent of total billed charges","","",""
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","34398.64","34398.64","34398.64","1 through 10","percent of total billed charges","","",""
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Endovascular Procedures","5194","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","19547.54","19547.54","24798.46","1 through 10","percent of total billed charges","","",""
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","20204.26","20204.26","20204.26","1 through 10","percent of total billed charges","","",""
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","18676.06","18676.06","18676.06","1 through 10","percent of total billed charges","","",""
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2868.62","2868.62","2868.62","1 through 10","percent of total billed charges","","",""
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pacemaker and Similar Procedures","5221","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","33247.17","33247.17","39865.14","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","21130.94","20892.55","40655.7","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","11009.95","11009.95","11009.95","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17087.22","12906.65","44087.66","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","27030.02","26379.94","55697.8","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","16394.82","16394.82","16394.82","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","25662.7","25662.7","25662.7","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12519.84","12519.84","12519.84","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","14708.54","14708.54","14708.54","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","26290.35","26290.35","26290.35","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5995.99","5995.99","5995.99","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","14496.26","14496.26","14496.26","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","13154.51","13154.51","13154.51","1 through 10","percent of total billed charges","","",""
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pacemaker and Similar Procedures","5222","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","21362.11","20221.74","49060.2","1 through 10","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","23600.18","19484.05","30878.75","11","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","7379.68","7379.68","7379.68","1 through 10","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","28548.77","16118.46","36900.72","14","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","31052.48","21339.4","40494.63","1 through 10","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","31415.13","20065.36","36680.42","1 through 10","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","23566.59","23566.59","30025.11","1 through 10","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","25877.94","25877.94","25877.94","1 through 10","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","44081.14","44081.14","44081.14","1 through 10","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","38372.47","38372.47","38372.47","1 through 10","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","20025.64","20025.64","22448.09","1 through 10","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","42720.6","42720.6","42720.6","1 through 10","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","18637.42","17798.83","32006.37","1 through 10","percent of total billed charges","","",""
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pacemaker and Similar Procedures","5223","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","19199.7","19199.7","19199.7","1 through 10","percent of total billed charges","","",""
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","50110.39","50110.39","50110.39","1 through 10","percent of total billed charges","","",""
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","28951.84","28951.84","46195.07","1 through 10","percent of total billed charges","","",""
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","26816","26816","26816","1 through 10","percent of total billed charges","","",""
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","48816.28","48816.28","48816.28","1 through 10","percent of total billed charges","","",""
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","14745.33","14745.33","14745.33","1 through 10","percent of total billed charges","","",""
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","31483.51","31483.51","31483.51","1 through 10","percent of total billed charges","","",""
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","22210.54","22210.54","22210.54","1 through 10","percent of total billed charges","","",""
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","27298.26","27298.26","27298.26","1 through 10","percent of total billed charges","","",""
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","21619.03","21619.03","21619.03","1 through 10","percent of total billed charges","","",""
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pacemaker and Similar Procedures","5224","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","31751.7","31751.7","31751.7","1 through 10","percent of total billed charges","","",""
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","27213.02","27213.02","27213.02","1 through 10","percent of total billed charges","","",""
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","21364.21","21364.21","22240.39","1 through 10","percent of total billed charges","","",""
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","20607.99","20607.99","20607.99","1 through 10","percent of total billed charges","","",""
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 ICD and Similar Procedures","5231","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","42040.21","32744.11","51027.35","1 through 10","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","50276.81","41435.96","58367.94","1 through 10","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","38658.07","38658.07","38658.07","1 through 10","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","32246.75","25983.44","61923.03","12","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","51185.86","26045.62","62719.08","16","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","48861.65","39952.48","56603.83","1 through 10","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","34188.91","34188.91","34188.91","1 through 10","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","28624.75","28624.75","28624.75","1 through 10","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","33603.14","33603.14","33603.14","1 through 10","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","44117.33","25221.15","66585.93","1 through 10","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","44345.38","43916.49","50689.67","1 through 10","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","26992.33","26992.33","66409.93","1 through 10","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","50730.72","30175.15","64595.24","1 through 10","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","53190.11","53190.11","53190.11","1 through 10","percent of total billed charges","","",""
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 ICD and Similar Procedures","5232","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","27968.75","27968.75","27968.75","1 through 10","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2545.98","1563.24","4276.89","185","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2445.63","1595.02","5019.55","93","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2684.19","1314.61","7177.81","378","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1765.02","1052.21","20664.31","20","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2699.55","1316.77","8573.6","338","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","2357.13","1086.17","4937.92","17","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2516.09","1379.47","6725.49","347","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","7589.1","7589.1","7589.1","1 through 10","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","4056.68","1853.17","8518.51","54","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1721.72","1065.41","10424.47","16","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","2706.48","1599.26","4128.61","61","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","3059.52","1580.48","9397.53","57","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2132.39","1257.4","10464.4","41","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","2209.11","2209.11","2209.11","1 through 10","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","60","60","60","1 through 10","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2274.07","1309.16","5146.69","429","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2205.84","1210.83","10367.66","47","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2333.74","1121.11","6724.44","144","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","2180.9","1481.14","11566.91","29","percent of total billed charges","","",""
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Blood Product Exchange and Related Services","5241","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2012.41","1227","6817.56","163","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","7583.27","4465.6","10009.97","28","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","6422.98","6422.98","6422.98","1 through 10","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","6714.13","4314.25","8822.05","142","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","3566.06","3566.06","3566.06","1 through 10","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","7985.69","4309.71","9724.13","66","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","8474.48","7127.92","11827.72","28","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","11814.55","11814.55","12330.93","1 through 10","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","11471.87","9012.43","19899.84","29","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","6674.68","5917.7","8706.17","19","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","5051.32","3889.07","13297.33","12","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","7402.09","3878.95","10828.52","35","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","7015.62","5519.93","9036.12","25","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7022.56","4926.65","8325.36","83","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","4096.48","3986.66","9315.63","1 through 10","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","6556.43","6556.43","6556.43","1 through 10","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","5812.06","3438.78","10594.65","32","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5795.05","4207.73","10317.7","26","percent of total billed charges","","",""
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Blood Product Exchange and Related Services","5242","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","7307.66","5636.35","8648.66","82","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","9758.18","8392.72","10759.17","44","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","8709.89","8709.89","8709.89","1 through 10","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","6141.93","6141.93","6141.93","1 through 10","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9333.5","7979.24","10484.82","77","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","9154.39","7305.43","15617.24","17","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","69.95","62.86","716.45","1 through 10","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7098.66","6654.89","8654.79","12","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","7845.32","7813.82","8786.6","1 through 10","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","9547.49","8622.48","10259.17","52","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8452.53","7021.72","9648.51","1 through 10","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7087.19","1745.72","8733.94","36","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","9536.48","8147.15","11135.64","52","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","9330.31","8144.37","9794.15","48","percent of total billed charges","","",""
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Blood Product Exchange and Related Services","5243","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","7285.22","7285.22","7285.22","1 through 10","percent of total billed charges","","",""
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","71516.37","71516.37","71964.99","1 through 10","percent of total billed charges","","",""
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","26785.76","2041.23","78722.95","1 through 10","percent of total billed charges","","",""
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","78874.56","75092.01","107012.14","1 through 10","percent of total billed charges","","",""
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","241.62","241.62","241.62","1 through 10","percent of total billed charges","","",""
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","3843.26","3843.26","3843.26","1 through 10","percent of total billed charges","","",""
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","5081.21","5081.21","22564.21","1 through 10","percent of total billed charges","","",""
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","29940.97","24312.67","150345.83","1 through 10","percent of total billed charges","","",""
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","21259.78","21259.78","25991.55","1 through 10","percent of total billed charges","","",""
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","75162.33","75162.33","75162.33","1 through 10","percent of total billed charges","","",""
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Blood Product Exchange and Related Services","5244","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","21724.24","21724.24","21724.24","1 through 10","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2631.63","1608.71","4489.36","92","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2101.34","1583.83","3480.55","30","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","2156.56","1089.31","6048.48","1 through 10","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2586.9","1637.14","4790.09","191","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","2194.89","1805.39","5901.47","1 through 10","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2587.08","1450.73","4657.15","227","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2436.93","1494.14","3950.68","127","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","1586.99","1586.99","4032.88","1 through 10","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2516.83","1620.54","3418.03","54","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1770.64","1229.14","11744.55","22","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","1938.7","1938.7","1938.7","1 through 10","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","1664.23","1664.23","1664.23","1 through 10","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","3373.65","3373.65","3373.65","1 through 10","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","1542.3","1542.3","2154.89","1 through 10","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","3118.45","3118.45","3118.45","1 through 10","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2597.24","1538.15","4933.12","32","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2149.78","1375.59","4321.84","118","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","4424.85","4424.85","4424.85","1 through 10","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2138.98","1238.08","6312.74","23","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2509.08","1619.48","5115.86","82","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","2679.47","1302.55","4734.51","51","percent of total billed charges","","",""
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Upper GI Procedures","5301","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2540.75","1379.74","5978.23","38","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","3163.91","1944.13","6995.43","91","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","3428.86","1703.41","6575.91","45","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5185.57","2043.53","6014.86","1 through 10","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","3157.61","1791.22","6361.71","157","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","2844.94","1776.16","3223.97","12","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","3083.14","1816.75","6765.07","167","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","1978","1978","2682.6","1 through 10","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","3965.49","1734.62","6734.93","76","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2357.21","1618.32","3884.67","25","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","4074.27","2254.93","8486.64","25","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","3046.4","3046.4","3046.4","1 through 10","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","3648.95","3170.95","10060.69","1 through 10","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4800.03","3970.52","8818.7","13","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","2070.53","2070.53","2070.53","1 through 10","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","2543.59","2543.59","2543.59","1 through 10","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3388.56","2022.21","6364.35","41","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","3104.65","3104.65","3104.65","1 through 10","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","3254.04","1643.97","5196.88","39","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2855.01","1868.87","6400.43","73","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","3896.54","2089.38","5996.33","37","percent of total billed charges","","",""
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Upper GI Procedures","5302","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","3507.96","2021.12","7461.21","19","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","3982.57","2250.14","6044.71","16","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","11535.99","11535.99","11535.99","1 through 10","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","4575.95","3166.53","6437.14","23","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","6667.09","6667.09","6667.09","1 through 10","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","5428.33","5428.33","7409.77","1 through 10","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","4489.61","2566.87","10194.01","26","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","4637.75","3954.55","6172.65","14","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","5010.44","4378.86","5923.11","1 through 10","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","5765.02","5765.02","5765.02","1 through 10","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","4346.07","4346.07","4346.07","1 through 10","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","3373.58","2854.32","7812.1","1 through 10","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5243.66","3616.35","6461.51","14","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2408.23","2408.23","11758.51","1 through 10","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","5644.83","4367.96","13896.16","1 through 10","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","16766.43","16766.43","16766.43","1 through 10","percent of total billed charges","","",""
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Upper GI Procedures","5303","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","4181.93","3445.74","8758.09","1 through 10","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2356.21","1931.8","3553.93","42","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2461.47","2102","3888.89","1 through 10","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2368.72","1661.59","3786.62","94","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2491.19","1759.82","3535.95","111","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","4551.83","4551.83","4551.83","1 through 10","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2245.23","351.93","3316.68","56","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","1891.44","1891.44","1891.44","1 through 10","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1817.42","323.34","2880.59","19","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2332.85","423.86","3528.88","61","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","1197.63","1197.63","1197.63","1 through 10","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","2259.24","2259.24","2259.24","1 through 10","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2553.46","1861.34","4180.94","1 through 10","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2129.24","1397.01","3376.08","55","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2255.19","2053.9","10506.95","1 through 10","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1999.37","743.43","3468.26","37","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","2519.4","1834.82","3477.91","31","percent of total billed charges","","",""
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Lower GI Procedures","5311","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2982.33","1911.36","5923.28","1 through 10","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","4326.12","2598.46","7545.21","105","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","3162.33","2296.22","4494.81","28","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","1015.76","1015.76","1015.76","1 through 10","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1850.2","1850.2","1850.2","1 through 10","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","3536.69","2274.19","7014.33","191","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","2807.65","2807.65","2807.65","1 through 10","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","3585.74","2393.45","7242.79","242","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","4206.55","2764.58","8018.08","124","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","3153.5","2274.43","5641.31","86","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2765.32","2054.36","4657.27","32","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","3258.98","3258.98","3258.98","1 through 10","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","6764.5","6764.5","6764.5","1 through 10","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","5026.42","2232.77","7896.95","14","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","2923.38","2923.38","2923.38","1 through 10","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","2017.13","2017.13","2223.22","1 through 10","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3411.31","1969.65","6650.7","101","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2448.72","1843.95","4212.32","19","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3555.03","2362.27","6656.06","59","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","3479.91","2384","6330.56","68","percent of total billed charges","","",""
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Lower GI Procedures","5312","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","3767.15","2718.69","7697.75","16","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","4875.75","3645.69","6025.98","1 through 10","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","3321.15","2910.45","10953.53","1 through 10","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","2642.1","2642.1","4458.83","1 through 10","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","4293.49","2658.13","6065.24","23","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","4518.43","4518.43","4518.43","1 through 10","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","4370.35","2658.24","7950.33","30","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","4696.35","4107.68","8597.24","14","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7456.76","7456.76","7456.76","1 through 10","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","3869.63","3069.01","6646.27","13","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","6935.13","5856.77","7737.01","1 through 10","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4810.22","1366.67","7831.67","16","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","10612.33","10612.33","10612.33","1 through 10","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","5841.25","4095.34","13177.24","1 through 10","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5012.74","4174.15","6489.94","1 through 10","percent of total billed charges","","",""
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Lower GI Procedures","5313","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2865.43","2865.43","6985.72","1 through 10","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","7140.65","4238.32","14840.33","25","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","5097.22","4184.63","13124.92","1 through 10","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","9775.14","9775.14","9892.55","1 through 10","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","7875.31","4681.39","15993.09","32","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","14864.48","14864.48","14864.48","1 through 10","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8485.42","5038.47","16031.33","30","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","7145.56","4977.21","12133.49","13","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","5768.31","5768.31","5768.31","1 through 10","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","8030.93","6984.75","8564.23","1 through 10","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","6571.76","5965.92","12346.32","1 through 10","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8754.84","5723.1","13118.83","1 through 10","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","8546.7","6299.17","14344.35","11","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","8227.4","5143.98","13045.75","11","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","9431.61","9431.61","11539.8","1 through 10","percent of total billed charges","","",""
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex GI Procedures","5331","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","4430.33","4430.33","4430.33","1 through 10","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","3632.77","2304.81","7873.83","30","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","3884.62","3884.62","3884.62","1 through 10","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","4893.66","2281.9","10504.74","60","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","9636.95","9636.95","9636.95","1 through 10","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","4525.91","1979.48","8006.89","58","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","4117.21","2164.86","6870.81","31","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","6862.18","6862.18","19466.83","1 through 10","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","3682.87","2473.33","10472.18","18","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","4706.56","4706.56","4706.56","1 through 10","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4168.98","2798.76","6116.95","1 through 10","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4348.66","2766.62","7407.16","39","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","9215.29","9215.29","9215.29","1 through 10","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","4317.89","2023.6","7612.14","28","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5414.57","3308.58","23377.31","1 through 10","percent of total billed charges","","",""
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","5341","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","4030.34","2366.18","8628.59","23","percent of total billed charges","","",""
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","5538.95","3949.55","17395.4","1 through 10","percent of total billed charges","","",""
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","6143.61","4096.66","27206.73","1 through 10","percent of total billed charges","","",""
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6974.11","4313.44","30435.01","16","percent of total billed charges","","",""
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","4439.29","3376.96","10188.91","1 through 10","percent of total billed charges","","",""
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","7554.54","6561.64","13027.63","1 through 10","percent of total billed charges","","",""
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","12029.64","12029.64","12029.64","1 through 10","percent of total billed charges","","",""
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","6087.5","3881.21","8156.49","1 through 10","percent of total billed charges","","",""
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6168.74","4031.97","11133.11","11","percent of total billed charges","","",""
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","35180.21","35180.21","35180.21","1 through 10","percent of total billed charges","","",""
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","25412.69","25412.69","25412.69","1 through 10","percent of total billed charges","","",""
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","5342","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","5743.11","4913.7","5859.81","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","12448.66","7112.98","21006.12","87","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","11779.39","8351.54","21166.11","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","7483.25","7483.25","7483.25","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","13016.78","7811.79","22251.45","145","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","13718.26","13718.26","13718.26","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","12217.12","7033.96","20677.88","238","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","11954","7265.84","20954.65","130","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","13443.35","13443.35","13443.35","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","12588.93","6678.6","20024.79","67","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","12415.75","8591.86","18170.54","12","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","10760.9","10760.9","10760.9","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","18356.07","18356.07","18356.07","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","14406.48","12102.91","14826.18","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","9878.55","6488.32","14246.02","36","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","8997.71","8997.71","8997.71","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","6858.42","6858.42","6858.42","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","11959.16","11959.16","15601.17","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8725.39","5467.39","17370.96","112","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","11769.8","6479.17","22132.85","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","12127.82","8468.53","15377.13","1 through 10","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","11868.59","6345.99","23050.32","91","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","10998.37","7468.8","18776.66","26","percent of total billed charges","","",""
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Laparoscopy and Related Services","5361","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8873.14","4911.62","16305.51","47","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","17956.72","12185.17","24873.31","82","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","16300.51","8203.13","25078.02","11","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","13603.92","13603.92","20273.85","1 through 10","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","17404.8","12303.38","24403.88","152","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","13121.1","12066.72","19277.12","1 through 10","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17267.4","12459.1","24143.74","187","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","17401.69","12621.49","25664.54","90","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","17444.44","13095.07","24108.89","52","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","16065.5","15657.71","26894.52","1 through 10","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","22556.9","22556.9","22556.9","1 through 10","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","16054.81","13182.72","21907.31","12","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15505.99","8840.39","21560.97","57","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","11445.16","9326.19","19338.46","1 through 10","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","15990.58","12741.58","22014.87","66","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","15805.52","9610.84","22781.64","29","percent of total billed charges","","",""
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Laparoscopy and Related Services","5362","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","14582.06","12944.47","19377","14","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","470.99","376.8","3280.04","1 through 10","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","388.22","213.31","459.1","19","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","202.16","202.16","202.16","1 through 10","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","422.79","219.03","1590.37","16","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","770.9","484.44","770.9","1 through 10","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","492.43","271.38","7988.16","29","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1987.46","372.54","14448.68","20","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","541.58","390.61","1440.72","1 through 10","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","83.67","83.67","83.67","1 through 10","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","1032.03","1032.03","1032.03","1 through 10","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","234.37","218.38","4048.36","1 through 10","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","555.59","431.19","3329.85","13","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1196.77","1196.77","1237.74","1 through 10","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2546.73","775.99","4301.3","1 through 10","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","542.97","542.97","542.97","1 through 10","percent of total billed charges","","",""
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Urology and Related Services","5371","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","219.6","209.14","219.6","1 through 10","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1375.98","563.49","3809.7","70","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","420.82","327.5","1456.31","24","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","310.16","310.16","2850.81","1 through 10","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1630.93","1289.36","3686.23","84","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","763.2","317.73","1589.69","25","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","951.35","366.78","3150.66","107","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1486.99","586.7","3522.89","74","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","385.55","385.55","385.55","1 through 10","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1062.8","490.67","1429.11","30","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","14236.99","14236.99","14236.99","1 through 10","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","2611.32","2611.32","2611.32","1 through 10","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","475.14","336.7","3097.14","1 through 10","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1747.16","137.97","3557.51","11","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","602.28","602.28","602.28","1 through 10","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1758.82","142.13","3856.45","20","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1288.12","892.36","1912.82","48","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1599.47","568.53","2244.06","107","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","342.99","99.26","4434.39","16","percent of total billed charges","","",""
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Urology and Related Services","5372","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","534.3","87.06","4865.92","18","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","3962.14","1809.44","6949.22","15","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","3828.28","1818.96","11786.41","1 through 10","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","2411.99","1795.46","4529.77","1 through 10","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","3811.29","2122.69","6802.05","69","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","3566.15","2479.35","6454.48","76","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","5976.99","5976.99","5976.99","1 through 10","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","3279.84","2383.85","5555.33","45","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","3111.57","3111.57","3111.57","1 through 10","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1276.05","850.42","5728.06","1 through 10","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","3366.13","1928.41","5323.94","1 through 10","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","2048.21","2048.21","2048.21","1 through 10","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","3096.62","1769.92","4568.61","22","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","3701.33","3701.33","3701.33","1 through 10","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2894.76","842.82","4262.87","57","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","3343.06","2249.99","5808.52","1 through 10","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3723.86","1518.82","7669.2","26","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","4022.99","2986.7","9626.95","1 through 10","percent of total billed charges","","",""
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Urology and Related Services","5373","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2951.68","662.65","4104.88","25","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","5931.93","4031.19","10607.19","41","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","4813.02","4159.31","6095.13","15","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","6309.37","6309.37","6309.37","1 through 10","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","5243.77","3633.63","8418.24","57","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","2554.47","2554.47","6189.32","1 through 10","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","4932.63","3607.68","9107.46","83","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","4961.18","3189.7","9266.39","46","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","4146.12","3725.63","6932.22","1 through 10","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","5580.81","3609.02","10857.98","14","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","13327.94","13327.94","13327.94","1 through 10","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","9322.84","9322.84","9322.84","1 through 10","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","3232.6","2331.91","6342.05","15","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4217.99","2520.08","9181.73","32","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","3653.34","3165.27","4643.84","11","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","4978.33","3362.84","8773.43","41","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","6212.82","2600.3","7770.98","11","percent of total billed charges","","",""
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Urology and Related Services","5374","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","4517.49","2824.14","9584.28","1 through 10","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","6326","5025.48","14241.29","17","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","8729.38","5395.96","10933.45","16","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5143.88","5143.88","10178.83","1 through 10","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","8908.54","5254.01","15214.37","30","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","9454.32","6246.42","16653.93","1 through 10","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10674.69","4340.86","17595.59","37","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","7950.12","6112.36","12225.92","14","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","6813.28","5705.38","10167.85","1 through 10","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7319.41","6311.27","14690.62","1 through 10","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","5998.65","5998.65","5998.65","1 through 10","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6214.49","4884.41","11367.12","1 through 10","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5730.64","4363.4","13109.43","1 through 10","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","7600.43","4499.38","13263.26","15","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","10655.07","10655.07","18026.42","1 through 10","percent of total billed charges","","",""
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Urology and Related Services","5375","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6570.22","6570.22","9230.16","1 through 10","percent of total billed charges","","",""
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","14350.39","11881.54","22398.09","1 through 10","percent of total billed charges","","",""
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","14305.54","6389.72","19568.97","1 through 10","percent of total billed charges","","",""
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","7195.16","7195.16","7195.16","1 through 10","percent of total billed charges","","",""
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6870.2","6870.2","6870.2","1 through 10","percent of total billed charges","","",""
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","12117.68","12117.68","12117.68","1 through 10","percent of total billed charges","","",""
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","10878.64","10878.64","10878.64","1 through 10","percent of total billed charges","","",""
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Urology and Related Services","5376","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","16697.37","16697.37","16697.37","1 through 10","percent of total billed charges","","",""
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","14707.78","14707.78","14707.78","1 through 10","percent of total billed charges","","",""
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Urology and Related Services","5377","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","34262.4","34262.4","34262.4","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","28539.82","28539.82","32676.55","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","17212.96","17212.96","17212.96","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","29593.86","22794.78","33576.6","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","29148.39","29139.84","33841.13","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","29686.36","29686.36","29686.36","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","28226.72","28226.72","28226.72","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","27581.86","27581.86","27581.86","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","50272.66","50272.66","50272.66","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","31369.39","31369.39","31369.39","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","24415.79","24415.79","27845.85","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","37255.42","37255.42","37255.42","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","34700.97","32595.99","42478.66","1 through 10","percent of total billed charges","","",""
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 8 Urology and Related Services","5378","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","32398.31","32398.31","32398.31","1 through 10","percent of total billed charges","","",""
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","4716.46","4716.46","4716.46","1 through 10","percent of total billed charges","","",""
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2461.02","2461.02","2461.02","1 through 10","percent of total billed charges","","",""
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","1388.64","1388.64","1861.84","1 through 10","percent of total billed charges","","",""
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","3693.16","3693.16","3693.16","1 through 10","percent of total billed charges","","",""
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3143.42","3143.42","5337.4","1 through 10","percent of total billed charges","","",""
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","3449.23","3449.23","5233.47","1 through 10","percent of total billed charges","","",""
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dialysis","5401","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1189.94","823.9","1994.92","272","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1218.98","869.05","2160.96","445","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1187.1","873.69","2112.85","887","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1187.15","885.91","1991.5","455","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1167.28","895.67","1751.58","373","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","430.71","430.71","430.71","1 through 10","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","1116.72","844.56","5149.12","1 through 10","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","1536.58","1536.58","1536.58","1 through 10","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1245.53","856.79","2489.4","392","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1247.08","822.91","2249.78","1175","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1394.29","587.08","2141.99","31","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1011.16","655.96","1940.16","20","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1371.22","878.59","2841.58","228","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1250.68","893.24","2714.6","74","percent of total billed charges","","",""
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Gynecologic Procedures","5411","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1203.02","829.77","2120.92","364","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1690.74","658.07","8002.42","20","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","798.35","798.35","798.35","1 through 10","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1290.4","706.48","5944","29","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","6.37","6.37","6.37","1 through 10","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1017.61","657.09","4946.41","53","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1537.02","727.55","3317.68","72","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","886.63","535.75","1295.23","1 through 10","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1164.08","704.68","2735.94","46","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","5068.92","5068.92","5068.92","1 through 10","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","2697.34","2697.34","2697.34","1 through 10","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1140.82","625.64","2515.27","17","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1222.81","659.21","2635.74","59","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1526.21","1526.21","1526.21","1 through 10","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2235.54","1111.12","4072.73","32","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1628.57","1628.57","1628.57","1 through 10","percent of total billed charges","","",""
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Gynecologic Procedures","5412","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","787.13","470.46","2045.19","11","percent of total billed charges","","",""
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","3958.37","3039.44","7674.08","12","percent of total billed charges","","",""
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","483.9","483.9","483.9","1 through 10","percent of total billed charges","","",""
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1812.77","445.18","7585.07","22","percent of total billed charges","","",""
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","5848.55","1344.57","8033.92","27","percent of total billed charges","","",""
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","4623.26","992.11","7943.41","17","percent of total billed charges","","",""
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2827.36","763.01","6142.19","12","percent of total billed charges","","",""
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","790.01","790.01","790.01","1 through 10","percent of total billed charges","","",""
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","7668.43","7668.43","7668.43","1 through 10","percent of total billed charges","","",""
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1511.15","617.3","6551.79","13","percent of total billed charges","","",""
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1941.74","1941.74","1941.74","1 through 10","percent of total billed charges","","",""
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3422.24","2929.02","8578.66","1 through 10","percent of total billed charges","","",""
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Gynecologic Procedures","5413","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6486.25","2271.76","8373.38","1 through 10","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","4165.41","2345.67","6926.23","38","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","4803.1","3788.5","8971.15","1 through 10","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","3853.13","3853.13","3853.13","1 through 10","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","4496.67","2508.85","6924.71","73","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","4183.58","2599.13","7343.79","109","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","5042.31","2779.63","7772.96","55","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2885.91","2610.72","5297.36","1 through 10","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","4479.68","2734.01","7725.19","50","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","7114.69","7114.69","7114.69","1 through 10","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","7336.3","7336.3","7336.3","1 through 10","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4728.42","567.92","7410.31","13","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4016.05","2128.28","7320.45","63","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","3706.9","3706.9","3706.9","1 through 10","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","4186.96","4186.96","4186.96","1 through 10","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3530.3","2708.84","6579.92","22","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5886.83","3349.04","14093.48","1 through 10","percent of total billed charges","","",""
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Gynecologic Procedures","5414","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","4052.1","3116.27","4448.64","11","percent of total billed charges","","",""
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","6254.18","5564.91","17066.8","1 through 10","percent of total billed charges","","",""
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","9192.47","4838.01","11878.59","1 through 10","percent of total billed charges","","",""
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6423.99","3853.02","11861.47","30","percent of total billed charges","","",""
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","5747.23","2489.14","10664.87","1 through 10","percent of total billed charges","","",""
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","8249.31","8249.31","8249.31","1 through 10","percent of total billed charges","","",""
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6471.37","6199.98","61622.45","1 through 10","percent of total billed charges","","",""
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","5387.05","5387.05","5964.52","1 through 10","percent of total billed charges","","",""
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","6514.73","6514.73","6514.73","1 through 10","percent of total billed charges","","",""
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Gynecologic Procedures","5415","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","5963.23","5963.23","5963.23","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","5339.94","3039.83","16309.89","29","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2780.25","292.19","8498.03","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","3528.43","3528.43","3528.43","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","4142.15","973.74","9028.47","38","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","3692.42","3692.42","3692.42","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","4532.97","1468.97","9841.54","40","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","6604.37","1055.42","14110.47","29","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2924.63","1151.65","12096.21","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2689.98","874.29","4689.53","12","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","2298.07","2298.07","2298.07","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","7707.56","7707.56","7707.56","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4915.6","3591.25","8227.24","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4527.96","263.72","10486.15","28","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","4031.13","2835.69","5151.17","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","4699.41","2719.26","19857.22","15","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","931.25","758.93","3484.97","22","percent of total billed charges","","",""
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Procedures","5431","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","3473.76","1311.78","6866.85","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","38625.89","38625.89","57430.38","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","30819.72","11473.89","43630.8","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","23991.7","16897.59","38106.84","13","percent of total billed charges","","",""
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","24232.59","20402.72","27297.15","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","12276.23","12276.23","43766.99","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","26473.29","26473.29","26473.29","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","20029.66","20029.66","20029.66","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13210.26","11845.29","35656.52","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","24149.16","24149.16","24149.16","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","17631.79","13428.98","24041.75","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Procedures","5432","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","28108.05","28108.05","28108.05","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","737.25","161.47","4189.58","90","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","843.96","178.79","2788.93","42","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","370.42","370.42","597.76","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","711.1","149.26","3210.26","206","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","408.22","132.62","1263.92","16","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","764.05","138.2","2876.65","191","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","617.85","174.42","2614.04","120","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","276.97","100.57","1342.08","142","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","216.88","3.32","1469.12","30","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","215.24","193.7","1390.87","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","1085.9","1085.9","1085.9","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","315.25","315.25","315.25","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","1608.64","1608.64","1608.64","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","1387.36","1387.36","1387.36","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","352.68","352.68","352.68","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","284.43","136","3252.28","1 through 10","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","276.32","131.57","726.09","128","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","470.82","35.74","2105.38","16","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","816.21","211.25","2771.3","59","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","219.02","124.9","749.97","55","percent of total billed charges","","",""
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nerve Injections","5441","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","134.4","12.86","1396.84","27","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1639.18","311.06","6012.46","75","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1133.14","237.9","21548.2","64","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","411.16","411.16","6725.69","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1367.95","368.52","3625.48","122","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","1109.58","189.47","2511.7","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1225.29","228.57","4050.4","102","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","941.78","95.21","3806.78","79","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","414.95","63.31","2192.95","16","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1111.8","281.71","3974.77","32","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","3062.2","3062.2","3062.2","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","953.54","205.27","953.54","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","1982.76","1220.63","3972.46","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1902.41","409.62","8322.44","30","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","938.17","156.82","3270.58","76","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","896.61","429.51","1625.28","1 through 10","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1385.88","279.26","4667.25","39","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","470.06","219.65","1662.63","23","percent of total billed charges","","",""
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nerve Injections","5442","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","748.46","156.82","4283.17","30","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","599.88","340.44","23021.92","27","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","508.25","179.55","4506.16","11","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","821.13","821.13","821.13","1 through 10","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1134.3","308.24","2548.54","42","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","647.67","275.06","2451.14","47","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","2985.44","2596.86","2985.44","1 through 10","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","1077.61","1077.61","1077.61","1 through 10","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","474.54","287.17","2706.55","18","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","280.56","50.66","496.95","1 through 10","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","580.96","325.66","1113.54","21","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","169.55","169.55","169.55","1 through 10","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","498.19","498.19","498.19","1 through 10","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","20123.93","322.28","20258.37","1 through 10","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","454.8","104.58","1276.13","24","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","19200.55","18662.1","37530.68","16","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","491.52","310.29","4858.88","11","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","500.27","360.39","626.13","16","percent of total billed charges","","",""
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nerve Injections","5443","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","951.91","951.91","951.91","1 through 10","percent of total billed charges","","",""
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Neurostimulator and Related Procedures","5461","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8536.99","8536.99","8536.99","1 through 10","percent of total billed charges","","",""
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1090.04","1090.04","1090.04","1 through 10","percent of total billed charges","","",""
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","58.77","58.77","58.77","1 through 10","percent of total billed charges","","",""
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1164.81","906.94","1203.76","1 through 10","percent of total billed charges","","",""
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1213.67","1213.67","3964.49","1 through 10","percent of total billed charges","","",""
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1432.33","1432.33","1432.33","1 through 10","percent of total billed charges","","",""
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7910.26","7910.26","7910.26","1 through 10","percent of total billed charges","","",""
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","31131.93","31131.93","31131.93","1 through 10","percent of total billed charges","","",""
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Neurostimulator and Related Procedures","5462","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","8136.52","8136.52","8136.52","1 through 10","percent of total billed charges","","",""
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","44801.43","44801.43","44801.43","1 through 10","percent of total billed charges","","",""
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Neurostimulator and Related Procedures","5463","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","34404.62","34404.62","34404.62","1 through 10","percent of total billed charges","","",""
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","12451.5","12451.5","12451.5","1 through 10","percent of total billed charges","","",""
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","35268.56","35268.56","35268.56","1 through 10","percent of total billed charges","","",""
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","96947.22","96947.22","96947.22","1 through 10","percent of total billed charges","","",""
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","36551.6","36551.6","36551.6","1 through 10","percent of total billed charges","","",""
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","4681.75","4681.75","4681.75","1 through 10","percent of total billed charges","","",""
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","43740.71","43740.71","43740.71","1 through 10","percent of total billed charges","","",""
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","38485.92","38485.92","38485.92","1 through 10","percent of total billed charges","","",""
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","32926.26","32926.26","32926.26","1 through 10","percent of total billed charges","","",""
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","20829.47","20829.47","46282.46","1 through 10","percent of total billed charges","","",""
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","44408.12","44408.12","44408.12","1 through 10","percent of total billed charges","","",""
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Neurostimulator and Related Procedures","5464","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10046.22","10046.22","10046.22","1 through 10","percent of total billed charges","","",""
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","41612.49","36404.99","50821.59","1 through 10","percent of total billed charges","","",""
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","41465.73","41465.73","41465.73","1 through 10","percent of total billed charges","","",""
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","37456.23","34706.86","46587.16","1 through 10","percent of total billed charges","","",""
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","47905.4","36447.64","59804.63","18","percent of total billed charges","","",""
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","35877.36","35188.06","40045.86","1 through 10","percent of total billed charges","","",""
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","34660.1","14232.25","47506.64","1 through 10","percent of total billed charges","","",""
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","34699.25","34699.25","34699.25","1 through 10","percent of total billed charges","","",""
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","34821.27","34821.27","34821.27","1 through 10","percent of total billed charges","","",""
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","33076.89","33076.89","33313.9","1 through 10","percent of total billed charges","","",""
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","45243.8","44914.39","48461","1 through 10","percent of total billed charges","","",""
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","23236.74","23236.74","49362.73","1 through 10","percent of total billed charges","","",""
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Neurostimulator and Related Procedures","5465","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","27636.78","27636.78","27636.78","1 through 10","percent of total billed charges","","",""
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25808.03","25808.03","26740.54","1 through 10","percent of total billed charges","","",""
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","3173.33","3173.33","3173.33","1 through 10","percent of total billed charges","","",""
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","25146.54","25146.54","25146.54","1 through 10","percent of total billed charges","","",""
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","28368","28368","28368","1 through 10","percent of total billed charges","","",""
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Implantation of Drug Infusion Device","5471","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","4705.42","3709.82","5520.74","1 through 10","percent of total billed charges","","",""
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","3468.54","3468.54","5293.84","1 through 10","percent of total billed charges","","",""
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","3788.31","2769.57","5106.56","1 through 10","percent of total billed charges","","",""
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","231.28","231.28","10844.56","1 through 10","percent of total billed charges","","",""
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2928.83","2928.83","5251.41","1 through 10","percent of total billed charges","","",""
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4643.84","3919.73","7720.51","1 through 10","percent of total billed charges","","",""
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3443.45","3443.45","3443.45","1 through 10","percent of total billed charges","","",""
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","4755.17","4755.17","4755.17","1 through 10","percent of total billed charges","","",""
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laser Eye Procedures","5481","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","4035.74","2203.39","7094.98","69","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","4148.55","3204.3","5896.48","88","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","3658.74","2149.94","9494.45","16","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","3993.32","3271.93","7101.78","183","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","4258.5","3023.37","7353.87","150","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","3405.25","2103.23","6696.1","24","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","4386.44","4386.44","4386.44","1 through 10","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","4457.89","3487.24","7823.94","72","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","3703.79","3327.93","5056.05","37","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","3488.46","2726.01","5237.46","67","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","4381.5","3301.31","5814.75","1 through 10","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","5178.93","5178.93","5178.93","1 through 10","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","3893.45","3466.73","4213.94","1 through 10","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","10527.6","10527.6","10527.6","1 through 10","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","3692.34","3692.34","3692.34","1 through 10","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","5669.88","3354.98","6913.94","23","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","2384.41","2384.41","4098.8","1 through 10","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","6630.93","6630.93","6630.93","1 through 10","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","3141.51","3141.51","3141.51","1 through 10","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4251.77","3145.57","6903.44","74","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","3562.41","1875.82","5903.27","36","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3912.83","2410.98","6406.75","58","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","4174.71","3427.16","7474.56","48","percent of total billed charges","","",""
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Intraocular Procedures","5491","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","4111.93","3172.29","9746.32","26","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","9830.76","5680.27","16878.42","54","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","10715.82","5523.63","17376.21","35","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","7659.88","7659.88","7659.88","1 through 10","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","12901.28","8836.74","14282.55","1 through 10","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","8790.27","5783.17","16547.19","127","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9313.22","5476.72","15881.4","140","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","11934.78","5449.98","17392.34","1 through 10","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","9796.97","5510.84","16443.87","54","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","12558.72","12558.72","15302.79","1 through 10","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","10241.37","6908.08","12802.46","11","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","12439.91","5648.24","23710.09","20","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","10099.28","10099.28","10099.28","1 through 10","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","11233.2","7284.61","17854.72","1 through 10","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","7323.57","7323.57","7323.57","1 through 10","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14242.33","6113.77","19096.38","19","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9475.86","5651.27","12072.1","33","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","9074.14","9074.14","13669.97","1 through 10","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7564.78","4007.32","16761.14","50","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","7790.59","4999.12","15515.73","63","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","6378.41","4751.08","16407.58","39","percent of total billed charges","","",""
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Intraocular Procedures","5492","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8864.92","6233.57","17114.44","18","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","10940.89","7511.04","19674.21","20","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","9417.18","6688.27","11315.6","12","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","10009.48","8287.4","27008.29","1 through 10","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","10292.15","6854.02","18157.34","62","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","10773.64","9424.84","21870.69","1 through 10","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10675.59","7591.35","16657.97","58","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","12010.67","8150.04","19903.68","29","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","8258.36","7645.18","10597.84","1 through 10","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7623.95","7201.55","9671.75","1 through 10","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","9812.13","9812.13","9812.13","1 through 10","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","9167.5","9167.5","9167.5","1 through 10","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","7867.65","7867.65","7867.65","1 through 10","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","15333.75","12330.64","17903.99","15","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","10888.59","10888.59","10888.59","1 through 10","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10298.42","7706.86","18563.08","25","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","10921.22","10921.22","18044.21","1 through 10","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7202.71","4732.36","10010.1","13","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10879.12","8077.69","14900.63","21","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","7690.94","7038.83","16630.81","1 through 10","percent of total billed charges","","",""
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Intraocular Procedures","5493","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10463.01","7697.43","14291.12","11","percent of total billed charges","","",""
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","23741.67","23741.67","23741.67","1 through 10","percent of total billed charges","","",""
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Intraocular Procedures","5494","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","22548.55","22548.55","22548.55","1 through 10","percent of total billed charges","","",""
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","10441.3","10441.3","10441.3","1 through 10","percent of total billed charges","","",""
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","23171.31","23171.31","23171.31","1 through 10","percent of total billed charges","","",""
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","21089.88","21089.88","21089.88","1 through 10","percent of total billed charges","","",""
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13259.06","13259.06","13259.06","1 through 10","percent of total billed charges","","",""
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","16913.25","16913.25","16913.25","1 through 10","percent of total billed charges","","",""
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","15665.28","15665.28","15665.28","1 through 10","percent of total billed charges","","",""
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Intraocular Procedures","5495","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","27619.37","27619.37","27619.37","1 through 10","percent of total billed charges","","",""
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Intraocular Procedures","5496","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1480.8","1480.8","1480.8","1 through 10","percent of total billed charges","","",""
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","5564.57","3213.76","5754.05","1 through 10","percent of total billed charges","","",""
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","3714.73","3714.73","3714.73","1 through 10","percent of total billed charges","","",""
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","3956.21","3956.21","3956.21","1 through 10","percent of total billed charges","","",""
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4169.71","2996.1","4455.2","1 through 10","percent of total billed charges","","",""
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","2067.85","2067.85","2067.85","1 through 10","percent of total billed charges","","",""
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Extraocular, Repair, and Plastic Eye Procedures","5501","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","210.51","210.51","210.51","1 through 10","percent of total billed charges","","",""
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","3441.52","3441.52","3441.52","1 through 10","percent of total billed charges","","",""
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2469.57","2469.57","4084","1 through 10","percent of total billed charges","","",""
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","3515.35","3515.35","5861.85","1 through 10","percent of total billed charges","","",""
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2849.94","2849.94","2849.94","1 through 10","percent of total billed charges","","",""
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","3394.84","3394.84","3394.84","1 through 10","percent of total billed charges","","",""
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","6013","6013","6013","1 through 10","percent of total billed charges","","",""
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4044.92","4044.92","4044.92","1 through 10","percent of total billed charges","","",""
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4066.42","4066.42","4109.46","1 through 10","percent of total billed charges","","",""
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Extraocular, Repair, and Plastic Eye Procedures","5502","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2745.09","2745.09","2745.09","1 through 10","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","5206.82","3025.74","12170.34","40","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","3919.07","2685.66","7120.88","22","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5529.84","3871.62","6827.38","1 through 10","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","4915.26","3111.48","7861.96","61","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","4007.48","2709.57","4906.1","1 through 10","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","4895.97","2957.56","9414.92","99","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","5258.01","2414.42","8151.94","45","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","3049.13","3049.13","5646.55","1 through 10","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","3571.09","2805.25","8644.86","1 through 10","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","4543.46","2906.34","5517.38","1 through 10","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","10126.05","10126.05","10126.05","1 through 10","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","2414.6","2414.6","2414.6","1 through 10","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","4042.46","4042.46","10754.79","1 through 10","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","6563.4","5611.74","12803.91","1 through 10","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4444.43","2563.53","6803.59","35","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4513.26","2445.48","7290.33","79","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","4441.07","2364.55","7662.54","15","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","4992.81","3030.35","8501.13","44","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5639.77","3515.24","7140.45","24","percent of total billed charges","","",""
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Extraocular, Repair, and Plastic Eye Procedures","5503","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","4566.21","3622.86","8908.66","23","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","5645.88","5120.96","15626.34","1 through 10","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","7973.31","6477.12","9273.68","1 through 10","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5471.94","5471.94","5471.94","1 through 10","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","6409.9","5188.22","11678.41","21","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","17028.56","17028.56","17028.56","1 through 10","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","7093.94","4643.23","11903.47","31","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","7307.87","3952.92","13467.91","18","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","8760.81","8760.81","10091.53","1 through 10","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","5350.38","5350.38","5350.38","1 through 10","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","10198.87","4390.84","17291.82","1 through 10","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","6999.4","5218.59","11729.81","1 through 10","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","7921.12","7921.12","7921.12","1 through 10","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5419.88","4586.68","8938.73","21","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","7662.08","7662.08","7662.08","1 through 10","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7568.56","5001.07","13709.24","1 through 10","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","7937.52","5577.33","10734.14","17","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","9637.2","9637.2","20995.02","1 through 10","percent of total billed charges","","",""
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Extraocular, Repair, and Plastic Eye Procedures","5504","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6489.67","4624.45","20433.85","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","390.82","194.94","1848.91","437","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","359.69","194.25","905.47","195","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","520.66","369.81","56649.08","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","371.6","160.54","3464.65","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","372.33","193.27","1612.37","901","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","312.5","194.25","589.15","21","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","373.65","162.08","1962.93","1114","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","372.33","202.62","992.11","753","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","284.22","239.87","372.53","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","261.81","149.88","562.36","123","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","387.5","192.48","2045.04","574","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","361.53","245.48","564.63","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","436.26","372.6","485.47","17","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","361.83","196.91","598.13","11","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","351.17","324.54","512.82","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","411.65","313.85","544.8","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","302.63","302.63","302.63","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","372.26","299.27","695.11","284","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","817.25","323.48","1462.66","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","2525.31","2525.31","2525.31","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","354.59","354.59","354.59","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","369.9","218.85","468.78","11","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","362.12","205.92","617.12","916","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","326.73","131.68","410.61","17","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","319.95","172.21","958.28","93","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","351.09","194.94","963.76","287","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","393.18","206.26","1397.93","232","percent of total billed charges","","",""
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Imaging without Contrast","5521","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","373.32","129.52","695.08","290","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","742.13","309.47","2153.65","822","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","493.38","247.51","1291.14","233","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","465.67","242.75","1264.93","17","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","720.7","286.15","1842.96","1529","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","507.41","262.7","2310.81","29","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","750.07","260.15","2042.87","1884","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","817.1","310.38","2093.26","1427","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","373.04","373.04","999.45","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","567.43","238.51","1569.01","130","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","738.73","309.27","1572.2","853","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","284.61","135.61","1431.09","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","398.38","398.38","398.38","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","564.1","564.1","1151.08","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","957.16","354.41","3430","20","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","150.45","3.45","2826.32","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","825","310.38","2744","45","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","1440.54","1440.54","1440.54","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","718.91","439.7","1944.39","565","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","642.88","642.88","642.88","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","842.9","755.67","1646.94","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","669.48","669.48","1075.35","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","657.73","370.42","1841.12","1182","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","695.72","344.15","2499.92","16","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","575.82","229.73","1417.64","131","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","784.75","281.76","2596.62","616","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","720.3","288.69","1577.8","311","percent of total billed charges","","",""
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Imaging without Contrast","5522","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","723.44","373.32","1670.49","560","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","856.6","340.12","3232.87","339","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1787.92","467.57","3931.6","83","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","728.32","728.32","728.32","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","981.08","764.82","2622.2","19","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","866.26","355.69","3022.38","637","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1009.89","276.71","3963.65","752","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","3485.38","260.54","4708.8","20","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","846.84","347.51","3411.58","490","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","1847.79","1108.22","2552.98","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1737.19","1328.24","2815.51","94","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","881.92","335.71","2726.2","264","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","2942.46","2942.46","2942.46","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","1918.01","1918.01","1918.01","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","1937.08","738.69","3189.91","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","453.61","409.2","5200.7","11","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","617.8","617.8","617.8","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1263.52","634.41","3589.66","220","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","3286.84","3286.84","3286.84","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","423.8","423.8","8303.88","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","63.25","63.25","63.25","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","899.77","342.27","3202.69","491","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","2584.07","758.52","5063.53","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1880.65","743.93","3375.71","71","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1193.11","325.04","3744.02","237","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1775.32","407.64","3233.37","132","percent of total billed charges","","",""
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging without Contrast","5523","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1267.11","355.38","2960.69","194","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","860.79","670.86","2255.42","871","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","780.9","625.52","1337.47","95","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","449.22","409.54","45310.9","13","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","810.39","666.18","1617.68","1491","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","782.38","490.4","1000","28","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","811.39","642.95","2595.03","1842","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","810.39","664.15","2983.88","973","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","938.44","938.44","5428.79","1 through 10","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","804.99","661.79","2892.3","308","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","663.73","491.54","931.72","63","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","758.53","145.82","914.08","1 through 10","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","832.86","832.86","832.86","1 through 10","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","774.97","774.97","6832.45","18","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","720.88","720.88","720.88","1 through 10","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","882.41","802.03","8240.51","1 through 10","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","543.16","543.16","543.16","1 through 10","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","728.11","682.37","2614.42","481","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","280.98","280.98","280.98","1 through 10","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","730.18","626.21","2149.35","1723","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1248.21","734.78","2157.02","13","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","730.86","500.25","949.79","52","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","829.43","608.67","2556.48","563","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","860.79","677.5","2530.67","194","percent of total billed charges","","",""
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Imaging without Contrast","5524","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","730.18","579.91","2623.48","515","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","853.56","480.13","1548.63","366","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","795.39","423.21","1595.81","146","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","1620.85","1620.85","1620.85","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","844.51","429.27","1462.64","616","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","701.7","348.93","952.4","28","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","812.41","425.63","1451.58","45","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","882.33","417.91","1713.53","505","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","853.54","452.56","1501.6","421","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","871.42","702.41","43868.35","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","708.86","312.72","1286.33","85","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","802.25","391.66","1259.42","131","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","812.57","812.57","1038.15","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","820.71","651.6","905.77","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","554.97","554.97","554.97","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","788.51","788.51","1319.98","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","771.02","771.02","771.02","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","844.36","402.94","1539.62","78","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","646.92","646.92","646.92","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","794.45","794.45","794.45","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","1058.57","818.68","1555.33","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","791.35","381.76","1387.23","226","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","2163.99","2163.99","6387.58","1 through 10","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","729.61","405.96","960.58","107","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","853.12","453.05","1327.79","273","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","939.33","508.7","1713.61","123","percent of total billed charges","","",""
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Imaging with Contrast","5571","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","747.48","134.34","1189.33","48","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1444.63","526.83","5415.41","483","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1430.98","452.44","36054.54","162","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","1979.27","1979.27","1979.27","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","587.68","379.29","39536.45","29","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1423.6","535.41","5936.86","888","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1456.56","485.28","11034.6","769","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","1684.38","541.12","4262.95","40","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1461.61","618.21","6551.25","525","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","528.03","268.98","1132.53","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1029.6","391.65","3948.88","93","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1550.51","470.29","3735.44","224","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","1859.78","1859.78","2173.09","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","531.35","531.35","531.35","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","1270.78","1242.36","6006.73","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","3267.05","3267.05","3267.05","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","679.44","448.48","5029.31","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","1544.51","1333.91","4226.79","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1318.98","317.96","6130.71","98","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","4012.79","4012.79","4012.79","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","1335.9","869.65","1387.24","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","1304.48","1252.89","1446.63","1 through 10","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1479.6","595.85","5062.72","287","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","2149.17","951.4","8213.03","12","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1180.2","415.02","10123.74","93","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1437.11","538.53","4163.11","363","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1676.89","592.32","4301.09","192","percent of total billed charges","","",""
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Imaging with Contrast","5572","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1492.03","52.73","4421.82","62","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","819.12","529.22","1920.26","21","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","710.64","608.71","1352.7","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1696.44","1696.44","1696.44","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","756.03","647.11","2484.26","47","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","756.53","675.2","1882.26","38","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","847.45","710.78","4568.74","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1046.09","752.07","4495.94","25","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","160.97","160.97","3398.28","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","753.35","677.66","4848.49","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","2352.4","2352.4","2352.4","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","4691.82","4691.82","4691.82","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","735.04","587.9","4128.19","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","810.72","549.45","2424.68","12","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","762.89","762.89","5475.55","1 through 10","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","908.96","763.25","3303.11","15","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","899.41","675.21","1473.66","13","percent of total billed charges","","",""
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Imaging with Contrast","5573","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","681.2","681.2","681.2","1 through 10","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","814.64","272.4","3085.72","66","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","711.18","256.55","1031.73","13","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","875.07","526.22","1517.15","1 through 10","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","827.17","694.57","1137.64","121","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","577.26","526.22","696.97","1 through 10","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","818.64","340.4","1159.45","117","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","825.9","671.37","1229.64","82","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","613.88","613.88","613.88","1 through 10","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","811.75","268.36","1120.19","49","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","614.51","467.89","1023.78","19","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","418.47","418.47","1001.3","1 through 10","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","678.43","663.14","1019.01","1 through 10","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","645.6","645.6","645.6","1 through 10","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","812.11","471.7","1085.4","51","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","711.18","598.38","1066.18","15","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","822.13","277.95","1216.93","35","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1049.35","738.08","1204.64","37","percent of total billed charges","","",""
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Nuclear Medicine and Related Services","5591","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","734","674.29","976.3","1 through 10","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1397.2","1147.85","5167.19","43","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1849.31","1085.99","2051.24","11","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1171.44","1171.44","1265.22","1 through 10","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1265.98","913.23","2143.91","103","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","974.87","974.87","2152.05","1 through 10","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1298.26","892.02","2146.28","116","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1250.24","960.17","2400.65","65","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1264.44","945.9","2109.21","28","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1224.71","887.73","1755.07","1 through 10","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","998.12","998.12","998.12","1 through 10","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","7330.32","7330.32","7330.32","1 through 10","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1050.83","782.34","1557.81","1 through 10","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1226.09","980.75","2123.11","25","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1262.49","921.34","1997.73","14","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1283.13","797.48","2146.84","30","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1375.95","1059.85","2285.9","30","percent of total billed charges","","",""
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Nuclear Medicine and Related Services","5592","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1769.17","1122.27","4836.27","1 through 10","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1410.85","1206.72","4851.06","51","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1316.4","1093.68","4168.98","30","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1424.07","1413.18","1448.19","1 through 10","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1412.76","1164.41","5312.62","97","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1404.33","1106.04","5238.39","86","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","1436.47","1273.39","7764.35","1 through 10","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1546.39","1138.39","5355.36","56","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","6667.12","6667.12","6667.12","1 through 10","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1409.15","1268.08","4870.38","41","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1056.55","881.38","3044.05","37","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","2514.11","2514.11","2514.11","1 through 10","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1358.24","1257.28","9683.56","1 through 10","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","1443.27","1443.27","1443.27","1 through 10","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","4283.69","4283.69","4283.69","1 through 10","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1272.93","1046.28","2640.56","26","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","5441.54","5441.54","5441.54","1 through 10","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1329.08","1066.9","5113.54","14","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1411.77","891.88","3591.18","24","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1412.77","1234.7","4986.54","62","percent of total billed charges","","",""
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Nuclear Medicine and Related Services","5593","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1528.13","1183.21","2263.87","1 through 10","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","5783.97","4881.73","13629.82","105","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","6322.53","4700.03","13246.7","49","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","4546.47","156.24","5236.28","11","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","6135.39","4881.72","13924.82","252","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","5663.7","4131.49","11453.18","260","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","4899.02","4288.03","13985.69","11","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","5835.14","4789.6","11915.26","141","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","6996.32","6492.09","19079.34","1 through 10","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","4457.75","3040.39","11192.6","50","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","5643.71","4916.17","11875.11","55","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","194.4","194.4","194.4","1 through 10","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","5886.16","5886.16","5886.16","1 through 10","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","3933.85","3933.85","3933.85","1 through 10","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4920.32","290.57","9574.39","40","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","9648.61","9648.61","9648.61","1 through 10","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","5259.94","5259.94","5259.94","1 through 10","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5098.1","4398.53","7544.09","80","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5974.84","4334.37","12468.04","59","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","6331.98","4701.36","13873.07","114","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","6597.95","5038.83","15150.55","59","percent of total billed charges","","",""
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Nuclear Medicine and Related Services","5594","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","5301.13","172.08","12452.69","17","percent of total billed charges","","",""
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","4645.37","2661.51","6131.6","1 through 10","percent of total billed charges","","",""
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2325.78","281.04","7378.41","1 through 10","percent of total billed charges","","",""
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","2230.87","2230.87","2230.87","1 through 10","percent of total billed charges","","",""
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2526.81","353.22","29219.41","1 through 10","percent of total billed charges","","",""
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","12038.43","7258.1","21801.33","1 through 10","percent of total billed charges","","",""
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","5906.26","5906.26","5906.26","1 through 10","percent of total billed charges","","",""
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","2641.73","2641.73","2641.73","1 through 10","percent of total billed charges","","",""
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","3524.88","3179.1","3524.88","1 through 10","percent of total billed charges","","",""
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2276.25","2276.25","7984.98","1 through 10","percent of total billed charges","","",""
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","33987.02","33987.02","33987.02","1 through 10","percent of total billed charges","","",""
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","35701.01","35701.01","35701.01","1 through 10","percent of total billed charges","","",""
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Therapeutic Radiation Treatment Preparation","5611","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6648.02","6648.02","6648.02","1 through 10","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2334.28","475.11","6272.91","29","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1602.74","367.59","3089.23","19","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2263.64","420.52","4743.45","76","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","554.63","554.63","554.63","1 through 10","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","3403.53","3403.53","3403.53","1 through 10","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2039.04","371.34","4718.47","133","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1817.49","420.52","3876.3","53","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","1512.93","1512.93","1512.93","1 through 10","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2226.56","446.05","3386.35","26","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","703.29","217.98","1937.67","11","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","2346.88","2346.88","2346.88","1 through 10","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","866.55","866.55","2725.57","1 through 10","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","1042.9","911.63","6421.51","1 through 10","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","3970.47","1093.07","113209.62","1 through 10","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","999.27","331.2","3964.37","27","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2010.43","278.04","5396.61","24","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1957.92","412.07","4435.87","41","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","2131.97","1804.5","2523.82","16","percent of total billed charges","","",""
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Therapeutic Radiation Treatment Preparation","5612","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1920.94","541.42","4722.23","21","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","8162.55","3141.31","11590.33","16","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","8554.89","6107.17","10329.25","11","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5890.07","5890.07","5890.07","1 through 10","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","8423.42","4796.39","11501.54","35","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","6023.17","6023.17","6023.17","1 through 10","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8655.76","2352.55","11411.93","52","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","7258.1","5936.81","10478.67","15","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","5909.56","4424.07","9749.72","1 through 10","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","9177.43","4653.06","11844.48","11","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","9322.86","9322.86","9322.86","1 through 10","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","7478.34","7478.34","7478.34","1 through 10","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","8730.24","8730.24","8834.81","1 through 10","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","8522.85","8522.85","8522.85","1 through 10","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7009.46","5652.34","9577.91","13","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","6985.86","5908.38","8204.98","11","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","6920.07","2412.92","11129.96","16","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","8864.35","3809.52","59157.75","1 through 10","percent of total billed charges","","",""
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Therapeutic Radiation Treatment Preparation","5613","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8058.35","1537.63","10600.79","1 through 10","percent of total billed charges","","",""
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1911.34","1911.34","1911.34","1 through 10","percent of total billed charges","","",""
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3726.3","3726.3","3726.3","1 through 10","percent of total billed charges","","",""
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Radiation Therapy","5621","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1734.22","1734.22","1734.22","1 through 10","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","7655.41","925.38","20954.49","18","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1219.82","1219.82","23224.05","1 through 10","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1505.94","1505.94","1505.94","1 through 10","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2144.22","1029.24","14047.92","36","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1418.07","925.37","16259.24","57","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1631.59","925.37","9463.36","27","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","942.64","645.05","14766.74","1 through 10","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2483.09","1291.9","18883.97","17","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","1586.2","1586.2","1586.2","1 through 10","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","1974.11","1974.11","1974.11","1 through 10","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","48938.75","48938.75","48938.75","1 through 10","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","863.79","831.42","11391.5","1 through 10","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1563.3","1167.01","3443.38","12","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","9617.85","1255.34","17854.29","1 through 10","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2429.88","1308.42","18255.67","14","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1660.86","1177.47","16725.83","15","percent of total billed charges","","",""
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Radiation Therapy","5622","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2609.6","1060.92","14507.7","1 through 10","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","3109.5","1497.09","30369.11","87","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","3764.96","1290.44","31157.67","78","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1475.3","1242.36","13319.38","1 through 10","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2920.46","1351","29318.61","197","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","9750.25","22.93","37677.72","1 through 10","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1955.52","1423.59","29318.61","291","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2377.4","1346","29174.18","134","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","13727.56","13727.56","13727.56","1 through 10","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2492.94","1250.28","23008.03","33","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1879.13","1491.95","25485.65","54","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","1710.65","1440.56","26740.35","1 through 10","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","3397.38","3397.38","3397.38","1 through 10","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","1858.97","1834.32","4903.36","1 through 10","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","2164.48","1955.52","7578.25","1 through 10","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1692.66","1345.09","22442.72","43","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","9296.2","9296.2","9296.2","1 through 10","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","1346","1346","22293.11","1 through 10","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","1512.36","1512.36","12206.81","1 through 10","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1697.46","1348.91","25359.34","116","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2879.57","1142.39","27605.83","34","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3308.28","1512.36","37558.93","78","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","4083.11","1598.38","38817.54","32","percent of total billed charges","","",""
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Radiation Therapy","5623","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","5289.6","1440.16","21582.71","24","percent of total billed charges","","",""
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","7552.87","7552.87","7552.87","1 through 10","percent of total billed charges","","",""
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","7737.45","7737.45","7737.45","1 through 10","percent of total billed charges","","",""
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","5946.48","5946.48","5946.48","1 through 10","percent of total billed charges","","",""
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","6632.41","6632.41","6632.41","1 through 10","percent of total billed charges","","",""
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4677.27","4677.27","4677.27","1 through 10","percent of total billed charges","","",""
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Radiation Therapy","5624","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","12885.52","4530.64","30214.62","45","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","16652.57","12801.36","30757.21","1 through 10","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","19379.3","5040.98","34273.27","50","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","12759.31","12759.31","34116.05","1 through 10","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10723.98","4783.61","32141.4","51","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","16938.09","5764.83","29553.58","27","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","10222.79","4187.06","12561.18","1 through 10","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","29645.91","29645.91","29645.91","1 through 10","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","25273.42","25273.42","25273.42","1 through 10","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","20342.62","5697.48","24393.02","1 through 10","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11911.18","4994.45","35293.33","15","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","12463.48","6276.61","27823.89","13","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","19881.28","4576.87","32386.93","18","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","27023.67","7451.46","40053.6","1 through 10","percent of total billed charges","","",""
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 6 Radiation Therapy","5626","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","25484.22","7032.16","37449.56","1 through 10","percent of total billed charges","","",""
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","3317.07","3317.07","3317.07","1 through 10","percent of total billed charges","","",""
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","10074.48","6616.23","15493.11","1 through 10","percent of total billed charges","","",""
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","965.02","965.02","965.02","1 through 10","percent of total billed charges","","",""
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","7500.48","5132.7","12363.56","1 through 10","percent of total billed charges","","",""
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","13584.36","13584.36","13584.36","1 through 10","percent of total billed charges","","",""
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","10262.88","10262.88","10262.88","1 through 10","percent of total billed charges","","",""
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","5237.45","5237.45","5237.45","1 through 10","percent of total billed charges","","",""
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7894.78","7894.78","7894.78","1 through 10","percent of total billed charges","","",""
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","967.53","967.53","967.53","1 through 10","percent of total billed charges","","",""
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","11745.4","11479.83","12520.65","1 through 10","percent of total billed charges","","",""
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","9873.97","9873.97","9873.97","1 through 10","percent of total billed charges","","",""
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 7 Radiation Therapy","5627","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2770.62","456.24","70834.71","14","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","53885.03","3014.57","66714.7","1 through 10","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1926.8","1926.8","1926.8","1 through 10","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","56307.74","1046.41","69444.33","13","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","70138.9","496.69","71557.48","30","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","26215.07","544.54","69445.67","20","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","45928.12","1808.03","54652.39","1 through 10","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","46776.65","45594.66","52890.57","1 through 10","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","641.58","433.03","70485.94","1 through 10","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","897.83","897.83","897.83","1 through 10","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","64239.97","64087.17","64239.98","1 through 10","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2776.65","2776.65","2776.65","1 through 10","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","49241.42","49241.42","49241.42","1 through 10","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2450.36","2203.37","2767.87","1 through 10","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2970.46","1756.16","66556.01","1 through 10","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","64224.76","851.9","70327.55","23","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","55308.48","3211.78","57212.73","12","percent of total billed charges","","",""
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapeutic Nuclear Medicine","5661","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2084.91","2084.91","2084.91","1 through 10","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","673.73","202.63","6766.97","51","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","829.33","175.27","9874.17","17","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","201.23","77.35","3745.52","1 through 10","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","474.63","176.23","5437.67","99","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","618.13","424.68","3948.45","1 through 10","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","542.74","155.65","4263.29","149","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","434.01","207.25","5263.95","69","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","485.17","188.35","839.99","11","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","324.83","176.63","1618.17","45","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","1376.69","1376.69","1376.69","1 through 10","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","10003.55","10003.55","13465.74","1 through 10","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","1046.32","1046.32","1046.32","1 through 10","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","543.47","219.8","4906.96","15","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","813.75","100.68","1589.7","127","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","917.76","160.13","2012.93","1 through 10","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","683.94","110.21","9452.73","39","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","465.14","264.37","4189.99","23","percent of total billed charges","","",""
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Pathology","5671","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","129.52","41.47","4738.86","23","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2673.25","328.22","19713.62","28","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","5816.28","1420.96","14627.2","1 through 10","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","332.44","304.08","921.98","1 through 10","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1080.26","286.93","7824.15","55","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","6674.2","6674.2","6674.2","1 through 10","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","769.18","282.09","12460.77","49","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","869.56","384.95","10762.35","30","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","4719.39","275.71","46504.84","1 through 10","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1737.78","769.95","14950.51","1 through 10","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","5514.84","5514.84","5514.84","1 through 10","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","340.97","299.85","10469.96","1 through 10","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","2874.58","290.42","4221.34","1 through 10","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2224.72","655.39","81087.41","1 through 10","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","328.88","328.88","328.88","1 through 10","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","319.42","158.3","3863.95","38","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2157.53","1041.65","6430.2","1 through 10","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2106.16","605.51","12140.79","13","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","674.06","654.1","679.02","1 through 10","percent of total billed charges","","",""
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Pathology","5672","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","53.23","52.32","8494.76","1 through 10","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1754.33","387.82","5539.59","148","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1957.39","504.3","4239.17","45","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","612.57","498.22","9383.69","11","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1555.55","352.47","8868.06","296","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","3170.61","441.23","12288.71","12","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1716.61","370.94","9218.5","326","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2290.86","833.27","13361.1","154","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1993.71","1262.11","27830.7","15","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1850.22","374.1","14994.94","44","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","1387.52","1387.52","1387.52","1 through 10","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","20407.1","18151.72","32078.25","1 through 10","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","2066.9","1637.7","3956.72","22","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","2079.03","487.63","6977.34","119","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","2424.14","2424.14","2424.14","1 through 10","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1484.83","524.36","17996.97","20","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","927.8","357.85","7247.81","212","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1727.93","609.87","12044.04","58","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3163.09","870.01","20943.58","109","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1880.14","359.02","30177.56","48","percent of total billed charges","","",""
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Pathology","5673","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","162.63","52.32","16200.24","83","percent of total billed charges","","",""
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","6752.13","6752.13","10090.46","1 through 10","percent of total billed charges","","",""
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","62640.44","62640.44","62640.44","1 through 10","percent of total billed charges","","",""
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","12515.04","8005.74","14053.32","1 through 10","percent of total billed charges","","",""
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","26421.18","20372.98","34994.76","1 through 10","percent of total billed charges","","",""
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","29926.73","12425.5","52789.76","1 through 10","percent of total billed charges","","",""
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","17277.2","17277.2","17277.2","1 through 10","percent of total billed charges","","",""
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","65185.77","65185.77","65185.77","1 through 10","percent of total billed charges","","",""
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","18959.18","18959.18","18959.18","1 through 10","percent of total billed charges","","",""
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","40413.56","40413.56","40413.56","1 through 10","percent of total billed charges","","",""
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","19513.25","19513.25","40102.57","1 through 10","percent of total billed charges","","",""
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","40617.02","40617.02","40617.02","1 through 10","percent of total billed charges","","",""
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Pathology","5674","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2202.76","668.68","4423.32","42","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1281.5","441.09","4079.36","14","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1523.99","415.74","4291.99","119","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","1529.23","1224.25","1529.23","1 through 10","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1414.14","245.45","8199.76","127","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1770.88","735.05","6789.34","92","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","4989.87","204.74","6822.2","19","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","846.27","92.86","1225.84","11","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","1508.05","1059.3","1508.05","1 through 10","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","2276.51","952.62","2276.51","1 through 10","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","1903.68","1676.97","4405.8","1 through 10","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","702.43","204.18","1651.28","13","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","926.41","128.9","6863.12","99","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","868.57","513.99","3195.84","20","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1442.05","532.31","6785.52","54","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1518.27","292.99","16736.55","29","percent of total billed charges","","",""
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Drug Administration","5691","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","767.16","27.35","1344.54","53","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","2807.4","362.62","18794.62","494","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","8382.76","554.88","17744.01","179","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","664.31","474.31","3100.85","26","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","3197.4","316.29","18794.34","972","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","797.26","280.52","2591.43","36","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","3572.13","244.3","18423.58","1435","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2966.88","349.6","18839.79","626","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","6512.69","845.59","11212.08","12","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","6177.88","177.86","19993.88","210","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2609.58","132.14","18678.02","240","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","2850.99","2850.99","2850.99","1 through 10","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","850.03","850.03","850.03","1 through 10","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","333.06","333.06","17284.02","1 through 10","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","366.65","241.68","2324.16","13","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","1118.35","332.19","2862.57","76","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","2122.06","2122.06","2652.58","1 through 10","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","770.58","78.48","16605.6","217","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","474.28","74.72","16352.54","748","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","188.37","188.37","188.37","1 through 10","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","4173.13","256.27","16680.53","233","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","5130.88","348.57","18940.99","480","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","4138.05","349.11","18839.82","270","percent of total billed charges","","",""
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Drug Administration","5692","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2871.63","91.53","16639.42","293","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1414.81","406.81","27288.42","400","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1063","385.38","8922.47","219","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","627.48","389.44","14105.32","12","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1213.3","436.36","19530.75","853","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","905.29","274.27","6510.04","1213","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","7173.62","363.33","22554.95","32","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1137.96","217.33","16729.59","509","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","13288.92","7116.88","15387.73","1 through 10","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","944.54","326.95","15473.12","307","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","840.31","347.89","17684.63","110","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","9522","9522","9522","1 through 10","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","1279.45","1155.67","6240.63","20","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","804.05","356.9","2198.61","73","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","1097.96","489.43","2517.44","294","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","814.56","385.72","14135.01","123","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","333.33","333.33","750.22","1 through 10","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","903.61","346.37","5234.95","925","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1532.18","402.68","15564.36","168","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1169.2","350.63","17286.56","280","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1574","517.77","19604.65","117","percent of total billed charges","","",""
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Drug Administration","5693","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","982.96","364.16","23835.48","398","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","4617.4","872.01","21257.31","1076","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","6018.41","730.79","22598.34","498","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","14802.69","1928.17","41987.06","70","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","3597.76","911.9","21758.21","2103","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","3603.68","943.36","22163.45","2476","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","7630.48","1433.33","30390.91","69","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","4879.41","872.56","26219.42","1422","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","1625.59","621.57","20443.08","1 through 10","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","3573.86","925.38","21903.01","285","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","4467.66","1296.14","20984.56","340","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","16007.7","9667.95","16328.32","26","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","1194.56","738.39","31866.4","18","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","1224.98","730.56","8486.29","87","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","1424.79","695.03","8827.76","257","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","7022.94","1239.2","20387.28","396","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","637.53","580.34","1827.2","1 through 10","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","1807.02","1683.58","1828.73","1 through 10","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","926.12","926.12","926.12","1 through 10","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2286.02","741.74","21994.99","1010","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","461.33","461.33","461.33","1 through 10","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","6024.79","810.07","29075.88","454","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3383.85","810.02","31625.85","938","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","7195.2","878.62","31441.69","304","percent of total billed charges","","",""
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Drug Administration","5694","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2429.75","645.46","18062.77","545","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","378.23","164.5","1018.37","525","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","259.01","137.75","1450.07","134","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","161.38","87.95","566.88","24","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","372.48","144.77","1168.4","958","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","283.18","130.99","833.15","25","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","286.55","126.44","963.65","1078","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","309.44","158.89","1052.73","694","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","386.31","376.35","409.94","1 through 10","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","259.72","142.13","982.19","96","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","271.6","179.14","1098.92","207","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","414.32","410.22","1122.5","1 through 10","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","458.95","458.95","458.95","1 through 10","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","393.78","393.78","393.78","1 through 10","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","392.29","128.68","2310.75","1 through 10","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","464.56","464.56","535.25","1 through 10","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","814.04","225.83","1373.62","19","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","305.4","305.4","305.4","1 through 10","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","247.08","119.75","573.06","181","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","150.75","150.75","150.75","1 through 10","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","279.57","119.26","560.35","807","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","662.94","662.94","662.94","1 through 10","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","227.51","116.77","988.69","98","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","314.67","144.95","1022.19","392","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","321.72","161.84","1224.16","179","percent of total billed charges","","",""
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Diagnostic Tests and Related Services","5721","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","335.6","117.88","560.35","309","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","867.83","290.19","1627.35","365","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","627.85","283.68","4213.01","46","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","860.37","513.63","4478.12","1 through 10","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","863.2","291.77","1597.51","531","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","490.23","407.06","6066.22","12","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","771.21","175.61","1447.38","642","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","863.2","276.56","1550.43","424","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","982.15","982.15","982.15","1 through 10","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","803.38","248.11","4728.45","26","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","724.38","206.39","1591.85","151","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","753.85","313.34","1020.98","12","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","718.03","718.03","718.03","1 through 10","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","3671.61","3671.61","3671.61","1 through 10","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","687.52","161.18","1050.72","225","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","1107.63","1107.63","1107.63","1 through 10","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","767.25","161.63","1232.03","632","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","400.79","299.43","3580.47","1 through 10","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","869.65","235.8","4162.78","28","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","700.74","293.35","1342.32","235","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","775.71","311.69","1461.86","140","percent of total billed charges","","",""
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Diagnostic Tests and Related Services","5722","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","823.09","260.4","1280.62","259","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","677.5","329.31","1631.02","131","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","498.9","397.36","1351.91","22","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","649.58","300.01","722.33","1 through 10","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1091.74","403.52","1646.69","212","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","499.81","243.74","853.51","12","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1236.3","336.49","1690.78","304","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1213.18","403.88","1670.72","189","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","567.44","402.81","1651.77","29","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","412.74","321.52","1313.76","1 through 10","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","1213.15","1213.15","1213.15","1 through 10","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","458.39","458.39","458.39","1 through 10","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","317.85","317.85","317.85","1 through 10","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","395.9","369.17","1135.16","22","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1092.3","356.86","1531.71","97","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1450.12","1334.35","5302.3","1 through 10","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","566.6","378.85","1428.26","20","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","623.87","377.6","1360.53","41","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","492.73","374.17","1288.33","41","percent of total billed charges","","",""
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Diagnostic Tests and Related Services","5723","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","502.39","389.19","1105.44","11","percent of total billed charges","","",""
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","26306.15","26306.15","26306.15","1 through 10","percent of total billed charges","","",""
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24460.67","24460.67","24460.67","1 through 10","percent of total billed charges","","",""
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","4653.84","4653.84","4653.84","1 through 10","percent of total billed charges","","",""
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","22396.42","22396.42","22396.42","1 through 10","percent of total billed charges","","",""
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","65671.4","65671.4","65671.4","1 through 10","percent of total billed charges","","",""
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","41800.46","41800.46","46100.49","1 through 10","percent of total billed charges","","",""
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Diagnostic Tests and Related Services","5724","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2420.89","1445.75","68040.79","1 through 10","percent of total billed charges","","",""
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","9054.58","8954.48","20100.63","1 through 10","percent of total billed charges","","",""
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","7780.09","5726.31","9188.42","1 through 10","percent of total billed charges","","",""
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9348.08","7117.51","12422.41","1 through 10","percent of total billed charges","","",""
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","10001.87","10001.87","18333.12","1 through 10","percent of total billed charges","","",""
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","9509.21","9509.21","9509.21","1 through 10","percent of total billed charges","","",""
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","26364.9","26364.9","26364.9","1 through 10","percent of total billed charges","","",""
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","7094.08","7094.08","10577.11","1 through 10","percent of total billed charges","","",""
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","142.91","142.91","142.91","1 through 10","percent of total billed charges","","",""
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Minor Procedures","5731","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","7620.71","7620.71","7620.71","1 through 10","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","320.12","107.27","500.11","61","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","293.87","106.35","1085.49","22","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","114.99","114.99","114.99","1 through 10","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","339.53","111.38","456.73","139","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","112.92","112.92","301.51","1 through 10","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","441.84","112.51","503.07","236","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","465.1","112.92","503.07","177","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","280.29","110.02","422.52","36","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","241.63","88.32","283.37","13","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","124","124","124","1 through 10","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","430.55","430.55","1790.2","1 through 10","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","238.34","99.45","444.59","1 through 10","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","419.06","128.76","453.28","183","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","3.5","3.5","3.5","1 through 10","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","153.95","85.08","287.77","18","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","308.22","107","1027.81","28","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","193.74","110.7","386.79","1 through 10","percent of total billed charges","","",""
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Minor Procedures","5732","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","419.06","241.19","453.28","56","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","159.84","93.04","1382.16","268","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","232.09","125.11","639.67","68","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","136.62","56.58","886.6","14","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","143.75","115.01","530.39","635","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","108.83","94.88","2578.87","13","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","142.9","84.95","493.93","886","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","143.75","118.98","710.74","447","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","111.05","111.05","111.05","1 through 10","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","142.4","109.62","403.27","265","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","120.47","80.21","390.45","71","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","75.53","75.53","75.53","1 through 10","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","243.9","243.9","1807.08","1 through 10","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","225.82","160.37","300.5","1 through 10","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","52234.86","52234.86","52234.86","1 through 10","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","119.4","113.43","256.79","129","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","2044.99","2044.99","2044.99","1 through 10","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","125.63","99.02","244.12","581","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","254.08","254.08","254.08","1 through 10","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","200.57","88.12","666.53","56","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","145.75","115.49","1455.61","158","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","221.7","102.22","1292.38","67","percent of total billed charges","","",""
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Minor Procedures","5733","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","119.74","110.84","201.96","138","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","401.26","146.89","1411.47","757","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","402.12","190.61","1444.68","280","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","327.98","92.83","1053.3","40","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","424.23","155.37","1562.54","1356","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","429.11","130.75","1882.11","1768","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","578.64","167.62","1703.24","53","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","500.35","167.78","1787.48","1048","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","141.6","132.28","1222.14","1 through 10","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","451.57","157.95","1230.08","498","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","265.41","116.5","779.38","217","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","280.77","240.91","865.89","1 through 10","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","458.62","458.62","458.62","1 through 10","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","423.42","423.42","423.42","1 through 10","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","689.93","249.19","4580.49","1 through 10","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","418.14","178.26","5283.6","95","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","625.13","218.08","3337.72","300","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","516.01","516.01","516.01","1 through 10","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","568.31","247.19","1746.54","250","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","557.87","557.87","557.87","1 through 10","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","131.1","131.1","634.69","1 through 10","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","812.18","812.18","812.18","1 through 10","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","244.15","182.77","419.65","1 through 10","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","476.2","164.67","1682.54","911","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","494.39","306.34","3107.42","1 through 10","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","322.93","124.25","1092.51","178","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","480.08","184.84","1249.07","564","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","444.02","149.17","1435.24","211","percent of total billed charges","","",""
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 4 Minor Procedures","5734","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","217.76","53.23","1027.27","557","percent of total billed charges","","",""
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1254.12","760.28","2526.56","1 through 10","percent of total billed charges","","",""
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","2136.53","786.67","61376.45","1 through 10","percent of total billed charges","","",""
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1177.13","840.74","56722.73","13","percent of total billed charges","","",""
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2503.23","783.22","59870.69","1 through 10","percent of total billed charges","","",""
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","3053.16","3053.16","3053.16","1 through 10","percent of total billed charges","","",""
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","703.7","590.38","2536.29","1 through 10","percent of total billed charges","","",""
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","175.82","175.82","175.82","1 through 10","percent of total billed charges","","",""
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1079.74","684.63","3794.81","27","percent of total billed charges","","",""
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","700.9","700.9","3948.04","1 through 10","percent of total billed charges","","",""
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 5 Minor Procedures","5735","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2546.6","2546.6","2546.6","1 through 10","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","225.81","166.05","425.14","22","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","199.8","156.38","295.15","21","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","209.49","209.49","388.33","1 through 10","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","240.81","169.37","458.01","50","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","410.34","410.34","410.34","1 through 10","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","221.36","113.42","429.76","55","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","247.87","169.37","453.75","37","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","185.25","95.76","400.48","21","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","153.92","111.05","334.68","1 through 10","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","216.47","216.47","216.47","1 through 10","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","127.9","127.9","127.9","1 through 10","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","222.7","198.89","545.55","1 through 10","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","223.34","166.25","827.66","29","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","163.08","140.78","340.42","1 through 10","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","250.4","167.74","422.36","20","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","225.82","159.12","396.67","19","percent of total billed charges","","",""
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Electronic Analysis of Devices","5741","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","297.03","199.45","397.56","13","percent of total billed charges","","",""
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","5696.54","5696.54","5696.54","1 through 10","percent of total billed charges","","",""
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","292.29","292.29","292.29","1 through 10","percent of total billed charges","","",""
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Electronic Analysis of Devices","5743","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","784.06","713.8","1197.55","15","percent of total billed charges","","",""
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","714.28","612.55","986.04","18","percent of total billed charges","","",""
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","805.65","612.26","1853.31","33","percent of total billed charges","","",""
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","760.4","760.4","760.4","1 through 10","percent of total billed charges","","",""
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","828.16","608.76","2073.12","35","percent of total billed charges","","",""
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","757.74","687.16","1080.24","20","percent of total billed charges","","",""
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","732.83","732.83","1940.08","1 through 10","percent of total billed charges","","",""
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","608.8","583.33","1531.48","1 through 10","percent of total billed charges","","",""
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","807.49","706.63","946.23","1 through 10","percent of total billed charges","","",""
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","594.24","567.59","665.26","1 through 10","percent of total billed charges","","",""
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","812.81","607.47","52624.01","1 through 10","percent of total billed charges","","",""
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","730.53","648.43","1578.69","12","percent of total billed charges","","",""
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Resuscitation and Cardioversion","5781","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","904.04","904.04","904.04","1 through 10","percent of total billed charges","","",""
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","18026.93","18026.93","18026.93","1 through 10","percent of total billed charges","","",""
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","693.53","693.53","693.53","1 through 10","percent of total billed charges","","",""
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2805.54","2805.54","2805.54","1 through 10","percent of total billed charges","","",""
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","706.34","706.34","706.34","1 through 10","percent of total billed charges","","",""
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","388.05","388.05","388.05","1 through 10","percent of total billed charges","","",""
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Treatment","5791","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2047.46","2047.46","2047.46","1 through 10","percent of total billed charges","","",""
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","6678.57","6678.57","6678.57","1 through 10","percent of total billed charges","","",""
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","13291.41","13291.41","13291.41","1 through 10","percent of total billed charges","","",""
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","7045.88","7045.88","7045.88","1 through 10","percent of total billed charges","","",""
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","113094.79","113094.79","113094.79","1 through 10","percent of total billed charges","","",""
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","37509.52","37509.52","37509.52","1 through 10","percent of total billed charges","","",""
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventilation Initiation and Management","5801","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","170.4","153.67","453.46","1 through 10","percent of total billed charges","","",""
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","151.04","151.04","151.04","1 through 10","percent of total billed charges","","",""
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","197.24","193.88","233.64","1 through 10","percent of total billed charges","","",""
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","193.3","108.64","241.34","34","percent of total billed charges","","",""
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","161.32","95.68","541.03","32","percent of total billed charges","","",""
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","192.45","192.45","192.45","1 through 10","percent of total billed charges","","",""
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","144.87","144.87","144.87","1 through 10","percent of total billed charges","","",""
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","278.18","276.54","791.32","1 through 10","percent of total billed charges","","",""
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","228.15","228.15","228.15","1 through 10","percent of total billed charges","","",""
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","160.02","121.04","321.86","31","percent of total billed charges","","",""
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","173.38","108.64","232.45","25","percent of total billed charges","","",""
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","149.07","96.65","165.88","1 through 10","percent of total billed charges","","",""
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 1 Health and Behavior Services","5821","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","194.49","138.17","308.55","1 through 10","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","335.97","212.95","786.3","39","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","257.78","48.82","610.24","90","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","227.74","4.45","604.56","128","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","481.93","223.25","692.56","58","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","481.43","39.58","2789.54","16","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","1206.36","681.16","1485.4","18","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","173.14","173.14","1216.5","1 through 10","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","214.73","191.32","301.85","57","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","327","201.46","716.05","207","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","227.91","196.21","229.26","22","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","251.35","215.9","538.56","32","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","390.26","232.16","584.94","13","percent of total billed charges","","",""
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 2 Health and Behavior Services","5822","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","224.18","201.46","544.72","101","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","138.04","100.02","242.2","598","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","112.36","97.05","187.92","31","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","88.75","88.75","88.75","1 through 10","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","149.13","115.03","246.93","1700","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","161.31","134.41","373.21","1 through 10","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","144.95","107.55","244.22","2412","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","149.1","106.2","296.6","980","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","148.96","148.96","148.96","1 through 10","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","144.48","113.28","241.37","925","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","117.88","78.4","181.47","85","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","117.38","117.38","187.83","25","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","161.27","120.79","664.63","16","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","195.06","140.45","396.6","29","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","164.11","164.11","164.11","1 through 10","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","151.02","124.36","425.26","302","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","125.85","125.85","125.85","1 through 10","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","146.03","91.17","212.59","31","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","151.93","116.21","353.96","150","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","134.41","115.04","265.8","460","percent of total billed charges","","",""
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Level 3 Health and Behavior Services","5823","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","210.71","117.04","578.29","50","percent of total billed charges","","",""
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","431.59","431.59","19071.76","1 through 10","percent of total billed charges","","",""
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","280.64","214.14","17636.13","1 through 10","percent of total billed charges","","",""
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","227.36","203.1","564.72","11","percent of total billed charges","","",""
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","199.33","183.05","19505.01","1 through 10","percent of total billed charges","","",""
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","227.36","227.36","392.09","1 through 10","percent of total billed charges","","",""
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","351.47","351.47","351.47","1 through 10","percent of total billed charges","","",""
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","1586.99","1586.99","1586.99","1 through 10","percent of total billed charges","","",""
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","750.4","750.4","750.4","1 through 10","percent of total billed charges","","",""
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","430.24","430.24","845.21","1 through 10","percent of total billed charges","","",""
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","734.62","298.47","2511.56","1 through 10","percent of total billed charges","","",""
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 Vaccine Administration","9398","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","428.22","428.22","428.22","1 through 10","percent of total billed charges","","",""
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1636.56","1636.56","1636.56","1 through 10","percent of total billed charges","","",""
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","8134.74","8134.74","8134.74","1 through 10","percent of total billed charges","","",""
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Whole blood for transfusion","9510","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","8182.99","6489.5","11485.59","16","percent of total billed charges","","",""
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","137012.61","137012.61","137012.61","1 through 10","percent of total billed charges","","",""
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","7810.09","3253.46","50023.26","14","percent of total billed charges","","",""
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10340.01","8070.42","47676.83","16","percent of total billed charges","","",""
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","10764.93","9911.41","12667.5","13","percent of total billed charges","","",""
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","8676.47","8676.47","8763.93","1 through 10","percent of total billed charges","","",""
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","84936.54","84936.54","84936.54","1 through 10","percent of total billed charges","","",""
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","9405.28","7349.95","18400.04","20","percent of total billed charges","","",""
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7919.76","2298.31","135054.84","19","percent of total billed charges","","",""
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","103686.24","103686.24","103686.24","1 through 10","percent of total billed charges","","",""
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","18946.11","18946.11","34813.76","1 through 10","percent of total billed charges","","",""
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","26925.28","26925.28","52685.27","1 through 10","percent of total billed charges","","",""
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukocytes reduced","9512","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9184.81","3331.49","9485.9","1 through 10","percent of total billed charges","","",""
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plasma, frz between 8-24hour","9513","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","18595.9","18595.9","18595.9","1 through 10","percent of total billed charges","","",""
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","3888.16","3888.16","3888.16","1 through 10","percent of total billed charges","","",""
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","4629","2799.79","7071.29","13","percent of total billed charges","","",""
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","4054.24","3311.29","7505.38","1 through 10","percent of total billed charges","","",""
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","4659.59","4659.59","4659.59","1 through 10","percent of total billed charges","","",""
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8749.96","8749.96","8749.96","1 through 10","percent of total billed charges","","",""
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Washed red blood cells unit","9518","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1012.69","1012.69","1012.69","1 through 10","percent of total billed charges","","",""
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Blood split unit","9520","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2105.06","2105.06","2105.06","1 through 10","percent of total billed charges","","",""
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","8672.71","2053.98","11277.31","19","percent of total billed charges","","",""
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9348.55","1827.45","12832.73","31","percent of total billed charges","","",""
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","11959.47","7546.14","14063.89","25","percent of total billed charges","","",""
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","9034.34","6771.99","11992.37","1 through 10","percent of total billed charges","","",""
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","8567.49","8567.49","8567.49","1 through 10","percent of total billed charges","","",""
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","8981.86","8264.85","10161.22","1 through 10","percent of total billed charges","","",""
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9596.73","2963.49","11951.87","29","percent of total billed charges","","",""
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10778.59","8809.96","11657.33","1 through 10","percent of total billed charges","","",""
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","2329.59","2329.59","2329.59","1 through 10","percent of total billed charges","","",""
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"RBC leukoreduced irradiated","9522","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9300.91","8481.61","10701.21","16","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","3574.5","3574.5","4001.15","1 through 10","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2602.77","2602.77","3285.35","1 through 10","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","3479.1","2315.46","4175.85","1 through 10","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","2333.03","2270.7","2640.58","1 through 10","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2820.7","2119.46","3396.56","12","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","3620.8","3122.18","5855.17","1 through 10","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2421.55","2421.55","3970.27","1 through 10","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","1996.07","1980.07","3485.61","1 through 10","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","3709.06","3218.77","4229.71","1 through 10","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3643.68","3643.68","3643.68","1 through 10","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","12032.7","12032.7","12032.7","1 through 10","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","5401.81","3135.61","5401.81","1 through 10","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","46099.09","46099.09","46099.09","1 through 10","percent of total billed charges","","",""
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Plate pheres leukoredu irrad","9530","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1681.38","1441.92","2470.36","74","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1914.46","1401.11","2947.87","70","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1381.87","915.88","1578.32","1 through 10","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1833.37","1442.16","3501.82","154","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","2307.4","1494.7","3569.86","1 through 10","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2333.68","1458.93","4314.35","117","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","2184.17","1637.36","3282.06","103","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","2220.46","1731","4046.68","25","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2266.42","2266.42","2266.42","1 through 10","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","1741.24","1316.25","3549.55","73","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","2659.88","1915.02","4190.97","76","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2105.01","2105.01","2105.01","1 through 10","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2208.33","1336.76","3698.53","71","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1512.88","1223.32","6926.78","19","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2300.11","1498.92","5061.57","94","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","2312.42","1780.97","3824.04","36","percent of total billed charges","","",""
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Platelets pheresis path redu","9536","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1910.97","1230.94","2838.97","23","percent of total billed charges","","",""
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3674.84","3674.84","3674.84","1 through 10","percent of total billed charges","","",""
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Covid-19 convalescent plasma","9540","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","132.9","56.69","167.2","8103","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","124.87","50.25","182.72","2509","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","178.26","178.26","178.26","1 through 10","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","119.23","51.58","161.07","275","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","132.9","53.77","184.86","15686","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","125.87","49.34","170.31","553","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","132.9","51.9","146.68","20706","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","110.96","102.21","255.53","22","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","132.9","53.77","159.51","10249","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","128.71","53.31","145.82","6007","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","119.44","48.47","160.97","1818","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","135.61","53.22","205.6","75","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","146.68","135.61","198.45","1 through 10","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","129.27","118.37","191.79","97","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","125.53","49.96","251.06","170","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","113.54","113.54","113.54","1 through 10","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","119.44","102.21","129.6","208","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","132.75","94.17","165.87","405","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","104.37","36.31","168.46","46","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","120.06","70.31","165.78","4544","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","128.69","79.72","135.09","38","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","129.17","81.81","146.18","17","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","143.5","142.65","322.66","1 through 10","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","131.61","100","177.92","56","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","116.84","48.16","129.52","20401","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","131.68","113.35","283.37","163","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","121.16","45.59","182.79","1713","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","135.71","60.27","186.4","5549","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","134.34","75.4","199.32","3124","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","131.9","131.9","131.9","1 through 10","percent of total billed charges","","",""
"Non-OPPS Clinic Services","N700","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","121.04","89.59","144.97","5423","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","302.19","92.21","976.61","2931","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","255.02","94.24","760.76","1020","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","653.1","653.1","653.1","1 through 10","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","163.5","61.02","544.79","138","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","297.73","88.92","974.8","6110","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","278.89","119.06","848.93","185","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","253.1","75.4","891.22","8673","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","146.24","30.71","853.59","39","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","292.28","85.92","972.79","4811","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","238.49","81.38","651.14","726","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","233.02","65.37","719.37","5323","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","188.15","64.08","40525.18","19","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","371.41","82.4","1012.27","21","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","282.47","151.67","1416.71","57","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","462.55","149.08","1026.17","146","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","597.5","146.47","1649.45","344","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","276.09","169.1","1377.24","12","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","299.7","149.07","729.43","568","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","461.83","73.1","529.72","11","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","96.95","66.28","412.9","24","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","190.65","190.36","190.65","1 through 10","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","214.32","84.69","376.84","11","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","315.06","106.76","949.75","7928","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","423.17","188.24","15674.77","22","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","248.75","77.42","886.12","702","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","282.73","90.48","1054.9","2143","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","299.08","97.79","968.65","938","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","203.77","203.77","624.21","1 through 10","percent of total billed charges","","",""
"Clinical Diagnostic Lab Services","N800","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","128.76","42.59","259.02","1163","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","300.44","86.78","1020.08","955","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","200.33","74.64","712.99","326","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","184.08","111.32","540.73","25","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","154.8","52.18","760.87","2436","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","302.69","109.39","992.94","41","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","130.65","48.73","835.09","3285","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","238.26","139.57","792.66","1949","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","90.51","85.67","478.65","1 through 10","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","95","65","525.28","346","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","230.62","95","638.46","1654","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","131.81","131.81","131.81","1 through 10","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","344.2","339.44","833.9","1 through 10","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","246.36","138.99","425","13","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","125.22","87.4","631.37","89","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","320.75","320.75","531.4","1 through 10","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","1046.68","150.87","2077.67","32","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","62.24","62.24","62.24","1 through 10","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","281.75","103.86","963.8","622","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","129.94","114.29","438.27","1 through 10","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","549.86","237.22","1928.09","12","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","1408.7","1408.7","1408.7","1 through 10","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","116.76","116.76","394.94","1 through 10","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","281.41","104.16","1006.67","1963","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","614.26","137.61","1822.12","30","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","112.8","10","406.53","115","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","290.94","130.69","912.89","750","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","160.48","95","493.26","933","percent of total billed charges","","",""
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Therapy Services","N801","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","308.46","120.92","1085.22","393","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","1475.05","1350.79","1683.97","100","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1401.56","1196.31","1586.02","50","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1462.71","1457.7","1562.63","1 through 10","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","1443.73","1350.79","1683.97","304","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","1361.62","1361.62","1706.7","1 through 10","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1458.45","1350.79","1701.14","520","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","1475.05","1172.45","1683.97","120","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","1332.55","1332.55","1332.55","1 through 10","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","1471.29","1347.34","1679.67","505","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","1311.41","1309.32","1527.19","35","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","1718.33","1718.33","1718.33","1 through 10","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","972.88","972.88","972.88","1 through 10","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","1725.73","1725.73","1725.73","1 through 10","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1300.83","1217.09","1441.43","22","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1338.17","1153.93","1586.02","22","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1432.79","1091.65","1594.41","72","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1443.73","1262.65","1683.97","70","percent of total billed charges","","",""
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mammography Services","N804","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","12843.63","12843.63","12843.63","1 through 10","percent of total billed charges","","",""
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","243.47","176.35","243.47","1 through 10","percent of total billed charges","","",""
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","243.47","243.47","243.47","1 through 10","percent of total billed charges","","",""
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","335","335","476","1 through 10","percent of total billed charges","","",""
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","95","95","95","1 through 10","percent of total billed charges","","",""
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","462.4","462.4","462.4","1 through 10","percent of total billed charges","","",""
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","469.84","469.84","469.84","1 through 10","percent of total billed charges","","",""
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Durable Medical Equipment","N805","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","321.94","202.7","572.41","1 through 10","percent of total billed charges","","",""
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","326.53","138.55","2082.94","1 through 10","percent of total billed charges","","",""
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","279.99","114.92","408.17","12","percent of total billed charges","","",""
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","359.26","310.78","450.13","1 through 10","percent of total billed charges","","",""
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","375.09","274","936.11","1 through 10","percent of total billed charges","","",""
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","304.66","304.66","455.47","1 through 10","percent of total billed charges","","",""
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","309.99","278.29","646.34","1 through 10","percent of total billed charges","","",""
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","531.89","202.2","595.01","1 through 10","percent of total billed charges","","",""
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","251.64","130.14","434.5","1 through 10","percent of total billed charges","","",""
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","213.49","213.49","213.49","1 through 10","percent of total billed charges","","",""
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","350.25","223.58","714.52","1 through 10","percent of total billed charges","","",""
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","80.01","50.08","719.99","1 through 10","percent of total billed charges","","",""
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Medicine","N809","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","2379.93","2379.93","2379.93","1 through 10","percent of total billed charges","","",""
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Observation, Other","N811","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1459.14","1459.14","1459.14","1 through 10","percent of total billed charges","","",""
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","113.8","99.94","127.92","57","percent of total billed charges","","",""
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","108.68","77.84","187.07","51","percent of total billed charges","","",""
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","112.17","97.44","250.13","45","percent of total billed charges","","",""
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","173.98","111.03","349.53","47","percent of total billed charges","","",""
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","95","95","95","1 through 10","percent of total billed charges","","",""
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","113.4","99.67","196.22","38","percent of total billed charges","","",""
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","110.59","110.41","135.76","1 through 10","percent of total billed charges","","",""
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","186.56","94.03","1915.65","18","percent of total billed charges","","",""
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","175.75","118.35","353.09","15","percent of total billed charges","","",""
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-covered Services","N900","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","105.62","104.58","156.76","24","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","240.65","184.09","580.58","98","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","758.32","362.67","39563.09","12","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","119.05","119.05","43591.37","1 through 10","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","260.86","188.69","580.57","244","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","241.04","184.03","580.57","264","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","468.03","468.03","746.75","1 through 10","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","535.86","535.86","535.86","1 through 10","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","246.49","191.16","638.08","132","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","261.71","176.94","843.56","18","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","221.33","173.6","289.55","214","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","258.25","258.25","258.25","1 through 10","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","182.6","182.6","182.6","1 through 10","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","2014.94","2014.94","2014.94","1 through 10","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","259.28","234.37","521.63","47","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","261.55","223.84","838.09","167","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","252.77","244.68","2251.95","13","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","249.26","59.27","592.42","53","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","288.59","250.51","562.77","19","percent of total billed charges","","",""
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Packaged Services","N902","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","339.96","241.82","906.51","33","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Aetna","All Commercial Plans","","100","","276.51","123.15","531.48","198","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","136.47","121.65","376.12","12","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Bcbs","All Commercial Plans","","100","","259.31","123.02","439.98","245","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","135.39","132.01","265.32","1 through 10","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","276.23","123.02","517.91","442","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Cigna","All Commercial Plans","","100","","284.58","123.02","531.48","281","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","347.54","241","518.32","1 through 10","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Ehp","Employee","","100","","284.73","132.4","429.65","97","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Humana","Military Tricare Government","","100","","188.28","188.28","188.28","1 through 10","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Humana","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Kaiser","All Commercial Plans","","100","","395.58","287.45","401.2","1 through 10","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Keystone Health","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","256.74","110.53","464.2","60","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Nalc","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Phcs","All Commercial Plans","","100","","732.57","732.57","732.57","1 through 10","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","257.47","116.38","388.5","176","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","241.99","133.19","363.43","1 through 10","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","270.86","126.23","435.58","156","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Usfhp","Prime Tricare Government","","100","","661.78","193.74","775.27","1 through 10","percent of total billed charges","","",""
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Not Recognized by OPPS","N905","APC","","","","","facility","outpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","259","96.9","514.93","79","percent of total billed charges","","",""
"HC CELLSEARCH CIRC TUMOR CEL","10001116097","CDM","301","RC","86152","HCPCS","facility","both","","","","1501","1501","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FOLIC ACID 82746","10001116117","CDM","300","RC","82746","HCPCS","facility","both","","","","90.5","90.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SALICYLATE-UR-Q80196","10001116119","CDM","300","RC","80196","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FATTY AC FREE 82725","10001116121","CDM","300","RC","82725","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CTC TEST W I&R","10001116123","CDM","301","RC","86153","HCPCS","facility","both","","","","32.5","32.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN B-1 84425","10001116127","CDM","300","RC","84425","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-DEOXY-NASE 86225","10001116135","CDM","300","RC","86225","HCPCS","facility","both","","","","99","99","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PSA (PROST SPEC ANTIG) SC","10001116145","CDM","300","RC","","","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PSA (PROST SPEC ANTIG) SC","10001116181","CDM","301","RC","","","facility","both","","","","153.5","153.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OCCULT BLD FECAL SCREENIN","10001116185","CDM","301","RC","","","facility","both","","","","24","24","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SALICYLATE-UR-Q80196","10001116193","CDM","300","RC","80196","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUCOPROTEIN-BLD","10001116195","CDM","300","RC","83872","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FATTY AC FREE 82725","10001116199","CDM","300","RC","82725","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUCOPROTEIN-UR","10001116207","CDM","300","RC","83872","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOGLOB-IGD 82784","10001116217","CDM","300","RC","82784","HCPCS","facility","both","","","","335","335","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIBODY TITRATION","10001116223","CDM","300","RC","86886","HCPCS","facility","both","","","","708.5","708.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF RBC MOLECULAR PHENO T","10001116225","CDM","300","RC","86901","HCPCS","facility","both","","","","296","296","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTIBODY TITER","10001116227","CDM","300","RC","86886","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIRECTED BLOOD DONOR COLL","10001116229","CDM","300","RC","86890","HCPCS","facility","both","","","","351","351","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTIGEN SCR RGT COMPAT UN","10001116231","CDM","300","RC","86902","HCPCS","facility","both","","","","224.5","224.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTIGEN SCR PT SERUM COMP","10001116233","CDM","300","RC","86904","HCPCS","facility","both","","","","121","121","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THAWING PLASMA","10001116235","CDM","300","RC","86927","HCPCS","facility","both","","","","91","91","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THAWING CRYOPRECIPITATE","10001116237","CDM","300","RC","86927","HCPCS","facility","both","","","","47.5","47.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PREFIX RBCS INC W/CHEM/DR","10001116239","CDM","300","RC","86970","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PREFIX RBCS DENSITY GRAD","10001116241","CDM","300","RC","86972","HCPCS","facility","both","","","","307","307","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ATYPICAL AB 86870","10001116243","CDM","300","RC","86870","HCPCS","facility","both","","","","437.5","437.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENZYME ANTIBODY IDENTIFIC","10001116245","CDM","300","RC","86870","HCPCS","facility","both","","","","438","438","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AUTOLOGOUS BLOOD COLLECT","10001116247","CDM","300","RC","86890","HCPCS","facility","both","","","","384","384","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BLOOD PRODCT IRRADTN 8694","10001116249","CDM","300","RC","86945","HCPCS","facility","both","","","","159","159","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC ELUTION","10001116251","CDM","300","RC","86860","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIRECT COOMBS 86880","10001116253","CDM","300","RC","86880","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CROSS MATCH-SPIN 86920","10001116255","CDM","300","RC","86920","HCPCS","facility","both","","","","86.5","86.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CROSS MATCH-INCUBATION","10001116257","CDM","300","RC","86921","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CROSS MATCH-ANTIGLOBIN","10001116259","CDM","300","RC","86922","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXTENDED DONOR TESTING","10001116261","CDM","300","RC","86890","HCPCS","facility","both","","","","106.5","106.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABO IMMUNE ANTI 86850","10001116263","CDM","300","RC","86850","HCPCS","facility","both","","","","145.5","145.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TYPING-RH SUBGR 86906","10001116265","CDM","300","RC","86906","HCPCS","facility","both","","","","117.5","117.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABO CELL GROUP 86900","10001116269","CDM","300","RC","86900","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABO GROUP 86900","10001116271","CDM","300","RC","86900","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TYPING,RHO ONLY 86901","10001116273","CDM","300","RC","86901","HCPCS","facility","both","","","","66.5","66.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TYPING, NOT ABO 86905","10001116275","CDM","300","RC","86905","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOTYPING-EA","10001116277","CDM","300","RC","86905","HCPCS","facility","both","","","","217.5","217.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INDIRECT COOMBS 86885","10001116279","CDM","300","RC","86885","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C-PEPTIDE 84681","10001116281","CDM","300","RC","84681","HCPCS","facility","both","","","","324.5","324.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC L.E. CELL PREP 85999","10001116283","CDM","300","RC","85999","HCPCS","facility","both","","","","171","171","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALDOSTERON-RIA 82088","10001116285","CDM","300","RC","82088","HCPCS","facility","both","","","","598.5","598.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP BE ANTIBODY","10001116287","CDM","300","RC","86707","HCPCS","facility","both","","","","303.5","303.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOGLOBULINS(IGA,IGG,I","10001116293","CDM","300","RC","82784","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OCCULT BLD FECAL SCREENIN","10001116295","CDM","301","RC","","","facility","both","","","","43","43","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASPIRIN TOLER 80196","10001116297","CDM","300","RC","80196","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-DEOXY-NASE86225","10001116299","CDM","300","RC","86225","HCPCS","facility","both","","","","256.5","256.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROSTATE SAT BX,1-20 SPEC","10001116305","CDM","314","RC","","","facility","both","","","","1123","1123","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY, IG/IGD/IGG/IGM EA","10001116307","CDM","300","RC","82784","HCPCS","facility","both","","","","39","39","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VENIPUNCTURE","10001116309","CDM","300","RC","36415","HCPCS","facility","both","","","","29","29","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTOPORPHYRINES QT 84202","10001116311","CDM","301","RC","84202","HCPCS","facility","both","","","","217.5","217.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN B-2 84252","10001116315","CDM","301","RC","84252","HCPCS","facility","both","","","","143","143","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BM PANEL 80048 W/ CALCIUM","10001116317","CDM","301","RC","80048","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMP PANEL 80053 W/ CO2 &","10001116319","CDM","301","RC","80053","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RENAL FUNCTION PANEL 8006","10001116321","CDM","301","RC","80069","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPATIC PANEL 80076 W/ PR","10001116323","CDM","301","RC","80076","HCPCS","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PSA DIAGNOSTIC TOTAL","10001116325","CDM","301","RC","84153","HCPCS","facility","both","","","","91","91","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEAVY METAL QNT EACH","10001116327","CDM","301","RC","83018","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN ELECT OTHER FLUID","10001116329","CDM","301","RC","84166","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTROLYTE PANEL","10001116335","CDM","301","RC","80051","HCPCS","facility","both","","","","39","39","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIPID PROFILE 80061","10001116341","CDM","301","RC","80061","HCPCS","facility","both","","","","140.5","140.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETAMINOPHINE","10001116343","CDM","301","RC","82003","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEOTIDASE - 83915","10001116345","CDM","301","RC","83915","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREEN, URINE QL","10001116347","CDM","301","RC","80100","HCPCS","facility","both","","","","268.5","268.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URINE TESTOSTERONE TOTAL","10001116349","CDM","301","RC","84403","HCPCS","facility","both","","","","145.5","145.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROSTATE SAT BX,21-40 SPE","10001116351","CDM","314","RC","","","facility","both","","","","1764.5","1764.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMITRIPTYLENE 80152","10001116353","CDM","301","RC","80152","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LECITHIN-SPHING 83661","10001116355","CDM","301","RC","83661","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMINOPHYL LEVEL 80198","10001116357","CDM","301","RC","80198","HCPCS","facility","both","","","","118.5","118.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHOLINEST&DDIBUC 82638","10001116359","CDM","301","RC","82638","HCPCS","facility","both","","","","46.5","46.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACENTAL LACTO 83632","10001116361","CDM","301","RC","83632","HCPCS","facility","both","","","","165.5","165.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CPK ISOENZYMES82552","10001116363","CDM","301","RC","82552","HCPCS","facility","both","","","","130","130","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROLACTIN LEVEL 84146","10001116365","CDM","301","RC","84146","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESTROGEN RECEPT 84233","10001116367","CDM","301","RC","84233","HCPCS","facility","both","","","","715","715","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALCITONIN RIA 82308","10001116369","CDM","301","RC","82308","HCPCS","facility","both","","","","202.5","202.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALCOHOL METHYL 84600","10001116371","CDM","301","RC","84600","HCPCS","facility","both","","","","81","81","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIO-CONV","10001116373","CDM","301","RC","82164","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URIC ACID (URINE)","10001116375","CDM","301","RC","84560","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ZINC 84630","10001116377","CDM","301","RC","84630","HCPCS","facility","both","","","","96.5","96.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARBAMAZE 80156","10001116379","CDM","301","RC","80156","HCPCS","facility","both","","","","118.5","118.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC FOLATE","10001116381","CDM","301","RC","82747","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T-4 - FREE","10001116383","CDM","301","RC","84439","HCPCS","facility","both","","","","118.5","118.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUCOSE-UR-QT","10001116385","CDM","301","RC","82945","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMIPRAMINE 80174","10001116387","CDM","301","RC","80174","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THIAMINE","10001116389","CDM","301","RC","84425","HCPCS","facility","both","","","","109.5","109.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TOBRA PK 80200","10001116391","CDM","301","RC","80200","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TOBRA 80200","10001116393","CDM","301","RC","80200","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THEOPHYLLINE-HP 80198","10001116395","CDM","301","RC","80198","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYOGLOBIN 83874","10001116397","CDM","301","RC","83874","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOGLOBIN, FETA 83030","10001116399","CDM","301","RC","83030","HCPCS","facility","both","","","","78.5","78.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLASMA HGB","10001116401","CDM","301","RC","83051","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN ELECT 84165 SERUM","10001116403","CDM","301","RC","84165","HCPCS","facility","both","","","","139.5","139.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC QUINIDINE,BLOOD 80194","10001116405","CDM","301","RC","80194","HCPCS","facility","both","","","","145","145","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IRON SAT % 83540","10001116407","CDM","301","RC","83540","HCPCS","facility","both","","","","46.5","46.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SODIUM, URINE 84300","10001116411","CDM","301","RC","84300","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POTASSIUM-URINE 84133","10001116413","CDM","301","RC","84133","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POTASSIUM 24 HR UR 84133","10001116415","CDM","301","RC","84133","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOS-PROSTAT-AC 84066","10001116417","CDM","301","RC","84066","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOSPHATASE, AL 84075","10001116419","CDM","301","RC","84075","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOSPORUS-UR 84105","10001116421","CDM","301","RC","84105","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PORPHOBILINOG QUAL 84106","10001116423","CDM","301","RC","84106","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PORPHOBINOG - QUANT 84110","10001116425","CDM","301","RC","84110","HCPCS","facility","both","","","","98.5","98.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OSMOLARITY-UR 83935","10001116427","CDM","301","RC","83935","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACID MUCOLYSA 83864 QT","10001116429","CDM","301","RC","83864","HCPCS","facility","both","","","","161","161","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAGNESIUM-UR83735","10001116431","CDM","301","RC","83735","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MEPROBAMATE, BLD 83805","10001116433","CDM","301","RC","83805","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEAD UR-QT 83655","10001116435","CDM","301","RC","83655","HCPCS","facility","both","","","","131.5","131.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LDH, URINE 83615","10001116437","CDM","301","RC","83615","HCPCS","facility","both","","","","53","53","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYDRXYPRLN FREE 83500","10001116439","CDM","301","RC","83500","HCPCS","facility","both","","","","232","232","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALPHAIFETOPROP SERUM 8210","10001116441","CDM","301","RC","82105","HCPCS","facility","both","","","","121","121","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYDRXPRLN TOT 83505","10001116443","CDM","301","RC","83505","HCPCS","facility","both","","","","232","232","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALCIUM, IONIZE 82330","10001116445","CDM","301","RC","82330","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BICARBONATE-CO2 82374","10001116447","CDM","301","RC","82374","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACIDYL","10001116449","CDM","301","RC","82690","HCPCS","facility","both","","","","90.5","90.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYANIDE 82600","10001116451","CDM","301","RC","82600","HCPCS","facility","both","","","","130.5","130.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYSTINE,QL-UR 82615","10001116453","CDM","301","RC","82615","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYSTINE,QT-UR","10001116455","CDM","301","RC","82131","HCPCS","facility","both","","","","131.5","131.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DELTA AMINO LEV82135","10001116457","CDM","301","RC","82135","HCPCS","facility","both","","","","115.5","115.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARBOXY HBG SAT 82375 QT","10001116459","CDM","301","RC","82375","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CREATINE-URINE-24HRS.8254","10001116461","CDM","301","RC","82540","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHOLINEST SERUM 82480","10001116465","CDM","301","RC","82480","HCPCS","facility","both","","","","707","707","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROGESTERONE RECEPTOR ASS","10001116467","CDM","301","RC","84234","HCPCS","facility","both","","","","784","784","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLORIDES-CSF 82438","10001116469","CDM","301","RC","82438","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETONE-QL 82009","10001116471","CDM","301","RC","82009","HCPCS","facility","both","","","","16.5","16.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GG TRANSPEPTID 82977","10001116473","CDM","301","RC","82977","HCPCS","facility","both","","","","115.5","115.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUTETHIMIDE-BL 82980","10001116475","CDM","301","RC","82980","HCPCS","facility","both","","","","147","147","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROSTATE SAT BX,41-60 SPE","10001116477","CDM","314","RC","","","facility","both","","","","3046.5","3046.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMIKACIN PEAK/TROGH 80150","10001116479","CDM","301","RC","80150","HCPCS","facility","both","","","","113","113","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ICD-ISOCITRIC 83570","10001116481","CDM","301","RC","83570","HCPCS","facility","both","","","","53","53","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C-6-PD","10001116483","CDM","301","RC","82955","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CAROTENE 82380","10001116485","CDM","301","RC","82380","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC XYLOSE TOLERANC 84620","10001116487","CDM","301","RC","84620","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CREATINE CLEAR 82575","10001116489","CDM","301","RC","82575","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMINO ACIDS-BLD","10001116491","CDM","301","RC","82131","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRYOGLOBULIN,QUAL/SEMIQT","10001116493","CDM","301","RC","82595","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SGP TRANSAMINAS 84460","10001116495","CDM","301","RC","84460","HCPCS","facility","both","","","","53","53","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRIGLYCERIDES 84478","10001116497","CDM","301","RC","84478","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHENYLALANIE 84030","10001116499","CDM","301","RC","84030","HCPCS","facility","both","","","","76.5","76.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LDH ISOZYMES 83625","10001116501","CDM","301","RC","83625","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CERULOPLASMIN,Q82390","10001116505","CDM","301","RC","82390","HCPCS","facility","both","","","","115.5","115.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTROPHOR-HGB83020","10001116507","CDM","301","RC","83020","HCPCS","facility","both","","","","121","121","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALDOLASE 82085","10001116511","CDM","301","RC","82085","HCPCS","facility","both","","","","53","53","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASES PCO2 82803","10001116515","CDM","301","RC","82803","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASES, PO2 82803","10001116517","CDM","301","RC","82803","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ART BLOOD GASES 82803","10001116519","CDM","301","RC","82803","HCPCS","facility","both","","","","195","195","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BILIRUBIN,DIREC82250","10001116521","CDM","301","RC","82248","HCPCS","facility","both","","","","43","43","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALBUMIN SERUM 82040","10001116523","CDM","301","RC","82040","HCPCS","facility","both","","","","35.5","35.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DILANTIN,QT 80185","10001116525","CDM","301","RC","80185","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OSMOLALITY-BLD 83930","10001116527","CDM","301","RC","83930","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CREATININE-UR OR OTHR SOU","10001116529","CDM","301","RC","82570","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HDL LIPOPROTEIN 83718","10001116531","CDM","301","RC","83718","HCPCS","facility","both","","","","127","127","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CK MB 82553","10001116533","CDM","301","RC","82553","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LITHIUM-BLOOD 80178","10001116535","CDM","301","RC","80178","HCPCS","facility","both","","","","39.5","39.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMYLASE-BLD 82150","10001116537","CDM","301","RC","82150","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN C 82180","10001116539","CDM","301","RC","82180","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETONE-QT 82010","10001116541","CDM","301","RC","82010","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALCOHOL-ETHYL 82055","10001116543","CDM","301","RC","82055","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BILIRUBIN,TOTA","10001116545","CDM","301","RC","82247","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC METAL SCREEN 83015","10001116547","CDM","301","RC","83015","HCPCS","facility","both","","","","90.5","90.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEUCINE AMINOPE 83670","10001116549","CDM","301","RC","83670","HCPCS","facility","both","","","","89.5","89.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIDOCAINE 80176","10001116551","CDM","301","RC","80176","HCPCS","facility","both","","","","101.5","101.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LDH 83615","10001116553","CDM","301","RC","83615","HCPCS","facility","both","","","","76.5","76.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SGO TRANSAMINAS 84450","10001116555","CDM","301","RC","84450","HCPCS","facility","both","","","","53","53","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NORTRIPTYLINE 80182","10001116557","CDM","301","RC","80182","HCPCS","facility","both","","","","135","135","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALCIUM-BLD 82310","10001116559","CDM","301","RC","82310","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLORIDES-BLD 82435","10001116563","CDM","301","RC","82435","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALDOSTERONE 82088","10001116565","CDM","301","RC","82088","HCPCS","facility","both","","","","211.5","211.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHOLESTEROL,TOT 82465","10001116567","CDM","301","RC","82465","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COPPER 82525","10001116571","CDM","301","RC","82525","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CREATININE-BLD 82565","10001116573","CDM","301","RC","82565","HCPCS","facility","both","","","","61.5","61.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYSTINE, QT BLD 82131","10001116575","CDM","301","RC","82131","HCPCS","facility","both","","","","131.5","131.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN A QUAN 84590","10001116579","CDM","301","RC","84590","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HB-METH, SULF, ET 83050","10001116581","CDM","301","RC","83050","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LACTIC AC BLD=Q 83605","10001116583","CDM","301","RC","83605","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIPASE-BLD 83690","10001116585","CDM","301","RC","83690","HCPCS","facility","both","","","","50.5","50.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAGNESIUM-BLD 83735","10001116587","CDM","301","RC","83735","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOSPHORUS BLD 84100","10001116589","CDM","301","RC","84100","HCPCS","facility","both","","","","35.5","35.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PH","10001116591","CDM","301","RC","82800","HCPCS","facility","both","","","","24.5","24.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POTASSIUM-BLD 84132","10001116593","CDM","301","RC","84132","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALK PHOS ISOENZ 84080","10001116595","CDM","301","RC","84080","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC METHANESPHRINES 83835","10001116597","CDM","301","RC","83835","HCPCS","facility","both","","","","130.5","130.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMMONIA 82140","10001116599","CDM","301","RC","82140","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SODIUM-BLD 84295","10001116601","CDM","301","RC","84295","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GTT-EACH ADD SP 82952","10001116605","CDM","301","RC","82952","HCPCS","facility","both","","","","29.5","29.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN, TOTAL 84155 SERU","10001116609","CDM","301","RC","84155","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN E ASSAY 84446","10001116611","CDM","301","RC","84446","HCPCS","facility","both","","","","131.5","131.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UREA NITROGEN 84520 QUANT","10001116613","CDM","301","RC","84520","HCPCS","facility","both","","","","42.5","42.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UREA CLEARANCE 84545","10001116615","CDM","301","RC","84545","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URIC ACID - BLD 84550","10001116617","CDM","301","RC","84550","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T-3 UPTAKE 84479","10001116619","CDM","301","RC","84479","HCPCS","facility","both","","","","106.5","106.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OCCULT BLOOD 82270 3 CARD","10001116621","CDM","301","RC","82270","HCPCS","facility","both","","","","24","24","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROSTATE SAT BX, >60 SPEC","10001116623","CDM","314","RC","","","facility","both","","","","3688.5","3688.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRYPSIN, QUAL 84488","10001116625","CDM","301","RC","84488","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UROBLINO-FEC 84577 QUANT","10001116627","CDM","301","RC","84577","HCPCS","facility","both","","","","90.5","90.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRYPSIN, SEMI 84490 QT","10001116629","CDM","301","RC","84490","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HISTAMINE 83088","10001116631","CDM","301","RC","83088","HCPCS","facility","both","","","","337","337","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACTH 82024","10001116633","CDM","301","RC","82024","HCPCS","facility","both","","","","286","286","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FERRITIN ASSAY 82728","10001116635","CDM","301","RC","82728","HCPCS","facility","both","","","","127","127","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CATECHOLAMINES BLOOD 8238","10001116637","CDM","301","RC","82383","HCPCS","facility","both","","","","241.5","241.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VMA 84585","10001116639","CDM","301","RC","84585","HCPCS","facility","both","","","","163.5","163.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HOMOVANILIC ACI 83150","10001116641","CDM","301","RC","83150","HCPCS","facility","both","","","","216","216","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC 17-HYDROXYCORT","10001116643","CDM","301","RC","83491","HCPCS","facility","both","","","","84.5","84.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KETOSTEROIDS 17 TOTAL","10001116645","CDM","301","RC","83586","HCPCS","facility","both","","","","148.5","148.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HAPTOGLOBIN 83010 QT","10001116647","CDM","301","RC","83010","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESTROGEN,TOTAL 82672","10001116649","CDM","301","RC","82672","HCPCS","facility","both","","","","148.5","148.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BENZODIAZEPINE 80154","10001116651","CDM","301","RC","80154","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHENCYCLIDINE","10001116653","CDM","301","RC","83992","HCPCS","facility","both","","","","109","109","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARBON MONOXIDES QUANT 82","10001116655","CDM","301","RC","82375","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ARSENIC 82175","10001116657","CDM","301","RC","82175","HCPCS","facility","both","","","","171","171","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRONESTYL LEVEL 80190","10001116659","CDM","301","RC","80190","HCPCS","facility","both","","","","130.5","130.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC N-ACETYL PROCAINAMIDE 801","10001116661","CDM","301","RC","80192","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CATECHOLAMINES FRECTIONAT","10001116663","CDM","301","RC","82384","HCPCS","facility","both","","","","310","310","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOGLOBIN GYLC 83036","10001116665","CDM","301","RC","83036","HCPCS","facility","both","","","","89.5","89.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PREGNANETRIOL 84138","10001116667","CDM","301","RC","84138","HCPCS","facility","both","","","","84.5","84.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PREGNANEDIOL QU 84135","10001116671","CDM","301","RC","84135","HCPCS","facility","both","","","","84.5","84.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HCG QUAL -- SPECIAL 89630","10001116673","CDM","301","RC","84703","HCPCS","facility","both","","","","86.5","86.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IRON, TOTAL BIND 83550","10001116675","CDM","301","RC","83550","HCPCS","facility","both","","","","61.5","61.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SALICYLATE-BLD 80196","10001116677","CDM","301","RC","80196","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IRON, TOTAL-BLD 83540","10001116679","CDM","301","RC","83540","HCPCS","facility","both","","","","37","37","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CATECHOLAMINES TOT URINE","10001116681","CDM","301","RC","82382","HCPCS","facility","both","","","","134.5","134.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEAD BLD-QT 83655","10001116683","CDM","301","RC","83655","HCPCS","facility","both","","","","134.5","134.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC 5-HIAA QT 83497","10001116685","CDM","301","RC","83497","HCPCS","facility","both","","","","99","99","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALCIUM TOLER 82331","10001116687","CDM","301","RC","82331","HCPCS","facility","both","","","","203","203","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OXALATE (URINE) 83945","10001116691","CDM","301","RC","83945","HCPCS","facility","both","","","","131","131","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IRON UNSAT BNG 83550","10001116693","CDM","301","RC","83550","HCPCS","facility","both","","","","43","43","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FATTY AC FREE Q 82725","10001116695","CDM","301","RC","82725","HCPCS","facility","both","","","","134.5","134.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFERRIN 86329","10001116697","CDM","301","RC","84466","HCPCS","facility","both","","","","101.5","101.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNO-IGG-CSF 82784","10001116699","CDM","301","RC","82784","HCPCS","facility","both","","","","113","113","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ORINASE TOLER 82953","10001116701","CDM","301","RC","82953","HCPCS","facility","both","","","","84.5","84.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUCOSE-CSF-QT","10001116703","CDM","301","RC","82945","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COPPER,URINE 82525","10001116705","CDM","301","RC","82525","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALCIUM-FECES 82310","10001116707","CDM","301","RC","82310","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FECAL FAT QUAL.","10001116709","CDM","301","RC","82705","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IGA, IGG, IGM-QT EACH 827","10001116711","CDM","301","RC","82784","HCPCS","facility","both","","","","195","195","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUTETHIMIDE-UR 82980","10001116713","CDM","301","RC","82980","HCPCS","facility","both","","","","147","147","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAPROBAMATE, UR 83805","10001116715","CDM","301","RC","83805","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UROBILINOGUR-UR-QUAL 8457","10001116717","CDM","301","RC","84578","HCPCS","facility","both","","","","90.5","90.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UROPORPHYRINS-QUANT 84120","10001116719","CDM","301","RC","84120","HCPCS","facility","both","","","","101.5","101.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNNGLOB-IGD 82784","10001116725","CDM","301","RC","82784","HCPCS","facility","both","","","","139.5","139.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IGE-QUANT 82785","10001116727","CDM","301","RC","82785","HCPCS","facility","both","","","","130.5","130.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYSOLINE LEVEL 80188","10001116729","CDM","301","RC","80188","HCPCS","facility","both","","","","111.5","111.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FAT, FECAL, TOTAL 82710QT","10001116731","CDM","301","RC","82710","HCPCS","facility","both","","","","131.5","131.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTROPHOR-CSF84165","10001116733","CDM","301","RC","84166","HCPCS","facility","both","","","","79","79","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN B-12 82607","10001116737","CDM","301","RC","82607","HCPCS","facility","both","","","","86.5","86.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN B-6 NPYR 84207","10001116741","CDM","301","RC","84207","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FOLIC ACID SER 82746","10001116743","CDM","301","RC","82746","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LACTOSE TOL EA 82952","10001116745","CDM","301","RC","82952","HCPCS","facility","both","","","","29.5","29.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYELIN BASIC PROTIEN-CSF","10001116747","CDM","301","RC","83873","HCPCS","facility","both","","","","218.5","218.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ERYTHROPOETIN 82668","10001116749","CDM","301","RC","82668","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CEA 82378","10001116751","CDM","301","RC","82378","HCPCS","facility","both","","","","109.5","109.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESTRADIOL BY RI82670","10001116753","CDM","301","RC","82670","HCPCS","facility","both","","","","180","180","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLASMA SEROTONIN 84260","10001116755","CDM","301","RC","84260","HCPCS","facility","both","","","","231.5","231.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TESTOSTERONE TOTAL 84403","10001116757","CDM","301","RC","84403","HCPCS","facility","both","","","","147","147","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BLOOD DIGOXIN 80162","10001116759","CDM","301","RC","80162","HCPCS","facility","both","","","","294","294","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASTTRI BY RIA 82941","10001116761","CDM","301","RC","82941","HCPCS","facility","both","","","","115.5","115.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSULIN LEVEL - TOTAL 835","10001116763","CDM","301","RC","83525","HCPCS","facility","both","","","","145","145","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC L-H BY RIA 83002","10001116765","CDM","301","RC","83002","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RENIN BY LEVEL 84244","10001116767","CDM","301","RC","84244","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CORTISOL PLASMA TOTAL 825","10001116769","CDM","301","RC","82533","HCPCS","facility","both","","","","109","109","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T-4 BY RIA","10001116771","CDM","301","RC","84436","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GROWTH HORMONE 83003","10001116775","CDM","301","RC","83003","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANDROSTENDIONE82157","10001116777","CDM","301","RC","82157","HCPCS","facility","both","","","","248.5","248.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TSH BY RIA 84443","10001116779","CDM","301","RC","84443","HCPCS","facility","both","","","","139.5","139.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PTH BY RIA 83970","10001116781","CDM","301","RC","83970","HCPCS","facility","both","","","","300.5","300.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACID PHOS RIA 84060","10001116783","CDM","301","RC","84060","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THY BNG GLOB - R 84442","10001116785","CDM","301","RC","84442","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THY BNG GLOB - R 84442","10001116787","CDM","301","RC","84442","HCPCS","facility","both","","","","145","145","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-GAMMA GLOB","10001116789","CDM","301","RC","82784","HCPCS","facility","both","","","","195","195","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRYFIBRINOGEN 82585","10001116791","CDM","301","RC","82585","HCPCS","facility","both","","","","24","24","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STONE XRAY DIFF 82370","10001116793","CDM","301","RC","82370","HCPCS","facility","both","","","","129","129","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FAT STAIN QT","10001116795","CDM","301","RC","82715","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PH, REACTION 83986","10001116797","CDM","301","RC","83986","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOSIDERIN QUAL 83070","10001116799","CDM","301","RC","83070","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OCCULT BLOOD 82273","10001116801","CDM","301","RC","82271","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DAU SCREEN QL","10001116803","CDM","301","RC","80100","HCPCS","facility","both","","","","217.5","217.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYME INDEX CSF*","10001116805","CDM","301","RC","82040","HCPCS","facility","both","","","","47.5","47.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRYPTASE","10001116807","CDM","301","RC","83520","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BOTULINUM TOXIN A AB","10001116809","CDM","301","RC","84182","HCPCS","facility","both","","","","746.5","746.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYCLOSPORIN","10001116811","CDM","301","RC","80158","HCPCS","facility","both","","","","282.5","282.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CMV QUAL PCR","10001116813","CDM","301","RC","87910","HCPCS","facility","both","","","","436.5","436.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN B-2 84252","10001116815","CDM","301","RC","84252","HCPCS","facility","both","","","","324.5","324.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BARBITURATE SCREEN 80101","10001116817","CDM","301","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC JAK2 MUTATION*","10001116821","CDM","301","RC","81270","HCPCS","facility","both","","","","861.5","861.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HLA TYPING CELIAC DISEASE","10001116823","CDM","301","RC","81376","HCPCS","facility","both","","","","1742.5","1742.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LAMATRIGINE","10001116825","CDM","301","RC","80299","HCPCS","facility","both","","","","66.5","66.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARIETAL CELL ANTIBODY","10001116827","CDM","301","RC","83516","HCPCS","facility","both","","","","61.5","61.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TISSUE TRANSGLUTIMANASE","10001116829","CDM","301","RC","83516","HCPCS","facility","both","","","","195","195","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THYRIOD STIM IMMUNOGLOB T","10001116831","CDM","301","RC","84445","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MICROALBUMIN (URINE)*","10001116833","CDM","301","RC","82043","HCPCS","facility","both","","","","123.5","123.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC METHAQUALONE","10001116835","CDM","301","RC","82542","HCPCS","facility","both","","","","87","87","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPIATE SCREEN URINE","10001116837","CDM","301","RC","","","facility","both","","","","114","114","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC S505 MUTATION ANALYSIS*","10001116839","CDM","301","RC","81402","HCPCS","facility","both","","","","887.5","887.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TAMOXIFEN P450*","10001116841","CDM","301","RC","81226","HCPCS","facility","both","","","","984","984","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP C VIRUS FIBROSURE*","10001116843","CDM","301","RC","82172","HCPCS","facility","both","","","","417","417","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEOCOMP PARANEOPLASTIC PR","10001116845","CDM","301","RC","84181","HCPCS","facility","both","","","","5930","5930","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAGUIDE 5FU","10001116847","CDM","301","RC","81479","HCPCS","facility","both","","","","2701.5","2701.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTHROMBIN GENE ANALYSIS","10001116849","CDM","301","RC","81240","HCPCS","facility","both","","","","148","148","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI MULLERIAN ASSESSR TM","10001116851","CDM","301","RC","83520","HCPCS","facility","both","","","","230","230","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BM PANEL 80048 W/CALCIUM","10001116853","CDM","301","RC","80048","HCPCS","facility","both","","","","233","233","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHYLOMICRONS (FLUID)","10001116855","CDM","301","RC","82664","HCPCS","facility","both","","","","262.5","262.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMP PANEL 80053 W/CO2&AL","10001116857","CDM","301","RC","80053","HCPCS","facility","both","","","","273","273","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALPHA GLOBIN GENE SEQ*","10001116859","CDM","301","RC","81479","HCPCS","facility","both","","","","98.5","98.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN 14 CSF","10001116861","CDM","301","RC","82397","HCPCS","facility","both","","","","240","240","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIPOPROFILE NMR*","10001116863","CDM","301","RC","83704","HCPCS","facility","both","","","","244.5","244.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INHIBIN B","10001116865","CDM","301","RC","83520","HCPCS","facility","both","","","","273","273","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NASH FIBROSURE*","10001116867","CDM","301","RC","82947","HCPCS","facility","both","","","","729","729","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SULFATIDE ANTIBODY TEST","10001116869","CDM","301","RC","83520","HCPCS","facility","both","","","","814","814","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RENAL FNCTNPANEL 80069","10001116871","CDM","301","RC","80069","HCPCS","facility","both","","","","217.5","217.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FUNGITEL(R)(1-3) BDGLUCAN","10001116873","CDM","301","RC","84311","HCPCS","facility","both","","","","528.5","528.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VOLTAGE GATED CALCIUM CHN","10001116875","CDM","301","RC","83519","HCPCS","facility","both","","","","229.5","229.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIGITOXIN","10001116877","CDM","301","RC","83520","HCPCS","facility","both","","","","67","67","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ETHYLENE GLYCOL, BLOOD","10001116879","CDM","301","RC","82693","HCPCS","facility","both","","","","51.5","51.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPATIC PANEL 80076 W/PRO","10001116881","CDM","301","RC","80076","HCPCS","facility","both","","","","215","215","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARNITINE TOTAL","10001116883","CDM","301","RC","82131","HCPCS","facility","both","","","","142.5","142.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARNITINE FREE","10001116885","CDM","301","RC","82131","HCPCS","facility","both","","","","142.5","142.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FENTANYL","10001116887","CDM","301","RC","","","facility","both","","","","310","310","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADMARK TAU, CSF","10001116889","CDM","301","RC","83520","HCPCS","facility","both","","","","2175","2175","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG ABUSE SCREEN, MECONI","10001116891","CDM","301","RC","","","facility","both","","","","151","151","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRICYCLICS (GEN) G0431","10001116893","CDM","301","RC","","","facility","both","","","","574","574","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHENYTOIN FREE","10001116897","CDM","301","RC","80186","HCPCS","facility","both","","","","153.5","153.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TACROLIMUS","10001116899","CDM","301","RC","80197","HCPCS","facility","both","","","","440.5","440.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GABAPENTIN","10001116901","CDM","301","RC","80299","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMIODARONE","10001116903","CDM","301","RC","80299","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY, DRUG","10001116905","CDM","301","RC","80299","HCPCS","facility","both","","","","57.5","57.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CAFFEINE","10001116907","CDM","301","RC","80299","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOMIPRAMINE LEVEL","10001116909","CDM","301","RC","82482","HCPCS","facility","both","","","","106.5","106.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESMETHYCLOMIPROMINE LEVE","10001116911","CDM","301","RC","80299","HCPCS","facility","both","","","","106.5","106.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SIROLIMUS","10001116913","CDM","301","RC","80299","HCPCS","facility","both","","","","268.5","268.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEVETIRACETAM","10001116915","CDM","301","RC","80299","HCPCS","facility","both","","","","151.5","151.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BETA HYDROXYBUTYRATE","10001116917","CDM","301","RC","82010","HCPCS","facility","both","","","","161","161","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALPHA 1 ANTRYPSIN PHENOTY","10001116919","CDM","301","RC","82104","HCPCS","facility","both","","","","64.5","64.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AFP AMNIO FLUID*","10001116921","CDM","301","RC","82106","HCPCS","facility","both","","","","57.5","57.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALUMINUM WHOLE BLOOD","10001116923","CDM","301","RC","82108","HCPCS","facility","both","","","","167.5","167.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMINO ACIDS-QUANT","10001116925","CDM","301","RC","82139","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BETAMICROGLOBULIN URINE","10001116927","CDM","301","RC","82232","HCPCS","facility","both","","","","47.5","47.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC B2 MICROGLOBULIN BLD","10001116929","CDM","301","RC","82232","HCPCS","facility","both","","","","47.5","47.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRAIN NATRIURETIC PEPTIDE","10001116931","CDM","301","RC","83880","HCPCS","facility","both","","","","572.5","572.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI GLIADIN 1ST","10001116933","CDM","301","RC","83520","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI GLIADIN 2ND","10001116935","CDM","301","RC","83520","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OXYCODONE CONFIRMATION","10001116937","CDM","301","RC","80102","HCPCS","facility","both","","","","385.5","385.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIPROPROTEIN","10001116939","CDM","301","RC","82172","HCPCS","facility","both","","","","86.5","86.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APOLIPOPROTEIN A","10001116941","CDM","301","RC","82172","HCPCS","facility","both","","","","86.5","86.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APOLIPOPROTEIN B","10001116943","CDM","301","RC","82172","HCPCS","facility","both","","","","86.5","86.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BILE ACIDS","10001116945","CDM","301","RC","82239","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMOGRANIN A","10001116947","CDM","301","RC","82397","HCPCS","facility","both","","","","196.5","196.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLORIDE - URINE 82436","10001116949","CDM","301","RC","82436","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HOMOCYSTINE, QUAN.","10001116951","CDM","301","RC","83090","HCPCS","facility","both","","","","390","390","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALCITONIN","10001116953","CDM","301","RC","82308","HCPCS","facility","both","","","","411","411","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROZAC (FLUOXETINE)","10001116955","CDM","301","RC","82742","HCPCS","facility","both","","","","329","329","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FREE PSA","10001116957","CDM","301","RC","84154","HCPCS","facility","both","","","","256","256","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PSA DIAGNOSTIC TOTAL","10001116959","CDM","301","RC","84153","HCPCS","facility","both","","","","256","256","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC METHYLMALONIC QT","10001116961","CDM","301","RC","83921","HCPCS","facility","both","","","","147","147","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THIOPURINE METABOLITES 6T","10001116963","CDM","301","RC","82492","HCPCS","facility","both","","","","735","735","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMIUM SERUM","10001116965","CDM","301","RC","82495","HCPCS","facility","both","","","","87.5","87.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COLLAGEN CROSS LINK","10001116967","CDM","301","RC","82523","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROHYPNOL","10001116969","CDM","301","RC","82542","HCPCS","facility","both","","","","265.5","265.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COLLAGEN CROSS LINK OTHER","10001116971","CDM","301","RC","82570","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VIT B12 UNSAT. BNDNG CAPA","10001116973","CDM","301","RC","82608","HCPCS","facility","both","","","","67","67","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DHEA-S","10001116975","CDM","301","RC","82627","HCPCS","facility","both","","","","43.5","43.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYDROCODONE LEVEL URINE","10001116977","CDM","301","RC","82646","HCPCS","facility","both","","","","212.5","212.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYDROMORPONE, UR","10001116979","CDM","301","RC","82649","HCPCS","facility","both","","","","130","130","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIHYDROTESTOSTERONE","10001116981","CDM","301","RC","82651","HCPCS","facility","both","","","","113","113","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADENOSINE DEAMINASE BLOOD","10001116983","CDM","301","RC","84311","HCPCS","facility","both","","","","220","220","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TPMT ENZYME ACTIVITY","10001116985","CDM","301","RC","82657","HCPCS","facility","both","","","","718","718","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTROPHORETIC TECHNIQUE","10001116987","CDM","301","RC","82664","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESTRONE","10001116989","CDM","301","RC","82679","HCPCS","facility","both","","","","222","222","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FETAL FIBRONECTIN  82731","10001116991","CDM","301","RC","82731","HCPCS","facility","both","","","","790.5","790.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOGLOBULIN M QT REF","10001116993","CDM","301","RC","82784","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOGLOBULIN SUBCLASSES","10001116995","CDM","301","RC","82787","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUCAGON","10001116999","CDM","301","RC","82943","HCPCS","facility","both","","","","76.5","76.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FRUCTOSAMINE","10001117001","CDM","301","RC","82985","HCPCS","facility","both","","","","42.5","42.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COBALT SERUM/PLASMA QT","10001117003","CDM","301","RC","83018","HCPCS","facility","both","","","","117.5","117.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC 17-HYDROXYPROGESTERONE","10001117005","CDM","301","RC","83498","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOMIC ONCOTYPE DX TEST","10001117007","CDM","301","RC","84999","HCPCS","facility","both","","","","6260.5","6260.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HISTINE ANTIBODY","10001117009","CDM","301","RC","83516","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PTH-RELATED PROTEIN","10001117011","CDM","301","RC","83519","HCPCS","facility","both","","","","248.5","248.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRYPSIN IMMUNOASSAY","10001117013","CDM","301","RC","83519","HCPCS","facility","both","","","","276.5","276.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRYPSINOGEN IMMUNOASSAY","10001117015","CDM","301","RC","83519","HCPCS","facility","both","","","","325.5","325.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUTAMIC ACID DECARBOXYLA","10001117017","CDM","301","RC","83519","HCPCS","facility","both","","","","164.5","164.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI GMB ANTIBODY","10001117019","CDM","301","RC","83520","HCPCS","facility","both","","","","193","193","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GANGLIOSIDE GM1 FIRST","10001117021","CDM","301","RC","83520","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GANGLIOSIDE GM1 SECOND","10001117023","CDM","301","RC","83520","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETYLCHOLINE BLOCKING AB","10001117025","CDM","301","RC","83519","HCPCS","facility","both","","","","127","127","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETYLCHOLINE MODULATING","10001117027","CDM","301","RC","83519","HCPCS","facility","both","","","","127","127","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSULIN FREE","10001117029","CDM","301","RC","83527","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LACTOFERRIN, STOOL","10001117031","CDM","301","RC","83630","HCPCS","facility","both","","","","178.5","178.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VAP CHOLESTOROL","10001117033","CDM","301","RC","83701","HCPCS","facility","both","","","","58.5","58.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GONADOTROPIN RELEASING HO","10001117035","CDM","301","RC","83727","HCPCS","facility","both","","","","824","824","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MANGANES LEVEL","10001117037","CDM","301","RC","83785","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYPOGLYCEMIC PANEL","10001117039","CDM","301","RC","83788","HCPCS","facility","both","","","","471.5","471.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC METHODONE LEVEL URINE","10001117041","CDM","301","RC","83840","HCPCS","facility","both","","","","543","543","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C1 ESTERRASE INHIBITION","10001117043","CDM","301","RC","83883","HCPCS","facility","both","","","","90.5","90.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FREE LIGHT CHAINS UR","10001117045","CDM","301","RC","83883","HCPCS","facility","both","","","","71.5","71.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FREE LIGHT CHAINS BL","10001117047","CDM","301","RC","83883","HCPCS","facility","both","","","","71.5","71.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEIC ACID EXTRACTION*","10001117049","CDM","301","RC","81479","HCPCS","facility","both","","","","451","451","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOLECULAR DX ENZYME DIGES","10001117051","CDM","301","RC","81479","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOLECULAR DX ENZYME DIGES","10001117053","CDM","301","RC","81479","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEIC ACID PROBE 1","10001117055","CDM","301","RC","81479","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEIC ACID PROBE 2","10001117057","CDM","301","RC","81479","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEIC ACID PROBE 3","10001117059","CDM","301","RC","81479","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEIC ACID PROBE 4","10001117061","CDM","301","RC","81479","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEIC ACID AMPLIFICATIO","10001117063","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEIC ACID AMPLIFICATIO","10001117065","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WARFARIN SENSITIVITY DETE","10001117067","CDM","301","RC","83900","HCPCS","facility","both","","","","726.5","726.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOCHROMATOSIS DNA/MUTAT","10001117069","CDM","301","RC","81256","HCPCS","facility","both","","","","498.5","498.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTHROMBIN GENE INTERPRE","10001117071","CDM","301","RC","81240","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MORPHINE","10001117073","CDM","301","RC","83925","HCPCS","facility","both","","","","340","340","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OSTEOCALCIN","10001117075","CDM","301","RC","83937","HCPCS","facility","both","","","","117.5","117.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE SPECIFIC ALKPHOS","10001117077","CDM","301","RC","84075","HCPCS","facility","both","","","","81","81","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PREALBUMIN  84134","10001117079","CDM","301","RC","84134","HCPCS","facility","both","","","","179.5","179.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYCLIC CITRULLIN PEPTIDE","10001117081","CDM","301","RC","84140","HCPCS","facility","both","","","","310.5","310.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROINSULIN","10001117085","CDM","301","RC","84206","HCPCS","facility","both","","","","238","238","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMNISURE PLACENTAL A1 MIC","10001117087","CDM","301","RC","84112","HCPCS","facility","both","","","","242.5","242.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETYLCHOLINE RECEPTOR AN","10001117089","CDM","301","RC","84238","HCPCS","facility","both","","","","127","127","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELENIUM LEVEL","10001117091","CDM","301","RC","84255","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SEX HORMONE BINDING GLOBU","10001117093","CDM","301","RC","84270","HCPCS","facility","both","","","","98.5","98.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADENOSINE DEAMINASE FLUID","10001117095","CDM","301","RC","84311","HCPCS","facility","both","","","","1373.5","1373.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FECAL REDUCING SUBSTANCE","10001117097","CDM","301","RC","84376","HCPCS","facility","both","","","","42.5","42.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLYCOMARK","10001117099","CDM","301","RC","84378","HCPCS","facility","both","","","","95.5","95.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T3-FREE","10001117101","CDM","301","RC","84481","HCPCS","facility","both","","","","34.5","34.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T3 REVERSE","10001117103","CDM","301","RC","84482","HCPCS","facility","both","","","","145.5","145.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TROPONIN-I QUANT 84484","10001117105","CDM","301","RC","84484","HCPCS","facility","both","","","","233","233","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UREA NITROGEN URINE","10001117107","CDM","301","RC","84540","HCPCS","facility","both","","","","101.5","101.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ARGININE VASPORESSIN","10001117109","CDM","301","RC","84588","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NIACIN","10001117111","CDM","301","RC","84591","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTROLYTE PANEL","10001117117","CDM","301","RC","80051","HCPCS","facility","both","","","","209","209","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIPID PROFILE 80061","10001117123","CDM","301","RC","80061","HCPCS","facility","both","","","","383.5","383.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETAMINOPHINE","10001117125","CDM","301","RC","82003","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VIP","10001117127","CDM","301","RC","84586","HCPCS","facility","both","","","","267.5","267.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ERYTHROPOIETIN","10001117129","CDM","301","RC","82668","HCPCS","facility","both","","","","414.5","414.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KLONOPIN","10001117131","CDM","301","RC","80154","HCPCS","facility","both","","","","244.5","244.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEOTIDASE-5 83915","10001117133","CDM","301","RC","83915","HCPCS","facility","both","","","","233.5","233.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREEN,URINE","10001117135","CDM","301","RC","80100","HCPCS","facility","both","","","","648.5","648.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TESTOSTERONE FREE","10001117137","CDM","301","RC","84402","HCPCS","facility","both","","","","394.5","394.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URINE TESTOSTERONE TOTAL","10001117139","CDM","301","RC","84403","HCPCS","facility","both","","","","394.5","394.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRO-PREDICTR METABLITES*","10001117141","CDM","301","RC","80299","HCPCS","facility","both","","","","845.5","845.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BARBITURATE SCREEN G0431","10001117143","CDM","301","RC","","","facility","both","","","","142.5","142.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMITRIPTYLENE 80152","10001117145","CDM","301","RC","80152","HCPCS","facility","both","","","","298.5","298.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESTRIOL 82677","10001117147","CDM","301","RC","82677","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LECITHIN-SPHING 83661","10001117149","CDM","301","RC","83661","HCPCS","facility","both","","","","481","481","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMINOPHYL LEVEL 80198","10001117151","CDM","301","RC","80198","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DDIBUC 82638","10001117153","CDM","301","RC","82638","HCPCS","facility","both","","","","151.5","151.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXTROGEN-FRACTIONATED 826","10001117155","CDM","301","RC","82671","HCPCS","facility","both","","","","432","432","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOTENSION CSF 82164","10001117157","CDM","301","RC","82164","HCPCS","facility","both","","","","331","331","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACENTAL LACTO 83632","10001117159","CDM","301","RC","83632","HCPCS","facility","both","","","","400.5","400.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CPK ISOENZYMES 82552","10001117161","CDM","301","RC","82552","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROLACTIN LEVEL 84146","10001117163","CDM","301","RC","84146","HCPCS","facility","both","","","","402.5","402.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C-PEPTIDE 84681","10001117165","CDM","301","RC","84681","HCPCS","facility","both","","","","324.5","324.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALCOHOL METHYL 84600","10001117169","CDM","301","RC","84600","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-SM MUSCLE","10001117171","CDM","301","RC","83516","HCPCS","facility","both","","","","298.5","298.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIO-CONV BLD","10001117173","CDM","301","RC","82164","HCPCS","facility","both","","","","331","331","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CSF OLIG BANDIN 83916","10001117175","CDM","301","RC","83916","HCPCS","facility","both","","","","478.5","478.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN D, 25-HYDROXY","10001117177","CDM","301","RC","82306","HCPCS","facility","both","","","","578.5","578.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CATHARTIC LAXATIVE PROFIL","10001117179","CDM","301","RC","82489","HCPCS","facility","both","","","","416","416","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URIC ACID (URINE)","10001117181","CDM","301","RC","84560","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN D,1,25-DIHYDROXY","10001117183","CDM","301","RC","82652","HCPCS","facility","both","","","","775.5","775.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ZINC  84630","10001117185","CDM","301","RC","84630","HCPCS","facility","both","","","","235.5","235.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARBAMAZE 80156","10001117187","CDM","301","RC","80156","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHYMOPAPAI","10001117189","CDM","301","RC","83520","HCPCS","facility","both","","","","420","420","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DISOPYRAM 80299","10001117191","CDM","301","RC","80299","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC FOLATE","10001117193","CDM","301","RC","82747","HCPCS","facility","both","","","","218.5","218.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T - 4 - FREE","10001117195","CDM","301","RC","84439","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THYROGLOBULIN 84432","10001117197","CDM","301","RC","84432","HCPCS","facility","both","","","","263.5","263.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PH CORD BLOOD 82800","10001117199","CDM","301","RC","82800","HCPCS","facility","both","","","","135","135","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUCOSE;24 HR UR","10001117201","CDM","301","RC","82945","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMIPRAMINE 80174","10001117203","CDM","301","RC","80174","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THIAMINE","10001117205","CDM","301","RC","84425","HCPCS","facility","both","","","","300.5","300.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TOBRAMYCIN PEAK","10001117207","CDM","301","RC","80200","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TOBRAMYCIN THROUGH","10001117209","CDM","301","RC","80200","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THEOPHYLLINE-HP 80198","10001117211","CDM","301","RC","80198","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VALIUM","10001117213","CDM","301","RC","80154","HCPCS","facility","both","","","","292.5","292.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ZOLOFT","10001117215","CDM","301","RC","80299","HCPCS","facility","both","","","","294.5","294.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PYRUVIC ACID 84210","10001117217","CDM","301","RC","84210","HCPCS","facility","both","","","","249","249","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYOGLOBIN 83874","10001117219","CDM","301","RC","83874","HCPCS","facility","both","","","","168","168","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOGLOBIN,FETA 83030","10001117221","CDM","301","RC","83030","HCPCS","facility","both","","","","192","192","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TOT PROTIEN-UR 84156","10001117223","CDM","301","RC","84156","HCPCS","facility","both","","","","98.5","98.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLASMA HGB","10001117225","CDM","301","RC","83051","HCPCS","facility","both","","","","203","203","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LORAZEPAM","10001117227","CDM","301","RC","80154","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN ELECT 84165 UR","10001117229","CDM","301","RC","84166","HCPCS","facility","both","","","","335","335","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESIMPRAMINE 80160","10001117231","CDM","301","RC","80160","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC QUINIDINE,BLOOD 80194","10001117233","CDM","301","RC","80194","HCPCS","facility","both","","","","351","351","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IRON SAT % 83540","10001117235","CDM","301","RC","83540","HCPCS","facility","both","","","","114.5","114.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LAC BL SET 82951","10001117237","CDM","301","RC","82951","HCPCS","facility","both","","","","131.5","131.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SODIUM, URINE 84300","10001117239","CDM","301","RC","84300","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SODIUM, 24 HR UR 84300","10001117241","CDM","301","RC","84300","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SODIUM NOT SERUM OR URINE","10001117243","CDM","301","RC","84302","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POTASSIUM-URINE 84133","10001117245","CDM","301","RC","84133","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POTASSIUM, 24 HR UR 84133","10001117247","CDM","301","RC","84133","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOS-PROSTAT-AC 84066","10001117249","CDM","301","RC","84066","HCPCS","facility","both","","","","148","148","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOSPHATASE, AL 84075","10001117251","CDM","301","RC","84075","HCPCS","facility","both","","","","131.5","131.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOSPHORUS-UR 84105","10001117253","CDM","301","RC","84105","HCPCS","facility","both","","","","85.5","85.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PORPHOBILINOG QUAL 84106","10001117255","CDM","301","RC","84106","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PORPHOBILINOG-QUANT 84110","10001117257","CDM","301","RC","84110","HCPCS","facility","both","","","","241.5","241.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OSMOLARITY-UR 83935","10001117261","CDM","301","RC","83935","HCPCS","facility","both","","","","111.5","111.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MERCURY-UR-QT 83825","10001117263","CDM","301","RC","83825","HCPCS","facility","both","","","","396","396","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PEPSINOGEN","10001117265","CDM","301","RC","83519","HCPCS","facility","both","","","","306","306","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IBD STEP GENERATION II SO","10001117267","CDM","301","RC","83520","HCPCS","facility","both","","","","454.5","454.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IBD IMMONOASSAY QT","10001117269","CDM","301","RC","83520","HCPCS","facility","both","","","","54.5","54.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IBD IMMUNOASSAY QT","10001117271","CDM","301","RC","83520","HCPCS","facility","both","","","","54.5","54.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IBD IMMONOASSAY QT","10001117273","CDM","301","RC","83520","HCPCS","facility","both","","","","54.5","54.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACID MUCOLYSA QT 83864","10001117275","CDM","301","RC","83864","HCPCS","facility","both","","","","389","389","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAGNESIUM-UR83735","10001117277","CDM","301","RC","83735","HCPCS","facility","both","","","","163","163","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MEPROBAMATE,BLD83805","10001117279","CDM","301","RC","83805","HCPCS","facility","both","","","","300.5","300.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEAD UR-QT 83655","10001117281","CDM","301","RC","83655","HCPCS","facility","both","","","","321.5","321.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LDH,URINE 83615","10001117283","CDM","301","RC","83615","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LDH (CSF) 83615","10001117285","CDM","301","RC","83615","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAGNESIUM","10001117287","CDM","301","RC","83735","HCPCS","facility","both","","","","28.5","28.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MTHFR MOLEC ISOLATE NUCLE","10001117289","CDM","301","RC","81479","HCPCS","facility","both","","","","752","752","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLASMINOGEN ACTIVATOR*","10001117291","CDM","301","RC","81400","HCPCS","facility","both","","","","477.5","477.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEIC ACID, HI RESOLUTE","10001117293","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENETIC EXAMINATION","10001117295","CDM","301","RC","81479","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUTATION ID","10001117297","CDM","301","RC","81401","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYDRXYPRLN FREE 83500","10001117299","CDM","301","RC","83500","HCPCS","facility","both","","","","284.5","284.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALPHAIFETOPROP SERUM 8210","10001117303","CDM","301","RC","82105","HCPCS","facility","both","","","","293.5","293.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYDRXYPRLN TOT 83505","10001117305","CDM","301","RC","83505","HCPCS","facility","both","","","","285.5","285.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOSPHORUS(INORGANIC)","10001117307","CDM","301","RC","84100","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALCIUM, IONIZE 82330","10001117309","CDM","301","RC","82330","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYCLIC AMP 82030","10001117311","CDM","301","RC","82030","HCPCS","facility","both","","","","402.5","402.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHENOTHIAZINES 84022","10001117313","CDM","301","RC","84022","HCPCS","facility","both","","","","131.5","131.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BICARBONATE-CO2 82374","10001117315","CDM","301","RC","82374","HCPCS","facility","both","","","","98.5","98.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACIDYL","10001117317","CDM","301","RC","82690","HCPCS","facility","both","","","","303.5","303.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYANIDE 82600","10001117319","CDM","301","RC","82600","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYSTINE,QT-UR","10001117323","CDM","301","RC","82131","HCPCS","facility","both","","","","321.5","321.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DELTA AMINO LEV82135","10001117325","CDM","301","RC","82135","HCPCS","facility","both","","","","284.5","284.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARBOXY HBG SAT QT 82375","10001117327","CDM","301","RC","82375","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CREATINE-URINE-24 HRS.825","10001117329","CDM","301","RC","82540","HCPCS","facility","both","","","","163","163","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COPROPORPH QL U84119","10001117331","CDM","301","RC","84119","HCPCS","facility","both","","","","241.5","241.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHOLINEST SERUM 82480","10001117333","CDM","301","RC","82480","HCPCS","facility","both","","","","190.5","190.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLORIDES-CSF 82438","10001117335","CDM","301","RC","82438","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETONE-QL 82009","10001117337","CDM","301","RC","82009","HCPCS","facility","both","","","","63.5","63.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GG TRANSPEPTID 82977","10001117339","CDM","301","RC","82977","HCPCS","facility","both","","","","284.5","284.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUTETHIMIDE-BL82980","10001117341","CDM","301","RC","82980","HCPCS","facility","both","","","","357","357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OSMOLALITY - STOOL","10001117343","CDM","301","RC","84999","HCPCS","facility","both","","","","111.5","111.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCRN URINE G0431","10001117345","CDM","301","RC","","","facility","both","","","","324","324","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMIKACIN PEAK/TROGH 80150","10001117347","CDM","301","RC","80150","HCPCS","facility","both","","","","273","273","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHOLONESTERASE RBC 82482","10001117349","CDM","301","RC","82482","HCPCS","facility","both","","","","203.5","203.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ICD-ISOCITRIC 83570","10001117351","CDM","301","RC","83570","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C-6-PD","10001117353","CDM","301","RC","82955","HCPCS","facility","both","","","","233.5","233.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CAROTENE 82380","10001117355","CDM","301","RC","82380","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC XYLOSE TOLERANC84620","10001117357","CDM","301","RC","84620","HCPCS","facility","both","","","","329","329","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CREATINE CLEAR 82575","10001117359","CDM","301","RC","82575","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMINO ACIDS-BLD QT","10001117361","CDM","301","RC","82131","HCPCS","facility","both","","","","1046","1046","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRYOGLOBULIN,QU82595","10001117363","CDM","301","RC","82595","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SGP TRANSAMINAS84460","10001117365","CDM","301","RC","84460","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRIGLYCERIDES 84478","10001117367","CDM","301","RC","84478","HCPCS","facility","both","","","","101.5","101.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHENYLALANIE 84030","10001117369","CDM","301","RC","84030","HCPCS","facility","both","","","","190.5","190.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LDH ISOZYMES 83625","10001117371","CDM","301","RC","83625","HCPCS","facility","both","","","","745","745","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GALACTOSE 82760","10001117373","CDM","301","RC","82760","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CERULOPLASMIN,Q82390","10001117375","CDM","301","RC","82390","HCPCS","facility","both","","","","284.5","284.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTROPHOR-HGB83020","10001117377","CDM","301","RC","83020","HCPCS","facility","both","","","","293.5","293.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALDOLASE 82085","10001117381","CDM","301","RC","82085","HCPCS","facility","both","","","","117.5","117.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASES,BLOOD 82803","10001117385","CDM","301","RC","82803","HCPCS","facility","both","","","","176","176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASES PCO2 82803","10001117387","CDM","301","RC","82803","HCPCS","facility","both","","","","178","178","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASES, PO2 82803","10001117389","CDM","301","RC","82803","HCPCS","facility","both","","","","178","178","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ART BLOOD GASES 82803","10001117391","CDM","301","RC","82803","HCPCS","facility","both","","","","476","476","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BILIRUBIN,DIRECT 82248","10001117395","CDM","301","RC","82248","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALBUMIN SERUM 82040","10001117397","CDM","301","RC","82040","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DILANTIN,QT 80185","10001117399","CDM","301","RC","80185","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OSMOLALITY-BLD 83930","10001117401","CDM","301","RC","83930","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CREATININE-UR OR OTHR SOU","10001117403","CDM","301","RC","82570","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALPHA-1-ANTITRY82103","10001117405","CDM","301","RC","82103","HCPCS","facility","both","","","","233.5","233.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HDL LIPOPROTEIN 83718","10001117407","CDM","301","RC","83718","HCPCS","facility","both","","","","303.5","303.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CK MB  82553","10001117409","CDM","301","RC","82553","HCPCS","facility","both","","","","235","235","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CREATINE PHOSPH 82550","10001117411","CDM","301","RC","82550","HCPCS","facility","both","","","","153.5","153.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LITHIUM-BLOOD 80178","10001117413","CDM","301","RC","80178","HCPCS","facility","both","","","","131","131","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMYLASE 82150","10001117415","CDM","301","RC","82150","HCPCS","facility","both","","","","131","131","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN C  82180","10001117417","CDM","301","RC","82180","HCPCS","facility","both","","","","148","148","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETONE-QT  82010","10001117419","CDM","301","RC","82010","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALCOHOL-ETHYL 82055","10001117421","CDM","301","RC","82055","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BILIRUBIN,TOTAL 82247","10001117423","CDM","301","RC","82247","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC METAL SCREEN 83015","10001117425","CDM","301","RC","83015","HCPCS","facility","both","","","","802.5","802.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BARBITURATE QUANT/CANNA","10001117427","CDM","301","RC","82205","HCPCS","facility","both","","","","535.5","535.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEUCINE AMINOPE 83670","10001117429","CDM","301","RC","83670","HCPCS","facility","both","","","","217.5","217.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CREATINE  82540","10001117431","CDM","301","RC","82540","HCPCS","facility","both","","","","163","163","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIDOCAINE 80176","10001117433","CDM","301","RC","80176","HCPCS","facility","both","","","","249","249","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LDH  83615","10001117435","CDM","301","RC","83615","HCPCS","facility","both","","","","190","190","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SGO TRANSAMINAS 84450","10001117437","CDM","301","RC","84450","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC METHOTREXATE 80299","10001117439","CDM","301","RC","80299","HCPCS","facility","both","","","","324.5","324.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NORTRIPTYLINE 80182","10001117441","CDM","301","RC","80182","HCPCS","facility","both","","","","324.5","324.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHENOBARBITAL 80184","10001117443","CDM","301","RC","80184","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BROMIDES-BLD 80299","10001117447","CDM","301","RC","80299","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALCIUM 82310","10001117449","CDM","301","RC","82310","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GALACTOSE TOLER 82760","10001117451","CDM","301","RC","82760","HCPCS","facility","both","","","","256.5","256.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLORIDES-BLD 82435","10001117453","CDM","301","RC","82435","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALDOSTERONE 82088","10001117455","CDM","301","RC","82088","HCPCS","facility","both","","","","588.5","588.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHOLESTEROL, TOT 82465","10001117457","CDM","301","RC","82465","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIPOPROTEIN PHE 83012","10001117459","CDM","301","RC","83700","HCPCS","facility","both","","","","432","432","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GTT 1ST 3 OF 5","10001117461","CDM","301","RC","82951","HCPCS","facility","both","","","","241.5","241.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GTT 1ST 3 OF 6","10001117463","CDM","301","RC","82951","HCPCS","facility","both","","","","293.5","293.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GTT 1ST 3 OF 7","10001117465","CDM","301","RC","82951","HCPCS","facility","both","","","","354","354","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GTT EACH ADD","10001117467","CDM","301","RC","82952","HCPCS","facility","both","","","","61","61","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GTT EACH ADD 5TH","10001117469","CDM","301","RC","82952","HCPCS","facility","both","","","","61","61","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GTT EACH ADD 6TH","10001117471","CDM","301","RC","82952","HCPCS","facility","both","","","","61","61","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GTT EAD ADD 7TH","10001117473","CDM","301","RC","82952","HCPCS","facility","both","","","","61","61","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COPPER  82525","10001117475","CDM","301","RC","82525","HCPCS","facility","both","","","","249.5","249.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CREATININE-BLD","10001117477","CDM","301","RC","82565","HCPCS","facility","both","","","","151.5","151.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYSTINE, QT BLD 82131","10001117481","CDM","301","RC","82131","HCPCS","facility","both","","","","383.5","383.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN A QUAN 84590","10001117485","CDM","301","RC","84590","HCPCS","facility","both","","","","201.5","201.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HB-METH, SULF, QT 83050","10001117487","CDM","301","RC","83050","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LACTIC AC BLD=Q83605","10001117491","CDM","301","RC","83605","HCPCS","facility","both","","","","229.5","229.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIPASE 83690","10001117493","CDM","301","RC","83690","HCPCS","facility","both","","","","134.5","134.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAGNESIUM-BLD 83735","10001117495","CDM","301","RC","83735","HCPCS","facility","both","","","","163","163","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASES, OXYGEN SA 82792","10001117497","CDM","301","RC","82810","HCPCS","facility","both","","","","178","178","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOSPHORUS BLD 84100","10001117499","CDM","301","RC","84100","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC P H OTHER THAN BLOOD 8398","10001117501","CDM","301","RC","83986","HCPCS","facility","both","","","","43","43","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASTRICE PH FREE & TOTAL","10001117503","CDM","301","RC","82930","HCPCS","facility","both","","","","43","43","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POTASSIUM-BLD 84132","10001117505","CDM","301","RC","84132","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALK PHOS ISOENZ84080","10001117507","CDM","301","RC","84080","HCPCS","facility","both","","","","300.5","300.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC METANEPHRINES (FRACTIONAT","10001117509","CDM","301","RC","83835","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMMONIA 82140","10001117511","CDM","301","RC","82140","HCPCS","facility","both","","","","224","224","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SODIUM-BLD 84295","10001117515","CDM","301","RC","84295","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUCOSE QUANT","10001117517","CDM","301","RC","82947","HCPCS","facility","both","","","","101.5","101.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GTT-FIRST 3","10001117519","CDM","301","RC","82951","HCPCS","facility","both","","","","190.5","190.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN, TOTAL OTHER SOUR","10001117521","CDM","301","RC","84157","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TOT PROT A/G-BL","10001117523","CDM","301","RC","84155","HCPCS","facility","both","","","","163","163","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN E ASSAY84446","10001117525","CDM","301","RC","84446","HCPCS","facility","both","","","","321.5","321.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UREA NITROGEN QT 84520","10001117527","CDM","301","RC","84520","HCPCS","facility","both","","","","101.5","101.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UREA CLEARANCE 84545","10001117529","CDM","301","RC","84545","HCPCS","facility","both","","","","139.5","139.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URIC ACID-BLD 84550","10001117531","CDM","301","RC","84550","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOSIDERIN QUANT 83071","10001117533","CDM","301","RC","83071","HCPCS","facility","both","","","","167.5","167.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T-3 UPTAKE 84479","10001117535","CDM","301","RC","84479","HCPCS","facility","both","","","","256","256","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OCCULT BLOOD; FECES 82270","10001117537","CDM","301","RC","82270","HCPCS","facility","both","","","","43","43","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MARIJUANA SCREEN G0431","10001117539","CDM","301","RC","","","facility","both","","","","142.5","142.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRYPSIN, QUAL 84488","10001117541","CDM","301","RC","84488","HCPCS","facility","both","","","","117.5","117.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UROBLINO-FEC QT 84577","10001117543","CDM","301","RC","84577","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FAT,FECAL,QUANT 48 HRS 82","10001117545","CDM","301","RC","82710","HCPCS","facility","both","","","","321.5","321.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRYPSIN,SEMI QT 84490","10001117547","CDM","301","RC","84490","HCPCS","facility","both","","","","139.5","139.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTOPPRPHY FEC 84202","10001117549","CDM","301","RC","84202","HCPCS","facility","both","","","","369.5","369.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HISTAMINE 83088","10001117551","CDM","301","RC","83088","HCPCS","facility","both","","","","812.5","812.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACTH 82024","10001117555","CDM","301","RC","82024","HCPCS","facility","both","","","","692.5","692.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FERRITIN ASSAY 82728","10001117557","CDM","301","RC","82728","HCPCS","facility","both","","","","303.5","303.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CATECHOLAMINES BLOOD 8238","10001117559","CDM","301","RC","82383","HCPCS","facility","both","","","","581","581","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VMA 84585","10001117561","CDM","301","RC","84585","HCPCS","facility","both","","","","396","396","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HOMOVANILIC ACI 83150","10001117563","CDM","301","RC","83150","HCPCS","facility","both","","","","519","519","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC 17-HYDROXYCORT 83491","10001117565","CDM","301","RC","83491","HCPCS","facility","both","","","","203.5","203.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LDL (LOW DENSITY LIPOPRO)","10001117567","CDM","301","RC","83721","HCPCS","facility","both","","","","302.5","302.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KETOSTEROIDS 17 TOTAL","10001117569","CDM","301","RC","83586","HCPCS","facility","both","","","","363","363","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DHA-DEHYDROAND","10001117571","CDM","301","RC","83520","HCPCS","facility","both","","","","550.5","550.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HAPTOGLOBIN 83010 QUANT","10001117573","CDM","301","RC","83010","HCPCS","facility","both","","","","292.5","292.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESTROGEN,TOTAL 82672","10001117575","CDM","301","RC","82672","HCPCS","facility","both","","","","363","363","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BENZODIAZEPINE 80154","10001117577","CDM","301","RC","80154","HCPCS","facility","both","","","","292.5","292.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BROMIDES 80299","10001117579","CDM","301","RC","80299","HCPCS","facility","both","","","","111.5","111.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTIEN ELECTROPHARISM SE","10001117581","CDM","301","RC","84165","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHENCYCLIDINE","10001117583","CDM","301","RC","83992","HCPCS","facility","both","","","","259.5","259.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARBON MONOXIDES QUANT 82","10001117585","CDM","301","RC","82375","HCPCS","facility","both","","","","235.5","235.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ARSENIC 82175","10001117587","CDM","301","RC","82175","HCPCS","facility","both","","","","417","417","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCAINAMIDE 80190","10001117589","CDM","301","RC","80190","HCPCS","facility","both","","","","429","429","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC N-ACETYL - PROCAINAMIDE","10001117591","CDM","301","RC","80192","HCPCS","facility","both","","","","429","429","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CATECHOLAMINES FRACTIONAT","10001117593","CDM","301","RC","82384","HCPCS","facility","both","","","","746","746","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VANCOMYCIN 80202","10001117595","CDM","301","RC","80202","HCPCS","facility","both","","","","293","293","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOGLOBIN GYLC83036","10001117597","CDM","301","RC","83036","HCPCS","facility","both","","","","217.5","217.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VALPROIC ACID 80164","10001117599","CDM","301","RC","80164","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TOPRIMATE LEVEL","10001117601","CDM","301","RC","80201","HCPCS","facility","both","","","","203.5","203.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PREGNANETRIOL 84138","10001117603","CDM","301","RC","84138","HCPCS","facility","both","","","","203.5","203.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PREGNANEDIOL QU 84135","10001117607","CDM","301","RC","84135","HCPCS","facility","both","","","","203.5","203.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SUGAR, INDETIFY84375","10001117609","CDM","301","RC","84375","HCPCS","facility","both","","","","203.5","203.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HCG QUAL 84703","10001117611","CDM","301","RC","84703","HCPCS","facility","both","","","","163","163","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IRON, TOTAL BIND83550","10001117613","CDM","301","RC","83550","HCPCS","facility","both","","","","153.5","153.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SALICYLATE 80196","10001117615","CDM","301","RC","80196","HCPCS","facility","both","","","","117.5","117.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IRON, TOTAL-BLD 83540","10001117617","CDM","301","RC","83540","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CATECHOLAMINES TOT URINE","10001117619","CDM","301","RC","82382","HCPCS","facility","both","","","","324","324","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEAD BLD-QT 83655","10001117621","CDM","301","RC","83655","HCPCS","facility","both","","","","324","324","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC 5-HIAA QT 83497","10001117623","CDM","301","RC","83497","HCPCS","facility","both","","","","243.5","243.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MERCURY-BLD-QT 83825","10001117625","CDM","301","RC","83825","HCPCS","facility","both","","","","396","396","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALCIUM TOLER 82331","10001117627","CDM","301","RC","82331","HCPCS","facility","both","","","","490.5","490.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STONE ANALYSIS QL 82355","10001117629","CDM","301","RC","82355","HCPCS","facility","both","","","","174.5","174.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OXALATE (URINE) 83945","10001117631","CDM","301","RC","83945","HCPCS","facility","both","","","","321.5","321.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLORAMPHENICOL82415","10001117633","CDM","301","RC","82415","HCPCS","facility","both","","","","203.5","203.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHENOLPHTHALEIN (STOOL)","10001117635","CDM","301","RC","84311","HCPCS","facility","both","","","","362","362","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BUTORPHANOL SCR UR REF","10001117637","CDM","301","RC","","","facility","both","","","","508","508","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OB GLUCOSE CHALLENGE","10001117639","CDM","301","RC","82951","HCPCS","facility","both","","","","178","178","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUCOSE 2HE 82950","10001117641","CDM","301","RC","82950","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFERRIN","10001117647","CDM","301","RC","84466","HCPCS","facility","both","","","","249","249","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAGNESIUM (STOOL)","10001117649","CDM","301","RC","83735","HCPCS","facility","both","","","","96.5","96.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYCLIC CITRULLIN PEPTIDE","10001117651","CDM","301","RC","83520","HCPCS","facility","both","","","","248.5","248.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC L S D SCREEN 82205","10001117653","CDM","301","RC","82205","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLORAL HYDRATE80299","10001117655","CDM","301","RC","80299","HCPCS","facility","both","","","","203.5","203.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIBRIUM-BLD 80299","10001117657","CDM","301","RC","80299","HCPCS","facility","both","","","","456","456","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MARIJUANA QUANT","10001117659","CDM","301","RC","82542","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ORINASE TOLER 82953","10001117661","CDM","301","RC","82953","HCPCS","facility","both","","","","232","232","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUCOSE-CSF-QT","10001117663","CDM","301","RC","82945","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COPPER, URINE 82525","10001117665","CDM","301","RC","82525","HCPCS","facility","both","","","","249.5","249.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUCOPROTEIN-SYN","10001117667","CDM","301","RC","83872","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALCIUM-FECES 82310","10001117669","CDM","301","RC","82310","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FECAL FAT QUAL.","10001117673","CDM","301","RC","82705","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IGA,IGD,IGG,IGM,EACH 8278","10001117677","CDM","301","RC","82784","HCPCS","facility","both","","","","476","476","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREEN, BLOOD","10001117679","CDM","301","RC","80100","HCPCS","facility","both","","","","1106","1106","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMPHETAMINE 82145","10001117681","CDM","301","RC","82145","HCPCS","facility","both","","","","193.5","193.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLORALHYDRATE 80299","10001117683","CDM","301","RC","80299","HCPCS","facility","both","","","","203.5","203.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUTETHIMIDE-UR82980","10001117685","CDM","301","RC","82980","HCPCS","facility","both","","","","357","357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC 10-HYRDROXYCARBAZEPINE","10001117687","CDM","301","RC","80299","HCPCS","facility","both","","","","75","75","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BUPROPRION BL","10001117689","CDM","301","RC","80299","HCPCS","facility","both","","","","196.5","196.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIBRIUM-UR 80299","10001117691","CDM","301","RC","80299","HCPCS","facility","both","","","","456","456","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MEPROBAMATE, UR 83805","10001117693","CDM","301","RC","83805","HCPCS","facility","both","","","","331","331","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UROBILINOGUR-UR-Q84578","10001117697","CDM","301","RC","84578","HCPCS","facility","both","","","","217.5","217.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UROPORPHYRINS-QT84120","10001117699","CDM","301","RC","84120","HCPCS","facility","both","","","","249","249","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SUGAR-UR-QT","10001117701","CDM","301","RC","82945","HCPCS","facility","both","","","","64.5","64.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CORTICOSTEROIDS 83491","10001117707","CDM","301","RC","83491","HCPCS","facility","both","","","","215.5","215.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PORPHYRINS, QUAL 84119","10001117709","CDM","301","RC","84119","HCPCS","facility","both","","","","212.5","212.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREEN SINGLE","10001117711","CDM","301","RC","","","facility","both","","","","256.5","256.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BUTAZOLADINE 80299","10001117713","CDM","301","RC","80299","HCPCS","facility","both","","","","203.5","203.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IGE-QUANT 82785","10001117715","CDM","301","RC","82785","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG LEVEL ANAL80299","10001117717","CDM","301","RC","80299","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRIMIDONE 80188","10001117719","CDM","301","RC","80188","HCPCS","facility","both","","","","271.5","271.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FAT,FECAL,QUANT 72 HRS 82","10001117721","CDM","301","RC","82710","HCPCS","facility","both","","","","321.5","321.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTROPHOR-CSF84165","10001117723","CDM","301","RC","84166","HCPCS","facility","both","","","","193.5","193.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALBUMIN REF","10001117727","CDM","301","RC","82040","HCPCS","facility","both","","","","28.5","28.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IGG INDEX REF","10001117729","CDM","301","RC","82784","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALBUMIN CSF REF","10001117731","CDM","301","RC","82042","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IGG SERUM REF","10001117733","CDM","301","RC","82784","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IGG CSF REF","10001117735","CDM","301","RC","82784","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOZAPINE/METABOLITE REF","10001117737","CDM","301","RC","82492","HCPCS","facility","both","","","","298.5","298.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESOXYCORTOCOSTERONE REF","10001117739","CDM","301","RC","82633","HCPCS","facility","both","","","","286","286","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREEN SINGLE","10001117741","CDM","301","RC","","","facility","both","","","","57.5","57.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN B-12 82607","10001117743","CDM","301","RC","82607","HCPCS","facility","both","","","","330.5","330.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN B-6 NPYR 84207","10001117747","CDM","301","RC","84207","HCPCS","facility","both","","","","390.5","390.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FOLIC ACID SER 82746","10001117749","CDM","301","RC","82746","HCPCS","facility","both","","","","298.5","298.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUSK ANTIBODY*","10001117751","CDM","301","RC","83519","HCPCS","facility","both","","","","1411.5","1411.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC METHYL, MALON AC","10001117753","CDM","301","RC","83921","HCPCS","facility","both","","","","193.5","193.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LUDIMIL LEVEL 80299","10001117755","CDM","301","RC","80299","HCPCS","facility","both","","","","432","432","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYELIN BASIC PROTEIN-CSF","10001117757","CDM","301","RC","83873","HCPCS","facility","both","","","","533","533","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROGESTERONE LEVEL","10001117759","CDM","301","RC","84144","HCPCS","facility","both","","","","43.5","43.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALPHA SUB UNIT","10001117761","CDM","301","RC","83519","HCPCS","facility","both","","","","272","272","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPIATES QUANT","10001117763","CDM","301","RC","83925","HCPCS","facility","both","","","","193","193","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT GLUCOSE QT BLD","10001117765","CDM","301","RC","82948","HCPCS","facility","both","","","","32.5","32.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT FECAL OCCULT BLD","10001117767","CDM","301","RC","82272","HCPCS","facility","both","","","","9.5","9.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT PH BODY FLUID","10001117769","CDM","301","RC","83986","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT CREATININE W/EFGR","10001117771","CDM","301","RC","82565","HCPCS","facility","both","","","","143","143","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ERYTHROPOETIN 82668","10001117773","CDM","301","RC","82668","HCPCS","facility","both","","","","298.5","298.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CEA 82378","10001117775","CDM","301","RC","82378","HCPCS","facility","both","","","","362.5","362.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESTRADIOL BY RI82670","10001117777","CDM","301","RC","82670","HCPCS","facility","both","","","","410.5","410.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLASMA SEROTONI84260","10001117779","CDM","301","RC","84260","HCPCS","facility","both","","","","552.5","552.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TESTOSTERONE TOTAL 84403","10001117781","CDM","301","RC","84403","HCPCS","facility","both","","","","410.5","410.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIGTOXIN-RIA-B 80299","10001117783","CDM","301","RC","80299","HCPCS","facility","both","","","","389","389","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIGOXIN LEVEL 80162","10001117785","CDM","301","RC","80162","HCPCS","facility","both","","","","335","335","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASTRI  82941","10001117787","CDM","301","RC","82941","HCPCS","facility","both","","","","284.5","284.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSULIN LEVEL- TOTAL 8352","10001117789","CDM","301","RC","83525","HCPCS","facility","both","","","","351","351","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC L-H BY RIA 83002","10001117791","CDM","301","RC","83002","HCPCS","facility","both","","","","452.5","452.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROGESTERONE-QT 84144","10001117793","CDM","301","RC","84234","HCPCS","facility","both","","","","399","399","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RENIN BY LEVEL 84244","10001117795","CDM","301","RC","84244","HCPCS","facility","both","","","","414.5","414.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CORTISOL PLASMA TOTAL 825","10001117797","CDM","301","RC","82533","HCPCS","facility","both","","","","259","259","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T-4 TOTAL","10001117799","CDM","301","RC","84436","HCPCS","facility","both","","","","235","235","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T3 84480","10001117801","CDM","301","RC","84480","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENTAMYCIN BY R 80170","10001117803","CDM","301","RC","80170","HCPCS","facility","both","","","","410.5","410.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GROWTH HORMONE 83003","10001117805","CDM","301","RC","83003","HCPCS","facility","both","","","","410.5","410.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANDROSTENDIONE82157","10001117807","CDM","301","RC","82157","HCPCS","facility","both","","","","594","594","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TSH 84443","10001117809","CDM","301","RC","84443","HCPCS","facility","both","","","","335","335","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FSH BY RIA 83001","10001117811","CDM","301","RC","83001","HCPCS","facility","both","","","","456","456","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROT-SPINAL FLU","10001117813","CDM","301","RC","84157","HCPCS","facility","both","","","","86.5","86.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PTH BY RIA 83970","10001117815","CDM","301","RC","83970","HCPCS","facility","both","","","","722","722","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PTH INTACT","10001117817","CDM","301","RC","83970","HCPCS","facility","both","","","","730.5","730.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACID PHOS RIA 84060","10001117819","CDM","301","RC","84060","HCPCS","facility","both","","","","235.5","235.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSULIN TOL RIA 80434","10001117821","CDM","301","RC","80434","HCPCS","facility","both","","","","1001.5","1001.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THY BNG GLOB-RI84442","10001117823","CDM","301","RC","84442","HCPCS","facility","both","","","","351","351","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HCG,SERUM QT 84702","10001117825","CDM","301","RC","84702","HCPCS","facility","both","","","","324","324","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESTROGENS(BLOOD) TOTAL","10001117827","CDM","301","RC","82672","HCPCS","facility","both","","","","98.5","98.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SOMATOMEDIN-C","10001117829","CDM","301","RC","84305","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VITAMIN K1","10001117831","CDM","301","RC","84597","HCPCS","facility","both","","","","458","458","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-GAMMA GLOB82150","10001117833","CDM","301","RC","82150","HCPCS","facility","both","","","","501","501","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRYFIBRINOGEN 82585","10001117835","CDM","301","RC","82585","HCPCS","facility","both","","","","105.5","105.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRYOGLOBULIN QUAL/SEMIQT","10001117837","CDM","301","RC","82595","HCPCS","facility","both","","","","169.5","169.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MICRO SATELLITE INSTABILI","10001117839","CDM","301","RC","81301","HCPCS","facility","both","","","","992","992","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DNA EXTRACT SO 1","10001117841","CDM","301","RC","81403","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DNA EXTRACT SO 2","10001117843","CDM","301","RC","81403","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PCR AMPLIFIED SO 1","10001117845","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PCR AMPLIFIED SO 2","10001117847","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SEP GEL ELECTROPHORESIS S","10001117849","CDM","301","RC","81479","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SEP GEL ELECTROPHORESIS S","10001117851","CDM","301","RC","81479","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LOSS OF HETEROZYGOSITY 18","10001117853","CDM","301","RC","81479","HCPCS","facility","both","","","","1059","1059","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABL KINASE*","10001117855","CDM","301","RC","81401","HCPCS","facility","both","","","","776.5","776.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SYNOVIAL CARCINOMA*","10001117857","CDM","301","RC","81479","HCPCS","facility","both","","","","1077","1077","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOGLOBIN GENE REARANG","10001117859","CDM","301","RC","81479","HCPCS","facility","both","","","","574.5","574.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T CELL RECEPTOR GENE*","10001117861","CDM","301","RC","81402","HCPCS","facility","both","","","","647.5","647.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELET DERIVED GRO FCT","10001117863","CDM","301","RC","81404","HCPCS","facility","both","","","","842.5","842.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EML4-ALK GENE FUSION BY P","10001117865","CDM","301","RC","81401","HCPCS","facility","both","","","","530","530","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PML/RARA T 15.17 QT PCR C","10001117867","CDM","301","RC","81315","HCPCS","facility","both","","","","352.5","352.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NRAS MUTATION ANALYSIS*","10001117869","CDM","301","RC","81404","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRAF MUTATION ANALYSIS*","10001117871","CDM","301","RC","81210","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DNA EXTRACT SO","10001117873","CDM","301","RC","81403","HCPCS","facility","both","","","","705.5","705.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PCR AMPLIFIED 1 SO*","10001117875","CDM","301","RC","81479","HCPCS","facility","both","","","","890.5","890.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PCR AMPLIFIED 2 SO","10001117877","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KRAS MUTATION ANALYSIS*","10001117879","CDM","301","RC","81275","HCPCS","facility","both","","","","647","647","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EGRF MUTATION ANALYSIS*","10001117881","CDM","301","RC","81235","HCPCS","facility","both","","","","1054.5","1054.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MGTM GENE METHYLATION ASS","10001117883","CDM","301","RC","81331","HCPCS","facility","both","","","","1208","1208","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STONE XRAY DIFF 82370","10001117885","CDM","301","RC","82370","HCPCS","facility","both","","","","222.5","222.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FAT STAIN QT","10001117887","CDM","301","RC","82705","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PH, REACTION OTH THAN BLD","10001117889","CDM","301","RC","83986","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOSIDERIN QUAL 83070","10001117891","CDM","301","RC","83070","HCPCS","facility","both","","","","99.5","99.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREEN SINGLE","10001117893","CDM","301","RC","","","facility","both","","","","57.5","57.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREEN SINGLE","10001117895","CDM","301","RC","","","facility","both","","","","57.5","57.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BENCE-JONES PRO 82044","10001117897","CDM","301","RC","82044","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYPERIMMUNE ANT","10001117899","CDM","636","RC","","","facility","both","","","","313.5","313.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR VIIA PER MCG J7189","10001117901","CDM","636","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR VIII HUMAN PER IU","10001117903","CDM","636","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY OF URINE ALBUNIM","10001117907","CDM","301","RC","82042","HCPCS","facility","both","","","","8.5","8.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY OF APOLIPROTEIN","10001117909","CDM","301","RC","82172","HCPCS","facility","both","","","","63.5","63.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BILIRUBIN TOTAL","10001117911","CDM","301","RC","82247","HCPCS","facility","both","","","","22.5","22.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMILUMINESCENT ASSAY","10001117913","CDM","301","RC","82397","HCPCS","facility","both","","","","53.5","53.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY, BLD/SERUM CHOLOEST","10001117915","CDM","301","RC","82465","HCPCS","facility","both","","","","18.5","18.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY OF GGT","10001117917","CDM","301","RC","82977","HCPCS","facility","both","","","","31.5","31.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY OF HAPTOGLOBIN QT","10001117919","CDM","301","RC","83010","HCPCS","facility","both","","","","53","53","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOASSAY NONANTIBODY","10001117921","CDM","301","RC","83516","HCPCS","facility","both","","","","46.5","46.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY NEPHELOMETRY NES","10001117923","CDM","301","RC","83883","HCPCS","facility","both","","","","57.5","57.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOLECULE NUCLEIC AMPLI 2","10001117925","CDM","301","RC","81383","HCPCS","facility","both","","","","138.5","138.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY PROTEIN URINE","10001117927","CDM","301","RC","84156","HCPCS","facility","both","","","","17","17","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN EPHORESIS/URINE/C","10001117929","CDM","301","RC","84166","HCPCS","facility","both","","","","71","71","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECTROPHOTOMETRY","10001117931","CDM","301","RC","84311","HCPCS","facility","both","","","","29.5","29.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFERASE (AST)(SGOT)","10001117933","CDM","301","RC","84450","HCPCS","facility","both","","","","22.5","22.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALANINE AMINO ALT SGPT","10001117935","CDM","301","RC","84460","HCPCS","facility","both","","","","24","24","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY OF TRIGLYCERIDES","10001117937","CDM","301","RC","84478","HCPCS","facility","both","","","","24.5","24.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SSP POTASSIUM 84132","10001117939","CDM","301","RC","84132","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY OF URINE CREATININE","10001117941","CDM","301","RC","82570","HCPCS","facility","both","","","","22.5","22.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RIA NONANTIBODY","10001117943","CDM","301","RC","83519","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOLECULE DOT/SLOT/BLOT","10001117945","CDM","301","RC","81479","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYSIS OF TISSUE CELLS","10001117947","CDM","301","RC","81479","HCPCS","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN WESTERN BLOT TEST","10001117949","CDM","301","RC","84182","HCPCS","facility","both","","","","74.5","74.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOLECULE MUTATION ID","10001117951","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOLECULE MUTATION ID 2ND","10001117953","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOLECULE MUTATION ID 3RD","10001117955","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOLECULE MUTATION ID 4TH","10001117957","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEIC ACID, HI RESOLUTE","10001117959","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEIC ACID, HI RESOLUTE","10001117961","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEIC ACID, HI RESOLUTE","10001117963","CDM","301","RC","81479","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-MOLECULAR DIAG; INTER","10001117969","CDM","301","RC","81479","HCPCS","facility","both","","","","33.5","33.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-MOLEC DIAG;AMP NUC AC","10001117971","CDM","301","RC","81479","HCPCS","facility","both","","","","138.5","138.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-MOLEC DIAG;ISOLAT/EXT","10001117973","CDM","301","RC","81240","HCPCS","facility","both","","","","33.5","33.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-AUTO ANTI-IGA QT","10001117975","CDM","301","RC","83519","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C I Q","10001117977","CDM","302","RC","86162","HCPCS","facility","both","","","","349","349","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEGIONELLA IGM TITER","10001117979","CDM","302","RC","86713","HCPCS","facility","both","","","","115.5","115.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VIRUS (CFT) 86171","10001117981","CDM","302","RC","86171","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYCOPLASMA PNEU IGM","10001117983","CDM","302","RC","86738","HCPCS","facility","both","","","","223.5","223.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLAMDIA PNEUM TWAR IGM","10001117985","CDM","302","RC","86632","HCPCS","facility","both","","","","249.5","249.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLU, 3 ANT-ST 86710","10001117987","CDM","302","RC","86710","HCPCS","facility","both","","","","151.5","151.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PAN T CD3","10001117991","CDM","302","RC","86359","HCPCS","facility","both","","","","106.5","106.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI - DNA","10001117993","CDM","302","RC","86225","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOELECTRO-Q 86320","10001117995","CDM","302","RC","86320","HCPCS","facility","both","","","","218.5","218.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC A-MITOCHON","10001117997","CDM","302","RC","86256","HCPCS","facility","both","","","","111","111","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-SM MUSCLE","10001117999","CDM","302","RC","86256","HCPCS","facility","both","","","","111","111","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T CELL, CD4, CD8, RATIO","10001118001","CDM","302","RC","86360","HCPCS","facility","both","","","","106.5","106.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FTA-BLOOD","10001118003","CDM","302","RC","86780","HCPCS","facility","both","","","","75.5","75.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPLEMENT, C-3 86160","10001118005","CDM","302","RC","86160","HCPCS","facility","both","","","","180.5","180.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPLEMENT TOTAL","10001118007","CDM","302","RC","86162","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNDELECTROPHARISM","10001118009","CDM","302","RC","86325","HCPCS","facility","both","","","","118.5","118.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPLEMENT C - 4 86160","10001118011","CDM","302","RC","86160","HCPCS","facility","both","","","","180.5","180.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC B-J PROT ELEC-B 86320","10001118013","CDM","302","RC","86320","HCPCS","facility","both","","","","218.5","218.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CA 15-3","10001118015","CDM","302","RC","86300","HCPCS","facility","both","","","","214.5","214.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP A AB-IGG","10001118017","CDM","302","RC","86708","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP B CORE ANTIBODY","10001118019","CDM","302","RC","86704","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP B SURFACE ANTIBODY","10001118021","CDM","302","RC","86706","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP BE ANTIBODY","10001118023","CDM","302","RC","86707","HCPCS","facility","both","","","","76.5","76.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP A AB-IGM","10001118025","CDM","302","RC","86709","HCPCS","facility","both","","","","139.5","139.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP B ANTIBODY 86707","10001118031","CDM","302","RC","86707","HCPCS","facility","both","","","","127","127","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC V.D.R.L. CSF 86592","10001118033","CDM","302","RC","86592","HCPCS","facility","both","","","","64.5","64.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-NUCLEAR TITER 86256","10001118035","CDM","302","RC","86256","HCPCS","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RA LATEX-QL 86430","10001118037","CDM","302","RC","86430","HCPCS","facility","both","","","","28.5","28.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYMES DISEASE TITER 86618","10001118039","CDM","302","RC","86618","HCPCS","facility","both","","","","113","113","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AGGLUT FEB EA 86000","10001118041","CDM","302","RC","86000","HCPCS","facility","both","","","","31.5","31.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHAGAS DISEASE SCREEN 860","10001118043","CDM","302","RC","86063","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-NUCLEAR AN 86225","10001118045","CDM","302","RC","86255","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STS. VDRL OR RP QUAL 8659","10001118047","CDM","302","RC","86592","HCPCS","facility","both","","","","31.5","31.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-STREPTOLY TITER 8606","10001118049","CDM","302","RC","86060","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THYROGLOB ANTI","10001118051","CDM","302","RC","86800","HCPCS","facility","both","","","","50.5","50.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AGGLUT TRICHINA","10001118053","CDM","302","RC","86784","HCPCS","facility","both","","","","76.5","76.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COLD AGGULT TITER","10001118055","CDM","302","RC","86157","HCPCS","facility","both","","","","46.5","46.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MONO-SCREEN TST 86308","10001118057","CDM","302","RC","86308","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RA LATEX-QT","10001118059","CDM","302","RC","86431","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASO - SCREEN 86063","10001118061","CDM","302","RC","86063","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C - REACTIVE PROT 86140","10001118063","CDM","302","RC","86140","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPLEMENT FIXA","10001118065","CDM","302","RC","86171","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HETEROPHIL TITE 86310","10001118067","CDM","302","RC","86310","HCPCS","facility","both","","","","50.5","50.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STS, VDRL OR RP QUANT 865","10001118069","CDM","302","RC","86593","HCPCS","facility","both","","","","31.5","31.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CA 125","10001118071","CDM","302","RC","86304","HCPCS","facility","both","","","","66.5","66.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TB GOLD(QUANTIFERON)","10001118073","CDM","302","RC","86480","HCPCS","facility","both","","","","134.5","134.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENCEPHALITIS PANEL(MENIN","10001118075","CDM","302","RC","86603","HCPCS","facility","both","","","","2594","2594","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TYPHOID SEROLOGY*","10001118077","CDM","302","RC","86768","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HELICOBACTOR PLYORI AB IG","10001118079","CDM","302","RC","86677","HCPCS","facility","both","","","","58.5","58.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TORCH TOTER PANEL*","10001118081","CDM","302","RC","86778","HCPCS","facility","both","","","","58.5","58.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MENINGOENCEPHALITIS PNL S","10001118083","CDM","302","RC","86603","HCPCS","facility","both","","","","2542.5","2542.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TULAREMIA ANTIBODY","10001118085","CDM","302","RC","86668","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PNEUMO SCRN IMMUNGL EA-AN","10001118087","CDM","302","RC","86403","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STREP PNEUMO AG(URINE)","10001118089","CDM","302","RC","86403","HCPCS","facility","both","","","","60.5","60.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STREP PNEUMO ANTIGEN BLOO","10001118091","CDM","302","RC","86403","HCPCS","facility","both","","","","61.5","61.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PNEUMONIA SCREEN - ASPERG","10001118093","CDM","302","RC","86606","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PNEUMOCOCCAL ANTIBODY","10001118095","CDM","302","RC","86609","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BARTONELLA ANTIBODY PANEL","10001118097","CDM","302","RC","86611","HCPCS","facility","both","","","","33.5","33.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC B QUINTANA IGG","10001118099","CDM","302","RC","86611","HCPCS","facility","both","","","","42.5","42.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC B HENSELAE IGM","10001118101","CDM","302","RC","86611","HCPCS","facility","both","","","","42.5","42.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC B QUINTANA IGM","10001118103","CDM","302","RC","86611","HCPCS","facility","both","","","","42.5","42.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COCCIDIOIDES IMMITIS ANTI","10001118105","CDM","302","RC","86635","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EHRLICHIA","10001118107","CDM","302","RC","86666","HCPCS","facility","both","","","","785","785","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FRANCISELLA ANTIBODY","10001118109","CDM","302","RC","86668","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYSTICERCUS ANTIBODY ELIS","10001118111","CDM","302","RC","86682","HCPCS","facility","both","","","","156","156","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HERPES SIMPLEX AB 1","10001118113","CDM","302","RC","86695","HCPCS","facility","both","","","","153.5","153.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEGIONELLA AB IGG","10001118117","CDM","302","RC","86713","HCPCS","facility","both","","","","165.5","165.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUMPS ANTIBODY IGG","10001118119","CDM","302","RC","86735","HCPCS","facility","both","","","","53","53","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARVOVIRUS IGG","10001118121","CDM","302","RC","86747","HCPCS","facility","both","","","","49.5","49.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARVOVIRUS IGM","10001118123","CDM","302","RC","86747","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMOEBA ANTIBODY","10001118125","CDM","302","RC","86753","HCPCS","facility","both","","","","121","121","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTOZOA ANTIBODY NOS","10001118127","CDM","302","RC","86753","HCPCS","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WEST NILE VIRUS AB IGM","10001118129","CDM","302","RC","86788","HCPCS","facility","both","","","","99.5","99.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WEST NILE VIRUS ANITBODY","10001118131","CDM","302","RC","86789","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VIRUS NOT ELSEWHERE SPECI","10001118133","CDM","302","RC","86790","HCPCS","facility","both","","","","47.5","47.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VIRUS ANTIBODY NOS","10001118135","CDM","302","RC","86790","HCPCS","facility","both","","","","53.5","53.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEGIONELLA IGM TITER","10001118139","CDM","302","RC","86713","HCPCS","facility","both","","","","165.5","165.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CMV, IGM TITER 86645","10001118141","CDM","302","RC","86645","HCPCS","facility","both","","","","284.5","284.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VAR. ZOST TITER 86787","10001118143","CDM","302","RC","86787","HCPCS","facility","both","","","","233","233","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TEICHOIC ACID TITER 86329","10001118145","CDM","302","RC","86329","HCPCS","facility","both","","","","411.5","411.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CIE - BACT ANTIGEN","10001118147","CDM","302","RC","86185","HCPCS","facility","both","","","","436.5","436.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RUBELLA IGM TIT 86762","10001118149","CDM","302","RC","86762","HCPCS","facility","both","","","","249","249","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COXSACKIE B1-6/ENTEROVIRU","10001118151","CDM","302","RC","86658","HCPCS","facility","both","","","","1271","1271","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMOEBA AGGLUTN 86753","10001118153","CDM","302","RC","86753","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HISTOPLAS AN 86698","10001118155","CDM","302","RC","86698","HCPCS","facility","both","","","","352","352","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEGIONELLA EIA 86713","10001118157","CDM","302","RC","86713","HCPCS","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RUBEOLA 86765","10001118159","CDM","302","RC","86765","HCPCS","facility","both","","","","232","232","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RUBELLA 86762","10001118161","CDM","302","RC","86762","HCPCS","facility","both","","","","267.5","267.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TOXOPLASMA 86777","10001118163","CDM","302","RC","86777","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TOXOPLASMA IGM 86778","10001118165","CDM","302","RC","86778","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WEST NILE VIRUS IGG","10001118167","CDM","302","RC","86789","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WEST NILE VIRUS IGM","10001118169","CDM","302","RC","86788","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BABESIA MICROTI IGG/IGM*","10001118171","CDM","302","RC","86753","HCPCS","facility","both","","","","189.5","189.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DENQUE FEVER ANTIBODY PAN","10001118173","CDM","302","RC","86790","HCPCS","facility","both","","","","394.5","394.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VIRUS (CFT) 86171","10001118175","CDM","302","RC","86171","HCPCS","facility","both","","","","218.5","218.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VIRUS,FLUORES 86255","10001118177","CDM","302","RC","86790","HCPCS","facility","both","","","","256.5","256.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADENOVIRUS 86603","10001118179","CDM","302","RC","86603","HCPCS","facility","both","","","","218.5","218.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYMPHOCYTIC 86727","10001118181","CDM","302","RC","86727","HCPCS","facility","both","","","","180.5","180.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYMPHOGRAN VEN","10001118183","CDM","302","RC","86729","HCPCS","facility","both","","","","193","193","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POLIO-CFT 86658","10001118185","CDM","302","RC","86658","HCPCS","facility","both","","","","437.5","437.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Q FEVER 86638","10001118187","CDM","302","RC","86638","HCPCS","facility","both","","","","129","129","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROCKY MTN SPOT 86000","10001118189","CDM","302","RC","86000","HCPCS","facility","both","","","","218.5","218.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENCEPH, EAST EQ 86652","10001118191","CDM","302","RC","86652","HCPCS","facility","both","","","","256.5","256.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARAINFLUENZA 86790","10001118193","CDM","302","RC","86790","HCPCS","facility","both","","","","421","421","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENCEPH/ST. LOUIS 86653","10001118195","CDM","302","RC","86653","HCPCS","facility","both","","","","129","129","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENCEPH, WEST EQ 86654","10001118197","CDM","302","RC","86654","HCPCS","facility","both","","","","129","129","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYCOPLAMS TITER 86738","10001118199","CDM","302","RC","86738","HCPCS","facility","both","","","","174.5","174.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CMV IGG TITER","10001118201","CDM","302","RC","86644","HCPCS","facility","both","","","","305.5","305.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENCEPH/CAL EQ","10001118203","CDM","302","RC","86651","HCPCS","facility","both","","","","129","129","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUMPS (CFT) 86735","10001118205","CDM","302","RC","86735","HCPCS","facility","both","","","","218.5","218.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PSITTASCOSIS-CFT 86631","10001118207","CDM","302","RC","86631","HCPCS","facility","both","","","","129","129","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HELIOCOBACTER AB TITTER I","10001118209","CDM","302","RC","86677","HCPCS","facility","both","","","","176","176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYCOPLASMA PNEU IGM","10001118211","CDM","302","RC","86738","HCPCS","facility","both","","","","306.5","306.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYCOPLASMA PNEUM IGG","10001118213","CDM","302","RC","86738","HCPCS","facility","both","","","","283","283","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLMDIA PNEUM TWAR IGG","10001118215","CDM","302","RC","86631","HCPCS","facility","both","","","","324.5","324.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLAMDIA PNEUM TWAR IGM","10001118217","CDM","302","RC","86632","HCPCS","facility","both","","","","324.5","324.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLU, 3 ANT-ST 86710","10001118219","CDM","302","RC","86710","HCPCS","facility","both","","","","396","396","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLU, 3 ANT-2ND 86710","10001118221","CDM","302","RC","86710","HCPCS","facility","both","","","","203.5","203.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EBV IGM NA 86664","10001118223","CDM","302","RC","86664","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EBV IGM VCA 86665","10001118225","CDM","302","RC","86665","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EBVIGG NA 86664","10001118227","CDM","302","RC","86664","HCPCS","facility","both","","","","159","159","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EBV IGG VCA 86665","10001118229","CDM","302","RC","86665","HCPCS","facility","both","","","","153.5","153.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HERPES SIMPLEX OTHER 8669","10001118231","CDM","302","RC","86694","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HERPES SIMPLEX TYPE 1, 86","10001118237","CDM","302","RC","86695","HCPCS","facility","both","","","","153.5","153.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BLASTOMYCES COMP FIX","10001118239","CDM","302","RC","86612","HCPCS","facility","both","","","","111","111","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BLASTOMYCES 1MM DIFF","10001118241","CDM","302","RC","86612","HCPCS","facility","both","","","","111","111","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SACCHAROMYCES IGG","10001118243","CDM","302","RC","86671","HCPCS","facility","both","","","","115.5","115.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SACCHAROMYCES IGA","10001118245","CDM","302","RC","86671","HCPCS","facility","both","","","","115.5","115.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INHIBIN A","10001118247","CDM","302","RC","86336","HCPCS","facility","both","","","","76.5","76.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CELIAC DISEASE SEROLOGY*","10001118249","CDM","302","RC","86255","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTIPHOSPOLIPID AB PANEL*","10001118251","CDM","302","RC","86148","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHYPHATADYLSERINE AB*","10001118253","CDM","302","RC","86148","HCPCS","facility","both","","","","145.5","145.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELET ANTIBODY INDIREC","10001118255","CDM","302","RC","86022","HCPCS","facility","both","","","","405","405","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOSPHATIDYLSERINE AB*","10001118257","CDM","302","RC","86148","HCPCS","facility","both","","","","145","145","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELET ASSOC AB IGG,IGM","10001118259","CDM","302","RC","86023","HCPCS","facility","both","","","","115.5","115.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTIPROTEINASE 3 AB","10001118261","CDM","302","RC","86021","HCPCS","facility","both","","","","76.5","76.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RESPIRATORY DISEASE PANEL","10001118263","CDM","302","RC","86003","HCPCS","facility","both","","","","334","334","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FOOD ALLERGY PROFILE*","10001118265","CDM","302","RC","86003","HCPCS","facility","both","","","","41","41","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HGA ANAPLASMOSIS*","10001118267","CDM","302","RC","86666","HCPCS","facility","both","","","","114.5","114.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN ELECTRPHORESIS UR","10001118269","CDM","302","RC","86335","HCPCS","facility","both","","","","133.5","133.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STRONGYLOIDES IGG ANTIBOD","10001118271","CDM","302","RC","86682","HCPCS","facility","both","","","","132.5","132.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIVER KIDNEY MICROSOME IG","10001118273","CDM","302","RC","86376","HCPCS","facility","both","","","","75.5","75.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LUPUS ERYTHEMATOSIS PROFI","10001118275","CDM","302","RC","86038","HCPCS","facility","both","","","","256","256","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROMETHEUS IBD DX W CHROH","10001118277","CDM","302","RC","86140","HCPCS","facility","both","","","","1115","1115","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SCLERODERMA AB SCL-70","10001118279","CDM","302","RC","86235","HCPCS","facility","both","","","","68.5","68.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTICARDIOLIPIN A/B","10001118281","CDM","302","RC","86147","HCPCS","facility","both","","","","634.5","634.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTINEURONAL A/B","10001118283","CDM","302","RC","86255","HCPCS","facility","both","","","","849","849","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRP, QUAN","10001118285","CDM","302","RC","86140","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FECAL ELECTROLYTES*","10001118287","CDM","302","RC","84302","HCPCS","facility","both","","","","34","34","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GRANULOCYTE ANTIBODY","10001118289","CDM","302","RC","86021","HCPCS","facility","both","","","","508.5","508.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SERONTONIN RELEASE ASSAY","10001118291","CDM","302","RC","86022","HCPCS","facility","both","","","","588.5","588.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRP CARDIO (HI SENS)","10001118295","CDM","302","RC","86141","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BETA2 GLYCOPROTIEN I","10001118297","CDM","302","RC","86146","HCPCS","facility","both","","","","222","222","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C1 ESTARRASE FUNCTIONAL","10001118299","CDM","302","RC","86161","HCPCS","facility","both","","","","70.5","70.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC JO-1 ANTIBODY","10001118301","CDM","302","RC","86235","HCPCS","facility","both","","","","104","104","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRINSIC BLOCKING FACTOR","10001118303","CDM","302","RC","86340","HCPCS","facility","both","","","","229.5","229.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PNH BY FLOW CYTOMETRY","10001118305","CDM","302","RC","86356","HCPCS","facility","both","","","","104","104","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PAN T CD3","10001118307","CDM","302","RC","86359","HCPCS","facility","both","","","","251.5","251.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BORDETELLA ANTIBODY1","10001118309","CDM","302","RC","86615","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BORDETELLA ANTIBODY2","10001118311","CDM","302","RC","86615","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HELMINTH SEROLOGY","10001118313","CDM","302","RC","86682","HCPCS","facility","both","","","","141.5","141.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PNEUMONITIS HYPERSENSITIV","10001118315","CDM","302","RC","86744","HCPCS","facility","both","","","","230","230","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CA 27.29","10001118317","CDM","302","RC","86300","HCPCS","facility","both","","","","285","285","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANCA PANEL","10001118319","CDM","302","RC","86021","HCPCS","facility","both","","","","1211","1211","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI - DNA","10001118321","CDM","302","RC","86225","HCPCS","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEOXYRIBONUCLEASE ANTIBOD","10001118323","CDM","302","RC","86215","HCPCS","facility","both","","","","202","202","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOELECTRO-Q 86320","10001118325","CDM","302","RC","86320","HCPCS","facility","both","","","","533","533","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC A-MITOCHON","10001118327","CDM","302","RC","86256","HCPCS","facility","both","","","","298.5","298.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T CELLS, CD4, CD8, RATIO","10001118329","CDM","302","RC","86360","HCPCS","facility","both","","","","266.5","266.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FTA - BLOOD","10001118331","CDM","302","RC","86780","HCPCS","facility","both","","","","190.5","190.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPLEMENT,C-3 86160","10001118335","CDM","302","RC","86160","HCPCS","facility","both","","","","434.5","434.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPLEMENT TOTAL","10001118337","CDM","302","RC","86162","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPLIMENT C-4 FLUID","10001118339","CDM","302","RC","86160","HCPCS","facility","both","","","","99.5","99.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDOMYSIAL ANITBODY SCREE","10001118341","CDM","302","RC","86255","HCPCS","facility","both","","","","193","193","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BORDETELLA PERTUSSIS IGG/","10001118343","CDM","302","RC","86615","HCPCS","facility","both","","","","274.5","274.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEPTOSPIRA AB SCREEN","10001118345","CDM","302","RC","86720","HCPCS","facility","both","","","","472","472","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HLA-B27","10001118347","CDM","302","RC","86812","HCPCS","facility","both","","","","434.5","434.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOELECT-FLDS 86325","10001118349","CDM","302","RC","86325","HCPCS","facility","both","","","","569","569","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOELECTROPHARISM","10001118351","CDM","302","RC","86325","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPLEMENT C-4 86160","10001118355","CDM","302","RC","86160","HCPCS","facility","both","","","","434.5","434.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC B-J PROT ELEC-B86320","10001118357","CDM","302","RC","86320","HCPCS","facility","both","","","","533","533","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SJORGRENS ANTIBODY FIRST","10001118359","CDM","302","RC","86235","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SJORGENS ANTIBODY SECOND","10001118361","CDM","302","RC","86235","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEURONAL NUCLEAR (HU) AB","10001118363","CDM","302","RC","86255","HCPCS","facility","both","","","","240","240","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEURONAL NUCLEAR (RI) AB","10001118365","CDM","302","RC","86255","HCPCS","facility","both","","","","325.5","325.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PURKINKE CELL CYTOPLAS AB","10001118367","CDM","302","RC","86255","HCPCS","facility","both","","","","294.5","294.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CA 15-3","10001118369","CDM","302","RC","86300","HCPCS","facility","both","","","","362","362","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CA 19-9","10001118371","CDM","302","RC","86301","HCPCS","facility","both","","","","336","336","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CA 125","10001118373","CDM","302","RC","86304","HCPCS","facility","both","","","","362","362","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP E ANTIBODIES*","10001118375","CDM","302","RC","86790","HCPCS","facility","both","","","","339","339","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP A AB-IGG","10001118377","CDM","302","RC","86708","HCPCS","facility","both","","","","215.5","215.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COLD AUTO ABSOR86978","10001118379","CDM","302","RC","86978","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPATITIS BC ANTIBODY IGM","10001118381","CDM","302","RC","86705","HCPCS","facility","both","","","","171","171","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP B CORE ANTIBODY","10001118383","CDM","302","RC","86704","HCPCS","facility","both","","","","171","171","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP B SURFACE ANTIBODY","10001118385","CDM","302","RC","86706","HCPCS","facility","both","","","","169.5","169.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPATITIS D   86692","10001118387","CDM","302","RC","86692","HCPCS","facility","both","","","","121","121","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP SCREEN-HBCAB","10001118389","CDM","302","RC","86704","HCPCS","facility","both","","","","98.5","98.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP SCREEN-HAAB","10001118391","CDM","302","RC","86709","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP SCREEN-HCAB","10001118393","CDM","302","RC","86803","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP BE ANTIBODY","10001118395","CDM","302","RC","86707","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP C AB","10001118397","CDM","302","RC","86803","HCPCS","facility","both","","","","217.5","217.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP A AB-IGM","10001118399","CDM","302","RC","86709","HCPCS","facility","both","","","","243.5","243.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI HIV 86703","10001118401","CDM","302","RC","86703","HCPCS","facility","both","","","","284.5","284.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WESTERN BLOT 86689","10001118403","CDM","302","RC","86689","HCPCS","facility","both","","","","559","559","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI HTLVI","10001118405","CDM","302","RC","86687","HCPCS","facility","both","","","","196.5","196.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HIV 1","10001118407","CDM","302","RC","86701","HCPCS","facility","both","","","","171","171","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HIV 2","10001118409","CDM","302","RC","86702","HCPCS","facility","both","","","","171","171","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HBNEUT","10001118411","CDM","302","RC","86382","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HCVRIB","10001118413","CDM","302","RC","86804","HCPCS","facility","both","","","","414.5","414.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HTLV II AB 86688","10001118415","CDM","302","RC","86688","HCPCS","facility","both","","","","196.5","196.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HLA TYPING - A,B,C","10001118417","CDM","302","RC","86813","HCPCS","facility","both","","","","2075","2075","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEUKOCYTE AB 86021","10001118419","CDM","302","RC","86021","HCPCS","facility","both","","","","215","215","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELET ANTIBODY DIRECT","10001118421","CDM","302","RC","86022","HCPCS","facility","both","","","","215","215","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI PLATELET AB INDIRECT","10001118423","CDM","302","RC","86022","HCPCS","facility","both","","","","99.5","99.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPERIN INDUCED PLATELET","10001118425","CDM","302","RC","86022","HCPCS","facility","both","","","","99.5","99.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI PLATELET AB DIRECT","10001118427","CDM","302","RC","86023","HCPCS","facility","both","","","","99","99","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP B SURF ANTI","10001118429","CDM","302","RC","86706","HCPCS","facility","both","","","","139.5","139.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC V.D.R.L. CSF 86592 QUAL","10001118431","CDM","302","RC","86592","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IGM ANTIBODY HEPATITER","10001118433","CDM","302","RC","86709","HCPCS","facility","both","","","","335","335","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WBLYME IGG","10001118435","CDM","302","RC","86617","HCPCS","facility","both","","","","104","104","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-THYROID PEROXIDASE A","10001118437","CDM","302","RC","86376","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WBLYME IGM","10001118439","CDM","302","RC","86617","HCPCS","facility","both","","","","104","104","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RA LATEX-QL 86430","10001118443","CDM","302","RC","86430","HCPCS","facility","both","","","","98","98","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYMES DISEASE TITER 86618","10001118445","CDM","302","RC","86618","HCPCS","facility","both","","","","104","104","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENA IGG & IGM","10001118447","CDM","302","RC","86235","HCPCS","facility","both","","","","351.5","351.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AGGLU TULAREMIA86668","10001118451","CDM","302","RC","86668","HCPCS","facility","both","","","","148","148","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AGGLUT FEB EA 86000","10001118453","CDM","302","RC","86000","HCPCS","facility","both","","","","118.5","118.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AGGLUT-BRUCELLA","10001118457","CDM","302","RC","86622","HCPCS","facility","both","","","","178","178","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-NUCLEAR ANTIBODY 860","10001118459","CDM","302","RC","86038","HCPCS","facility","both","","","","99","99","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANA, TITER 86039","10001118461","CDM","302","RC","86039","HCPCS","facility","both","","","","99.5","99.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MICROSOMAL ANTI85385","10001118463","CDM","302","RC","86376","HCPCS","facility","both","","","","261.5","261.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STS. VDRL OR RP86592 QUAL","10001118465","CDM","302","RC","86592","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-STREPTOLY 86060","10001118467","CDM","302","RC","86060","HCPCS","facility","both","","","","178","178","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THYROGLOB ANTI","10001118469","CDM","302","RC","86800","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AGGLUT TRICHINA","10001118471","CDM","302","RC","86784","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COLD AGGULT TITER","10001118473","CDM","302","RC","86157","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAST TEST EACH","10001118477","CDM","302","RC","86003","HCPCS","facility","both","","","","203","203","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MONO-SCREEN TST 86308","10001118479","CDM","302","RC","86308","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RA LATEX-QT","10001118481","CDM","302","RC","86431","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANITBODIES, FTA BLOOD","10001118483","CDM","302","RC","86780","HCPCS","facility","both","","","","256.5","256.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASO-SCREEN 86063","10001118485","CDM","302","RC","86063","HCPCS","facility","both","","","","131","131","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C-REACTIVE PROT86140","10001118487","CDM","302","RC","86140","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AGG LEPTO DEFIN86597","10001118489","CDM","302","RC","86720","HCPCS","facility","both","","","","284.5","284.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HETEROPHIL TITE86310","10001118493","CDM","302","RC","86310","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STS,VDRL OR RP86593 QUANT","10001118495","CDM","302","RC","86593","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BENCE-JONES QUANT*","10001118497","CDM","302","RC","86335","HCPCS","facility","both","","","","233.5","233.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALLERGEN SPECIFIC IGE","10001118499","CDM","302","RC","86003","HCPCS","facility","both","","","","22.5","22.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOGLOBULIN ASSAY","10001118501","CDM","302","RC","86023","HCPCS","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C-REACTIVE PROTEIN","10001118503","CDM","302","RC","86140","HCPCS","facility","both","","","","22.5","22.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLYCOPROTEIN ANTIBODY","10001118505","CDM","302","RC","86146","HCPCS","facility","both","","","","103","103","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDIOLIPIN ANTIBODY","10001118507","CDM","302","RC","86147","HCPCS","facility","both","","","","103","103","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOSPHOLIPID ANTIBODY","10001118509","CDM","302","RC","86148","HCPCS","facility","both","","","","40.5","40.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DNA ANTIBODY","10001118511","CDM","302","RC","86225","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DNA ANTIBODY SIGNLE STRAN","10001118513","CDM","302","RC","86225","HCPCS","facility","both","","","","49.5","49.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUCLEAR ANTIGEN ANTIBODY","10001118515","CDM","302","RC","86235","HCPCS","facility","both","","","","71.5","71.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOURESCENT ANTIBODY SCRE","10001118517","CDM","302","RC","86255","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYME DISEASE ANTIBODY","10001118519","CDM","302","RC","86618","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CMV ANITBODY","10001118521","CDM","302","RC","86644","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CMV ANTIBODY, IGM","10001118523","CDM","302","RC","86645","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENCEPHALITIS AB CALIFORNI","10001118525","CDM","302","RC","86651","HCPCS","facility","both","","","","54.5","54.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENCEPHALITIS AB EASTERN","10001118527","CDM","302","RC","86652","HCPCS","facility","both","","","","54.5","54.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENCEPHALITIS AB ST LOUIS","10001118529","CDM","302","RC","86653","HCPCS","facility","both","","","","54.5","54.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENCEPHALITIS AB WESTERN","10001118531","CDM","302","RC","86654","HCPCS","facility","both","","","","54.5","54.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENTEROVIRUS ANTIBODY","10001118533","CDM","302","RC","86658","HCPCS","facility","both","","","","54.5","54.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EHRLICHIA ANTIBODY","10001118535","CDM","302","RC","86666","HCPCS","facility","both","","","","42.5","42.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HERPES SIMPLEX TEST","10001118537","CDM","302","RC","86694","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HERPES SIMPLEX TYPE 1 TES","10001118539","CDM","302","RC","86695","HCPCS","facility","both","","","","54.5","54.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HERPES SIMPLEX TYPE 2","10001118541","CDM","302","RC","86696","HCPCS","facility","both","","","","79.5","79.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFLUENZA VIRUS ANTIBODY","10001118543","CDM","302","RC","86710","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYMPH CHORIOMENINGITIS AB","10001118545","CDM","302","RC","86727","HCPCS","facility","both","","","","53","53","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUMPS ANTIBODY","10001118547","CDM","302","RC","86735","HCPCS","facility","both","","","","54.5","54.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RUBELLA ANTIBODY","10001118549","CDM","302","RC","86762","HCPCS","facility","both","","","","114.5","114.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RUBEOLA ANTIBODY","10001118551","CDM","302","RC","86765","HCPCS","facility","both","","","","41","41","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SALMONELL ANTIBODY","10001118553","CDM","302","RC","86768","HCPCS","facility","both","","","","54.5","54.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TOXOPLASMA ANTIBODY","10001118555","CDM","302","RC","86777","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VARICELLA-ZOSTER ANTIBODY","10001118557","CDM","302","RC","86787","HCPCS","facility","both","","","","53","53","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNODIFFUSION OUCHTERLO","10001118559","CDM","302","RC","86331","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNODIFFUSION OUCHTERLO","10001118561","CDM","302","RC","86331","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASPERGILLUS AB 1","10001118563","CDM","302","RC","86606","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASPERGILLUS AB 2","10001118565","CDM","302","RC","86606","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASPERGILLUS AB 3","10001118567","CDM","302","RC","86606","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FUNGUS AB 1","10001118569","CDM","302","RC","86671","HCPCS","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FUNGUS AB 2","10001118571","CDM","302","RC","86671","HCPCS","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP E IGG","10001118573","CDM","302","RC","86790","HCPCS","facility","both","","","","53.5","53.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-DIFF ABSORBTIONS","10001118575","CDM","302","RC","86978","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-INHIBITION STUDIES","10001118577","CDM","302","RC","86977","HCPCS","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-TITRATION OF ANTIBODY","10001118579","CDM","302","RC","86976","HCPCS","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-DRUG STUDIES","10001118581","CDM","302","RC","86975","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-PLATELET AB XM","10001118583","CDM","302","RC","86022","HCPCS","facility","both","","","","683.5","683.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-PLATELET AB SCREEN","10001118585","CDM","302","RC","86022","HCPCS","facility","both","","","","125.5","125.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-PLATELET ANTIBODY ID","10001118587","CDM","302","RC","86022","HCPCS","facility","both","","","","527","527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-PLATELET ANTIGEN TYPE","10001118589","CDM","302","RC","86022","HCPCS","facility","both","","","","29.5","29.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-PLATELET ANTIGEN TYPE","10001118591","CDM","302","RC","86022","HCPCS","facility","both","","","","29.5","29.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-PLATELET ANTIGEN TYPE","10001118593","CDM","302","RC","86849","HCPCS","facility","both","","","","29.5","29.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-SERUM SCR CYTOTOX PRA","10001118595","CDM","302","RC","86807","HCPCS","facility","both","","","","75.5","75.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-SERUM SCR CYTOTOX PRA","10001118597","CDM","302","RC","86808","HCPCS","facility","both","","","","57","57","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-FLOW CYTOMETRY FOR AB","10001118599","CDM","302","RC","86849","HCPCS","facility","both","","","","7","7","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-SERUM SCR CYTOTOX PRA","10001118601","CDM","302","RC","86807","HCPCS","facility","both","","","","181","181","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-SERUM SCR CYTOTOX PRA","10001118603","CDM","302","RC","86808","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-FLOW CYTOMETRY FOR AB","10001118605","CDM","302","RC","86849","HCPCS","facility","both","","","","16.5","16.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-HLA TYPING-SEROLOGICA","10001118607","CDM","302","RC","86813","HCPCS","facility","both","","","","349.5","349.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FIBRINOGEN, ACTIVITY 8538","10001118609","CDM","305","RC","85384","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VISCOSITY, SERUM 85810","10001118611","CDM","305","RC","85810","HCPCS","facility","both","","","","79","79","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACID HEMOLYSIS 85475","10001118613","CDM","305","RC","85475","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE MARROW EXAM","10001118615","CDM","305","RC","85097","HCPCS","facility","both","","","","87","87","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALKPHOS SMEAR 85540","10001118619","CDM","305","RC","85540","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ERYTHROCYTE CNT 85041","10001118623","CDM","305","RC","85041","HCPCS","facility","both","","","","16.5","16.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOGLOBIN","10001118625","CDM","305","RC","85018","HCPCS","facility","both","","","","24.5","24.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WBC ONLY","10001118629","CDM","305","RC","85048","HCPCS","facility","both","","","","26.5","26.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOGLOBIN, CYAN 85018","10001118631","CDM","305","RC","85018","HCPCS","facility","both","","","","24","24","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE MARROW  85097","10001118633","CDM","305","RC","85097","HCPCS","facility","both","","","","86.5","86.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMATROCRIT","10001118635","CDM","305","RC","85014","HCPCS","facility","both","","","","27.5","27.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RETICULOCYTE CN AUTO","10001118639","CDM","305","RC","85045","HCPCS","facility","both","","","","29.5","29.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SED RATE NON AUTO","10001118641","CDM","305","RC","85651","HCPCS","facility","both","","","","26","26","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SICKLE CELL PRE 85660","10001118643","CDM","305","RC","85660","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOGLOBIN FETA 85460","10001118645","CDM","305","RC","85460","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACT PTT SUB 85732","10001118647","CDM","305","RC","85732","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EUGLOGULIN CLOT 85360","10001118649","CDM","305","RC","85360","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR II ASSAY 85210","10001118651","CDM","305","RC","85210","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR VIII ASSAY 85240","10001118653","CDM","305","RC","85240","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR IX ASSAY","10001118655","CDM","305","RC","85250","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR X ASSAY 85260","10001118657","CDM","305","RC","85260","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTO XI ASSAY 85270","10001118659","CDM","305","RC","85270","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR XII ASSAY 85280","10001118661","CDM","305","RC","85280","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR XIII ASSAY 85290","10001118663","CDM","305","RC","85290","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CIRCULATION ANT 85300","10001118665","CDM","305","RC","85300","HCPCS","facility","both","","","","49.5","49.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FIBRIN PR 85362","10001118667","CDM","305","RC","85362","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTAMINE SULF 85530","10001118669","CDM","305","RC","85530","HCPCS","facility","both","","","","39.5","39.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARTIAL THROMBO 85730","10001118671","CDM","305","RC","85730","HCPCS","facility","both","","","","43","43","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR V ASSAY 85220","10001118673","CDM","305","RC","85220","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR VII ASSAY 85230","10001118675","CDM","305","RC","85230","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOT RETRACTION 85170","10001118677","CDM","305","RC","85170","HCPCS","facility","both","","","","24","24","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THROMBIN TIME PLASMA 8567","10001118679","CDM","305","RC","85670","HCPCS","facility","both","","","","31.5","31.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTHROMBIN TIM 85610","10001118681","CDM","305","RC","85610","HCPCS","facility","both","","","","35.5","35.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR III ASSAY 85300","10001118683","CDM","305","RC","85300","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTHRO SUM TST 85612","10001118685","CDM","305","RC","85611","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C B C","10001118687","CDM","305","RC","85025","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOGLOBIN 85018","10001118689","CDM","305","RC","85018","HCPCS","facility","both","","","","24","24","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR 5 LEIDEN","10001118691","CDM","305","RC","85220","HCPCS","facility","both","","","","440.5","440.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LUPUS ANTICOAGULANT","10001118693","CDM","305","RC","85705","HCPCS","facility","both","","","","306","306","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN C ACTIVITY","10001118695","CDM","305","RC","85303","HCPCS","facility","both","","","","302.5","302.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN S TOTAL","10001118697","CDM","305","RC","85305","HCPCS","facility","both","","","","90.5","90.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACTIVATED PROTEIN C RESIS","10001118699","CDM","305","RC","85307","HCPCS","facility","both","","","","185","185","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN S FREE","10001118701","CDM","305","RC","85306","HCPCS","facility","both","","","","90.5","90.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KAOLIN CLOTTING TIME","10001118703","CDM","305","RC","85347","HCPCS","facility","both","","","","321.5","321.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLASMINOGEN FIBRINOLYTIC","10001118705","CDM","305","RC","85420","HCPCS","facility","both","","","","313.5","313.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APT","10001118707","CDM","305","RC","85460","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RUSSELLS VIPER VENOM TIME","10001118709","CDM","305","RC","85612","HCPCS","facility","both","","","","54.5","54.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RISTOCETIN COFACTOR","10001118711","CDM","305","RC","85245","HCPCS","facility","both","","","","404.5","404.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ART HEMOGLOBIN 85018","10001118713","CDM","305","RC","85018","HCPCS","facility","both","","","","121","121","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FIBRINOGEN, QUA 85384 ACT","10001118715","CDM","305","RC","85384","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VISCOSITY, SERUM 85810","10001118717","CDM","305","RC","85810","HCPCS","facility","both","","","","193.5","193.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACID HEMOLYSIS 85475","10001118719","CDM","305","RC","85475","HCPCS","facility","both","","","","135","135","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPARIN ANTI-XA ASSAY","10001118721","CDM","305","RC","85520","HCPCS","facility","both","","","","420","420","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION REACTION","10001118723","CDM","305","RC","86078","HCPCS","facility","both","","","","91","91","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VON WILLEBRAND FACTR VIII","10001118727","CDM","305","RC","85246","HCPCS","facility","both","","","","194.5","194.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC D-DIMER QUANT","10001118729","CDM","305","RC","85379","HCPCS","facility","both","","","","222","222","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC D-DIMER  QUAL/SEMIQT 8537","10001118731","CDM","305","RC","85378","HCPCS","facility","both","","","","129","129","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELET NEUTRALIZATION","10001118733","CDM","305","RC","85597","HCPCS","facility","both","","","","113","113","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELET COUNT 85049","10001118735","CDM","305","RC","85049","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALK PHOS SMEAR 85540","10001118737","CDM","305","RC","85540","HCPCS","facility","both","","","","142.5","142.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IN/OUT BLOOD CT85027","10001118739","CDM","305","RC","85027","HCPCS","facility","both","","","","148","148","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MORPH RBC OTHER 85008","10001118741","CDM","305","RC","85008","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ERYTHROCYTE CNT85041","10001118743","CDM","305","RC","85041","HCPCS","facility","both","","","","75","75","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOGLOBIN","10001118745","CDM","305","RC","85018","HCPCS","facility","both","","","","85.5","85.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BLD CT; MANUAL DIFF WBC C","10001118747","CDM","305","RC","85007","HCPCS","facility","both","","","","64.5","64.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WBC & DIFF BLD 85025","10001118749","CDM","305","RC","85025","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WBC ONLY","10001118751","CDM","305","RC","85048","HCPCS","facility","both","","","","74.5","74.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOGLOBIN,CYAN85018","10001118753","CDM","305","RC","85018","HCPCS","facility","both","","","","75","75","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMP BLOOD CNT 85025","10001118755","CDM","305","RC","85025","HCPCS","facility","both","","","","163.5","163.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TOTAL EO COUNT 85048","10001118757","CDM","305","RC","85048","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMATOCRIT","10001118759","CDM","305","RC","85014","HCPCS","facility","both","","","","74.5","74.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RETICULOCYTE CN AUTO 8504","10001118763","CDM","305","RC","85045","HCPCS","facility","both","","","","78.5","78.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SED RATE NON AUTO","10001118765","CDM","305","RC","85651","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SICKLE CELL PRE85660","10001118767","CDM","305","RC","85660","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMOGLOBIN FETA85460","10001118769","CDM","305","RC","85460","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VON WILLEBRAND MULTIMERS","10001118773","CDM","305","RC","85247","HCPCS","facility","both","","","","156","156","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR 13","10001118775","CDM","305","RC","85290","HCPCS","facility","both","","","","114","114","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTITHROMBIN III","10001118777","CDM","305","RC","85300","HCPCS","facility","both","","","","108.5","108.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN C ANTIGEN","10001118779","CDM","305","RC","85302","HCPCS","facility","both","","","","109","109","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN S (TOTAL)","10001118781","CDM","305","RC","85305","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN S (FREE)","10001118783","CDM","305","RC","85306","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR 8 INHIBITOR","10001118785","CDM","305","RC","85335","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACT PTT SUB 85732","10001118787","CDM","305","RC","85732","HCPCS","facility","both","","","","164.5","164.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EUGLOGULIN CLOT85360","10001118789","CDM","305","RC","85360","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR II ASSAY85210","10001118791","CDM","305","RC","85210","HCPCS","facility","both","","","","182.5","182.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR VIII ASS85240","10001118793","CDM","305","RC","85240","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR IX ASSAY85250","10001118795","CDM","305","RC","85250","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR X ASSAY 85260","10001118797","CDM","305","RC","85260","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR XI ASSAY85270","10001118799","CDM","305","RC","85270","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR XII ASSA85280","10001118801","CDM","305","RC","85280","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR XIII ASS85290","10001118803","CDM","305","RC","85290","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CIRCULATING ANT85300","10001118805","CDM","305","RC","85300","HCPCS","facility","both","","","","292.5","292.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELET AGGREG","10001118807","CDM","305","RC","85576","HCPCS","facility","both","","","","375.5","375.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELET MANUAL COUNT 855","10001118809","CDM","305","RC","85032","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FIBRIN SPLIT PR85362","10001118811","CDM","305","RC","85362","HCPCS","facility","both","","","","176","176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTAMINE SULF 85530","10001118813","CDM","305","RC","85530","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARTIAL THROMBO85730","10001118815","CDM","305","RC","85730","HCPCS","facility","both","","","","106.5","106.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THROMBOPLASTIN SUBSTITUTI","10001118817","CDM","305","RC","85732","HCPCS","facility","both","","","","163.5","163.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR V ASSAY 85220","10001118819","CDM","305","RC","85220","HCPCS","facility","both","","","","266","266","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR VII ASSA85230","10001118821","CDM","305","RC","85230","HCPCS","facility","both","","","","266","266","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BLEEDING TIME 85002","10001118823","CDM","305","RC","85002","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR I ASSAY 85384","10001118827","CDM","305","RC","85384","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOT RETRACTION85170","10001118829","CDM","305","RC","85170","HCPCS","facility","both","","","","66.5","66.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THROMBIN TIME PLATELET 85","10001118831","CDM","305","RC","85670","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTHROMBIN TIM85610","10001118833","CDM","305","RC","85610","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR III ASSA85300","10001118835","CDM","305","RC","85300","HCPCS","facility","both","","","","302.5","302.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTHRO SUB TST 85611","10001118837","CDM","305","RC","85611","HCPCS","facility","both","","","","164.5","164.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SSP HEMOGRAM 85021","10001118839","CDM","305","RC","85027","HCPCS","facility","both","","","","64.5","64.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-UNIT SICKLING RBC RED","10001118841","CDM","305","RC","85660","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEGIONELLA CULTURE","10001118845","CDM","306","RC","87040","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HERPES CULT 87252","10001118847","CDM","306","RC","87252","HCPCS","facility","both","","","","223.5","223.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANAROBIC CULT 87075","10001118849","CDM","306","RC","87075","HCPCS","facility","both","","","","108.5","108.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONCENTRATION T 87015","10001118851","CDM","306","RC","87015","HCPCS","facility","both","","","","46.5","46.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRYPT ANTGEN SCRN","10001118853","CDM","306","RC","87328","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOCHEM, 1ST PANEL","10001118855","CDM","306","RC","87077","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOCHEM, EA ADD'L PANEL","10001118857","CDM","306","RC","87077","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CULT STOOL VIBRIO","10001118859","CDM","306","RC","87046","HCPCS","facility","both","","","","26","26","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CULT STOOL E COLI","10001118861","CDM","306","RC","87046","HCPCS","facility","both","","","","26","26","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BLOOD CULTURE 87040","10001118863","CDM","306","RC","87040","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AFB SMEAR ONLY 87206","10001118865","CDM","306","RC","87206","HCPCS","facility","both","","","","35.5","35.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AFB ID 87118","10001118867","CDM","306","RC","87118","HCPCS","facility","both","","","","127","127","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AFB CULT CONC/ID","10001118869","CDM","306","RC","87116","HCPCS","facility","both","","","","98.5","98.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AFB SENST 87190","10001118871","CDM","306","RC","87190","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VIRAL CULTURE 87252","10001118875","CDM","306","RC","87252","HCPCS","facility","both","","","","176","176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BACT.CULT,URINE, ID KIT","10001118877","CDM","306","RC","87088","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VIRUS LD;TISS CUL,ADDL ST","10001118879","CDM","306","RC","87253","HCPCS","facility","both","","","","178","178","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FUNGUS YEAST ID 87106","10001118881","CDM","306","RC","87106","HCPCS","facility","both","","","","115.5","115.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SENSITIVITY MIC","10001118883","CDM","306","RC","87186","HCPCS","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SENSITIVITY KB","10001118885","CDM","306","RC","87184","HCPCS","facility","both","","","","39.5","39.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MACROSCOPIC EXAM;ARTHROPO","10001118887","CDM","306","RC","87168","HCPCS","facility","both","","","","43","43","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DARKFIELD 87164","10001118889","CDM","306","RC","87164","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BACT, SMEAR, STA","10001118891","CDM","306","RC","87205","HCPCS","facility","both","","","","31.5","31.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FUNGUS CULT NOT SKIN HAIR","10001118893","CDM","306","RC","87102","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CULTURE BACTERIA 87070","10001118895","CDM","306","RC","87070","HCPCS","facility","both","","","","75.5","75.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CULT FUNGI DEF LD;MOLD","10001118897","CDM","306","RC","87107","HCPCS","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COLONY CNT-URI 87086 QT","10001118899","CDM","306","RC","87086","HCPCS","facility","both","","","","35.5","35.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP B SURFACE AG","10001118901","CDM","306","RC","87340","HCPCS","facility","both","","","","79","79","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP BE ANTIGEN","10001118903","CDM","306","RC","87350","HCPCS","facility","both","","","","76.5","76.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOSTRIDIUM TOXIN","10001118905","CDM","306","RC","87324","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MALARIA SMEARS 87207","10001118907","CDM","306","RC","87207","HCPCS","facility","both","","","","84.5","84.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP B SURF ANTI","10001118909","CDM","306","RC","87340","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COCCIDIO AGGLUT","10001118911","CDM","306","RC","87899","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC O&P STOOL EXAM","10001118913","CDM","306","RC","87177","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PIN WORM SLIDE","10001118915","CDM","306","RC","87172","HCPCS","facility","both","","","","31.5","31.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECIM OR MAT I 87210","10001118917","CDM","306","RC","87210","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRICHOMONADS, WE 87210","10001118919","CDM","306","RC","87210","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TAPEWORM INDENT","10001118921","CDM","306","RC","87169","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SERUM BACTERICIDE","10001118927","CDM","306","RC","87197","HCPCS","facility","both","","","","131.5","131.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFUENZA A/B PCR REFLEX H","10001118931","CDM","306","RC","87798","HCPCS","facility","both","","","","186.5","186.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFUENZA A H1N1*","10001118933","CDM","306","RC","87798","HCPCS","facility","both","","","","463.5","463.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AZITHROMYCIN SUSCEPTIBILI","10001118935","CDM","306","RC","87186","HCPCS","facility","both","","","","155.5","155.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SUSCEPTIBILITY TEST 2 DRU","10001118937","CDM","306","RC","87186","HCPCS","facility","both","","","","171","171","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADENOVIRUS PCR/DNA PROBE","10001118939","CDM","306","RC","87798","HCPCS","facility","both","","","","178.5","178.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYCLOSPORA/ISOSPORA*","10001118941","CDM","306","RC","87015","HCPCS","facility","both","","","","99.5","99.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BABESIA BY PCR","10001118943","CDM","306","RC","87798","HCPCS","facility","both","","","","657.5","657.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC JC POLYOMA VIRUS DNA PCR","10001118945","CDM","306","RC","87798","HCPCS","facility","both","","","","255","255","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC B PERTUSSIA/PARAPERTUSSIA","10001118947","CDM","306","RC","87798","HCPCS","facility","both","","","","569","569","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HUMAN HERPES VIRUS 8 DNA","10001118949","CDM","306","RC","87798","HCPCS","facility","both","","","","338.5","338.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARVOVIRUS B19 DNA PCR","10001118951","CDM","306","RC","87798","HCPCS","facility","both","","","","267.5","267.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BABESIA MICROTI DNA PCR","10001118953","CDM","306","RC","87798","HCPCS","facility","both","","","","264.5","264.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EBV DNA QT PCR","10001118955","CDM","306","RC","87799","HCPCS","facility","both","","","","595","595","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VZV DNA QL PCR","10001118957","CDM","306","RC","87798","HCPCS","facility","both","","","","498.5","498.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HSV TYPE 1&2 DNA PCR*","10001118959","CDM","306","RC","87529","HCPCS","facility","both","","","","264.5","264.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HERPES SIMPLEX 1","10001118961","CDM","306","RC","87529","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENTEROVIRUS PCR","10001118963","CDM","306","RC","87498","HCPCS","facility","both","","","","544.5","544.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTHRAX SCREEN, BLOOD CUL","10001118965","CDM","306","RC","87040","HCPCS","facility","both","","","","658","658","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTHRAX BLOOD CULT ONLY S","10001118967","CDM","306","RC","87040","HCPCS","facility","both","","","","373","373","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTHRAX SCREEN, NASAL CUL","10001118969","CDM","306","RC","87070","HCPCS","facility","both","","","","36.5","36.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADENO VIRAL CULTURE","10001118971","CDM","306","RC","87254","HCPCS","facility","both","","","","285.5","285.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STREP A CULT 87081","10001118973","CDM","306","RC","87081","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CMV AMTOGENEMIA","10001118975","CDM","306","RC","87252","HCPCS","facility","both","","","","285.5","285.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HSV RAPID CULTURE","10001118977","CDM","306","RC","87252","HCPCS","facility","both","","","","285.5","285.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VZV VIRAL CULTURES","10001118979","CDM","306","RC","87252","HCPCS","facility","both","","","","285.5","285.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFLUENZA A VIRAL CULTURE","10001118981","CDM","306","RC","87252","HCPCS","facility","both","","","","285.5","285.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFLUENZA B","10001118983","CDM","306","RC","87252","HCPCS","facility","both","","","","285.5","285.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARAINFLUENZA VIRAL CULTU","10001118985","CDM","306","RC","87252","HCPCS","facility","both","","","","285.5","285.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RSV VIRAL CULTURE","10001118987","CDM","306","RC","87252","HCPCS","facility","both","","","","286","286","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENTEROVIRUS VIRAL CULTURE","10001118989","CDM","306","RC","87252","HCPCS","facility","both","","","","285.5","285.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONCETRATION PLUS ISOLATI","10001118991","CDM","306","RC","87116","HCPCS","facility","both","","","","130","130","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYCOBACTERIUM ID","10001118993","CDM","306","RC","87118","HCPCS","facility","both","","","","61.5","61.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ETEST MIC AEROBE","10001118995","CDM","306","RC","87181","HCPCS","facility","both","","","","95.5","95.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ETEST ANAEROBE","10001118997","CDM","306","RC","87181","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SUSCEPTIBILITY YEAST PANE","10001118999","CDM","306","RC","87186","HCPCS","facility","both","","","","644","644","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SYNERGY STUDIES (EA)","10001119001","CDM","306","RC","87186","HCPCS","facility","both","","","","354","354","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FUNGI, EA DRUG  87192","10001119003","CDM","306","RC","87181","HCPCS","facility","both","","","","336.5","336.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLRCNT STAIN FOR BCTRIA/F","10001119005","CDM","306","RC","87206","HCPCS","facility","both","","","","130.5","130.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASPERGILLUS ANTIGEN","10001119007","CDM","306","RC","87305","HCPCS","facility","both","","","","253","253","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CMV ANTIGENT DETECTION DF","10001119009","CDM","306","RC","87332","HCPCS","facility","both","","","","145","145","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HISTO AG IMMUNO UR","10001119011","CDM","306","RC","87385","HCPCS","facility","both","","","","301","301","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RSV RAPID TEST","10001119013","CDM","306","RC","87420","HCPCS","facility","both","","","","53.5","53.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROTAVIRUS BY EIA","10001119015","CDM","306","RC","87425","HCPCS","facility","both","","","","53.5","53.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RPD FLU ANTIBODY (AREADY","10001119017","CDM","306","RC","87400","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLU - RAPID A","10001119019","CDM","306","RC","87400","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLU RAPID B","10001119021","CDM","306","RC","87400","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEGIONELLA UR ANTIGEN","10001119023","CDM","306","RC","87449","HCPCS","facility","both","","","","58.5","58.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLAMYDIA PNEUM TWAR","10001119025","CDM","306","RC","87486","HCPCS","facility","both","","","","425.5","425.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLAMYDIA TRACHOMATIS,AMP","10001119027","CDM","306","RC","87491","HCPCS","facility","both","","","","167.5","167.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOSTRIDIUM DIFF (PCR)","10001119029","CDM","306","RC","87493","HCPCS","facility","both","","","","215","215","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CMV QUANT PCR","10001119031","CDM","306","RC","87496","HCPCS","facility","both","","","","712.5","712.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENTEROVIRUS, DNA, AMP PRO","10001119033","CDM","306","RC","87498","HCPCS","facility","both","","","","196.5","196.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYCROBCTR TB AMPLFD PROBE","10001119035","CDM","306","RC","87556","HCPCS","facility","both","","","","331","331","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYCOBACERIA AVIUMINTERCEL","10001119037","CDM","306","RC","87561","HCPCS","facility","both","","","","638","638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEISSERIA GONORROHEAE AMP","10001119039","CDM","306","RC","87591","HCPCS","facility","both","","","","167.5","167.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STAPH A, DNA, AMP PROBE","10001119041","CDM","306","RC","87640","HCPCS","facility","both","","","","196.5","196.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MR-STAPH, DNA, AMP PROBE","10001119043","CDM","306","RC","87641","HCPCS","facility","both","","","","196.5","196.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STREP B, DNA, AMP PROBE","10001119045","CDM","306","RC","87653","HCPCS","facility","both","","","","196.5","196.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WEST NILE CSF PCR","10001119047","CDM","306","RC","87798","HCPCS","facility","both","","","","1109.5","1109.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEGIONELLA DNA PROBE","10001119053","CDM","306","RC","87540","HCPCS","facility","both","","","","251","251","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEGIONELLA CULTURE","10001119055","CDM","306","RC","87040","HCPCS","facility","both","","","","233","233","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STREP SCREEN 87081","10001119057","CDM","306","RC","87880","HCPCS","facility","both","","","","127.5","127.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLAMYDIA CULT 87110","10001119059","CDM","306","RC","87110","HCPCS","facility","both","","","","281","281","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HERPES CULT 87252","10001119061","CDM","306","RC","87252","HCPCS","facility","both","","","","508.5","508.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLAMIDIA SMEAR 87207","10001119063","CDM","306","RC","87207","HCPCS","facility","both","","","","174.5","174.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANAEROBIC CULT 87075","10001119065","CDM","306","RC","87075","HCPCS","facility","both","","","","244.5","244.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC H.PYLORI STOOL ANTIGENS","10001119067","CDM","306","RC","87338","HCPCS","facility","both","","","","351.5","351.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLMYDIA PNEUM CULT 87110","10001119069","CDM","306","RC","87110","HCPCS","facility","both","","","","486","486","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYME PCR BLOOD","10001119071","CDM","306","RC","87476","HCPCS","facility","both","","","","673","673","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYME PCR FLUID","10001119073","CDM","306","RC","87476","HCPCS","facility","both","","","","673","673","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CULTURE, TISSUE","10001119075","CDM","306","RC","87070","HCPCS","facility","both","","","","273","273","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONCENTRATION T87015","10001119077","CDM","306","RC","87015","HCPCS","facility","both","","","","129","129","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEGIONELLA DFA ANTGN","10001119079","CDM","306","RC","87278","HCPCS","facility","both","","","","231.5","231.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRYPT ANTGEN SCRN","10001119081","CDM","306","RC","87328","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYPT ANTGN TITER","10001119083","CDM","306","RC","87328","HCPCS","facility","both","","","","383.5","383.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GIARDIA,AG,EIA,STOOL","10001119085","CDM","306","RC","87329","HCPCS","facility","both","","","","70.5","70.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOCHEM, 1ST PANEL","10001119087","CDM","306","RC","87077","HCPCS","facility","both","","","","127","127","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOCHEM, EA ADD'L PANEL","10001119089","CDM","306","RC","87077","HCPCS","facility","both","","","","79.5","79.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CULT STOOL VIBRIO","10001119091","CDM","306","RC","87046","HCPCS","facility","both","","","","46.5","46.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CULT STOOL E COLI","10001119093","CDM","306","RC","87046","HCPCS","facility","both","","","","46.5","46.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BLOOD CULTURE 87040","10001119095","CDM","306","RC","87040","HCPCS","facility","both","","","","190","190","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRYPTOSPORDIOSIS(STOOL)*","10001119097","CDM","306","RC","87015","HCPCS","facility","both","","","","88.5","88.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TICK ID","10001119099","CDM","306","RC","87168","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SMEAR(FLOURESCENT/ACID)","10001119101","CDM","306","RC","87206","HCPCS","facility","both","","","","23.5","23.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFLUENZA VIRUS CULTURE","10001119103","CDM","306","RC","87254","HCPCS","facility","both","","","","253","253","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SHIGA TOXINS, STL","10001119105","CDM","306","RC","87427","HCPCS","facility","both","","","","143","143","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHLM TRACHMTS, DIR PROB 8","10001119107","CDM","306","RC","87490","HCPCS","facility","both","","","","168","168","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRYPTOSPORIDIUM","10001119109","CDM","306","RC","87272","HCPCS","facility","both","","","","96.5","96.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AFB SMEAR ONLY 87206","10001119111","CDM","306","RC","87206","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AFB ID 87118","10001119113","CDM","306","RC","87118","HCPCS","facility","both","","","","212","212","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AFB CULT CONC/ID 87117","10001119115","CDM","306","RC","87116","HCPCS","facility","both","","","","225","225","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AFB SENST 87190","10001119117","CDM","306","RC","87186","HCPCS","facility","both","","","","164","164","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BACT. CULT, THROAT 87060","10001119119","CDM","306","RC","87070","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BACT. CULT, OTHER, DEFIN","10001119121","CDM","306","RC","87070","HCPCS","facility","both","","","","156","156","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BACT.CULT, STOOL 87045","10001119123","CDM","306","RC","87045","HCPCS","facility","both","","","","168","168","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VIRAL CULTURE 87252","10001119125","CDM","306","RC","87252","HCPCS","facility","both","","","","303.5","303.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BACT.CULT URIN ID KIT EA","10001119129","CDM","306","RC","87088","HCPCS","facility","both","","","","142.5","142.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BACT CULT, ANAEROBIC 8707","10001119131","CDM","306","RC","87075","HCPCS","facility","both","","","","168","168","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VIRUS LD;TISS CUL,ADDL ST","10001119133","CDM","306","RC","87253","HCPCS","facility","both","","","","347","347","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FUNG CULT, SKIN 87101","10001119135","CDM","306","RC","87101","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COLONY CNT-WATE00000","10001119137","CDM","306","RC","87102","HCPCS","facility","both","","","","76.5","76.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FUNG CULT, BLOOD 87103","10001119139","CDM","306","RC","87103","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SENSITIVITY MIC","10001119141","CDM","306","RC","87186","HCPCS","facility","both","","","","644","644","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SENSITIVITY KB","10001119143","CDM","306","RC","87184","HCPCS","facility","both","","","","99","99","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SERUMBACTERICID","10001119145","CDM","306","RC","87197","HCPCS","facility","both","","","","303.5","303.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MACROSCOPIC EXAM;ARTHROPO","10001119147","CDM","306","RC","87168","HCPCS","facility","both","","","","78.5","78.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DARKFIELD 87164","10001119149","CDM","306","RC","87164","HCPCS","facility","both","","","","111","111","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FUNGUS,SMEAR 87220","10001119151","CDM","306","RC","87220","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BACT, SMEAR, STAI","10001119153","CDM","306","RC","87205","HCPCS","facility","both","","","","70.5","70.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FUNGCULT NOT SKINHAIRNAIL","10001119155","CDM","306","RC","87102","HCPCS","facility","both","","","","190.5","190.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FUNGUS ID 87106","10001119157","CDM","306","RC","87106","HCPCS","facility","both","","","","190.5","190.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CULTURE BACTERI87070","10001119159","CDM","306","RC","87070","HCPCS","facility","both","","","","176","176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BETA STREP B 87081","10001119161","CDM","306","RC","87081","HCPCS","facility","both","","","","207.5","207.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CULT FUNGI DEF LD; MOLD","10001119163","CDM","306","RC","87107","HCPCS","facility","both","","","","180.5","180.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TYPING, POLYVAL 87151","10001119165","CDM","306","RC","87147","HCPCS","facility","both","","","","190.5","190.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COLONY CNT-URI 87086","10001119167","CDM","306","RC","87086","HCPCS","facility","both","","","","114.5","114.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYCOPLASMS CULTURE 87109","10001119169","CDM","306","RC","87109","HCPCS","facility","both","","","","183.5","183.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOSTRIDIUM OX","10001119171","CDM","306","RC","87324","HCPCS","facility","both","","","","421","421","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HELICOBCTR SCRN","10001119173","CDM","306","RC","87081","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYCOPLASMA PNEUM CULT","10001119175","CDM","306","RC","87109","HCPCS","facility","both","","","","845.5","845.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYCOPPLAMA GENITAL CULT","10001119177","CDM","306","RC","87109","HCPCS","facility","both","","","","456","456","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HERPES SIMPLEX 2 86696","10001119179","CDM","306","RC","87529","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHL/GC DNA PROBE","10001119189","CDM","306","RC","87660","HCPCS","facility","both","","","","168","168","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT SMEAR WET PREP","10001119191","CDM","306","RC","87210","HCPCS","facility","both","","","","32.5","32.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STOOL VRE SCREEN","10001119193","CDM","306","RC","87081","HCPCS","facility","both","","","","46.5","46.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRSA SCREEN","10001119195","CDM","306","RC","87081","HCPCS","facility","both","","","","46.5","46.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NOROVIRUS RNA/PCR","10001119197","CDM","306","RC","87081","HCPCS","facility","both","","","","623","623","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WEST NILE BLOOD PCR","10001119199","CDM","306","RC","87798","HCPCS","facility","both","","","","1110","1110","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MICROSPORIDIA EXAM*","10001119201","CDM","306","RC","87015","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPATITIS B DNA PCR QT","10001119203","CDM","306","RC","87517","HCPCS","facility","both","","","","657","657","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TREPONEMA PALLIDUM PCR","10001119205","CDM","306","RC","87798","HCPCS","facility","both","","","","473","473","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HIV1 GENOTYPE/VIRTUAL PHE","10001119207","CDM","306","RC","87901","HCPCS","facility","both","","","","1016","1016","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HIV1 DNA BY PCR","10001119209","CDM","306","RC","87535","HCPCS","facility","both","","","","390","390","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HCV GENOTYPE","10001119211","CDM","306","RC","87902","HCPCS","facility","both","","","","763","763","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP B SURFACE AG","10001119213","CDM","306","RC","87340","HCPCS","facility","both","","","","151.5","151.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP SCREEN-HBSAG","10001119215","CDM","306","RC","87340","HCPCS","facility","both","","","","86.5","86.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP BE ANTIGEN","10001119217","CDM","306","RC","87350","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HIV P24 ANTIGEN","10001119219","CDM","306","RC","87390","HCPCS","facility","both","","","","391","391","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HIV- 1 RNA QT","10001119221","CDM","306","RC","87536","HCPCS","facility","both","","","","658.5","658.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HCVRNA QT","10001119223","CDM","306","RC","87522","HCPCS","facility","both","","","","658.5","658.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HIV RNA QUAL","10001119225","CDM","306","RC","87535","HCPCS","facility","both","","","","599","599","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOSTRIDIUM TOXIN","10001119227","CDM","306","RC","87324","HCPCS","facility","both","","","","160","160","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MALARIA ID 87207","10001119231","CDM","306","RC","87207","HCPCS","facility","both","","","","270.5","270.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FILARIA ID 87207","10001119233","CDM","306","RC","87207","HCPCS","facility","both","","","","300.5","300.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BLOOD PARASITES 87207","10001119235","CDM","306","RC","87207","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPATITIS B SURFACE ANTIG","10001119237","CDM","306","RC","87340","HCPCS","facility","both","","","","203.5","203.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HPV AMPLIFIED PROBE*","10001119239","CDM","306","RC","87621","HCPCS","facility","both","","","","295","295","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HPV DNA AMP PROBE","10001119241","CDM","306","RC","87621","HCPCS","facility","both","","","","145","145","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BARTONELLA HENSELAE PCR","10001119243","CDM","306","RC","87798","HCPCS","facility","both","","","","1550","1550","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC O&P STOOL EXAM","10001119245","CDM","306","RC","87177","HCPCS","facility","both","","","","249","249","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TAPEWORM INDENT 87208","10001119247","CDM","306","RC","87169","HCPCS","facility","both","","","","178","178","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PIN WORM SLIDE 87208","10001119249","CDM","306","RC","87172","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECIM OR MAT I 87210","10001119251","CDM","306","RC","87210","HCPCS","facility","both","","","","99.5","99.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRICHOMONADS,WE 87210","10001119253","CDM","306","RC","87210","HCPCS","facility","both","","","","99.5","99.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HSV DNA AMP PROBE","10001119257","CDM","306","RC","87529","HCPCS","facility","both","","","","132.5","132.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DETECT AGENT NOS, DNA, QU","10001119259","CDM","306","RC","87798","HCPCS","facility","both","","","","145","145","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHENOTYPE INFECT AGENT DR","10001119261","CDM","306","RC","87900","HCPCS","facility","both","","","","515","515","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SMEAR SPECIAL STAIN","10001119263","CDM","306","RC","87207","HCPCS","facility","both","","","","26.5","26.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR VIIA 1.2 MG J7189/","10001119265","CDM","636","RC","","","facility","both","","","","3105","3105","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VOLUME MEASURE 81050 URIN","10001119267","CDM","307","RC","81050","HCPCS","facility","both","","","","34","34","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HOMOGETISIC AC 81005","10001119269","CDM","307","RC","81005","HCPCS","facility","both","","","","121","121","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UA SCREEN 81003","10001119275","CDM","307","RC","81003","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URINE, MICROSCOP 81015","10001119277","CDM","307","RC","81015","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SUGAR, QUANT","10001119279","CDM","307","RC","81002","HCPCS","facility","both","","","","16.5","16.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URINALYSIS,ROUT 81001","10001119281","CDM","307","RC","81001","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALBUMIN, QUAL 81005","10001119283","CDM","307","RC","81005","HCPCS","facility","both","","","","16.5","16.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BILE,QUAL 81005","10001119285","CDM","307","RC","81005","HCPCS","facility","both","","","","16.5","16.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URINALYSIS 81001","10001119287","CDM","307","RC","81001","HCPCS","facility","both","","","","23.5","23.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MELANIN","10001119291","CDM","307","RC","81005","HCPCS","facility","both","","","","103","103","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HOMOGETISIC AC 81005","10001119293","CDM","307","RC","81005","HCPCS","facility","both","","","","293.5","293.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR VIIA 2ND 1.2 MG J7","10001119297","CDM","636","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECIFIC GRAVITY","10001119299","CDM","307","RC","81002","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VOLUME MEASURE 81050 URIN","10001119301","CDM","307","RC","81050","HCPCS","facility","both","","","","32.5","32.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETONE CONFIRM 81005","10001119303","CDM","307","RC","81005","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OCCULT BLOOD; URINE 82273","10001119305","CDM","307","RC","81002","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IN/OUT URINE 81003","10001119307","CDM","307","RC","81003","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UA SCREEN 81003","10001119309","CDM","307","RC","81003","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URINE, MICROSCOP 81015","10001119311","CDM","307","RC","81015","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUCOSE, QUAL","10001119313","CDM","307","RC","81002","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URINALYSIS,ROUTINE 81001","10001119315","CDM","307","RC","81001","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALBUMIN, QUAL","10001119317","CDM","307","RC","81002","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BILE, QUAL","10001119319","CDM","307","RC","82239","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT URINE HCG QL","10001119321","CDM","307","RC","81025","HCPCS","facility","both","","","","153.5","153.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SSP URINALYSIS 81003","10001119323","CDM","307","RC","81003","HCPCS","facility","both","","","","34","34","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTISPERMAT ANT 89325","10001119335","CDM","309","RC","89325","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLUID CELL COUNT 89051","10001119337","CDM","309","RC","89051","HCPCS","facility","both","","","","31.5","31.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SEMEN ANALYSIS POST VAS 8","10001119339","CDM","309","RC","89321","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTHRAX,NASAL EOSINOPHIL","10001119341","CDM","309","RC","89190","HCPCS","facility","both","","","","36.5","36.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTISPERMAT ANT 89325","10001119355","CDM","309","RC","89325","HCPCS","facility","both","","","","235.5","235.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLUID CELL COUNT 89051","10001119357","CDM","309","RC","89051","HCPCS","facility","both","","","","85.5","85.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SEMEN ANALYSIS POST VAS 8","10001119359","CDM","309","RC","89321","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NASAL SMEAR, EOS89190","10001119361","CDM","309","RC","89190","HCPCS","facility","both","","","","66.5","66.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WBC STOOL  89055","10001119363","CDM","309","RC","89055","HCPCS","facility","both","","","","66.5","66.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC JOINT FLUID CRY 89060","10001119365","CDM","309","RC","89060","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPLITTING PC","10001119367","CDM","309","RC","86985","HCPCS","facility","both","","","","139","139","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AUTOLOGOUS BLOOD","10001119369","CDM","309","RC","86890","HCPCS","facility","both","","","","277.5","277.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PEDI-PACK ALIQ","10001119371","CDM","309","RC","86985","HCPCS","facility","both","","","","102.5","102.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THAWING CRYO","10001119373","CDM","309","RC","86927","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THAWING FFP","10001119375","CDM","309","RC","86927","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THAWING COAGULUM","10001119377","CDM","309","RC","86927","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THAWING FP24","10001119379","CDM","309","RC","86927","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RECONSTITUTING RBC & FFP","10001119381","CDM","309","RC","86965","HCPCS","facility","both","","","","39","39","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-RETIC SEPARATION","10001119383","CDM","309","RC","86972","HCPCS","facility","both","","","","721","721","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-PRETREATMENT OF RBC'S","10001119385","CDM","309","RC","86970","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-HEMO/AGGLUTININ SCRN","10001119387","CDM","309","RC","86940","HCPCS","facility","both","","","","236","236","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-ANTIGLOBULIN XM","10001119389","CDM","309","RC","86922","HCPCS","facility","both","","","","84.5","84.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-INCUBATION XM","10001119391","CDM","309","RC","86921","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-IMMEDIATE SPIN","10001119393","CDM","309","RC","86920","HCPCS","facility","both","","","","94.5","94.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-RH PHENOTYPE COMPLETE","10001119395","CDM","309","RC","86906","HCPCS","facility","both","","","","78","78","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-PT ANTIGENS","10001119397","CDM","309","RC","86905","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-UNIT ANTIGN SCR W/PT","10001119399","CDM","309","RC","86904","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-UNIT ANTIGN SCRN W/RE","10001119401","CDM","309","RC","86902","HCPCS","facility","both","","","","81","81","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-RH TYPE","10001119403","CDM","309","RC","86901","HCPCS","facility","both","","","","34.5","34.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-ABO TYPE","10001119405","CDM","309","RC","86900","HCPCS","facility","both","","","","44.5","44.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-DIRECT COOMBS","10001119407","CDM","309","RC","86880","HCPCS","facility","both","","","","32.5","32.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-ANTIBODY ID RBC","10001119409","CDM","309","RC","86870","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-RBC ELUTION","10001119411","CDM","309","RC","86860","HCPCS","facility","both","","","","94.5","94.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-ANTIBODY SCREEN","10001119413","CDM","309","RC","86850","HCPCS","facility","both","","","","67","67","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREEN PER UN","10001119415","CDM","309","RC","86905","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREEN PER UN","10001119417","CDM","309","RC","86905","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREEN PER UN","10001119419","CDM","309","RC","86905","HCPCS","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREEN PER UN","10001119421","CDM","309","RC","86905","HCPCS","facility","both","","","","38","38","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREEN PER UN","10001119423","CDM","309","RC","86905","HCPCS","facility","both","","","","43.5","43.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREENED 1","10001119425","CDM","309","RC","86905","HCPCS","facility","both","","","","155.5","155.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREENED 2","10001119427","CDM","309","RC","86905","HCPCS","facility","both","","","","253","253","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREENED 3","10001119429","CDM","309","RC","86905","HCPCS","facility","both","","","","293","293","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREENED 4","10001119431","CDM","309","RC","86905","HCPCS","facility","both","","","","434","434","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREENED 5","10001119433","CDM","309","RC","86905","HCPCS","facility","both","","","","493.5","493.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREENED 6","10001119435","CDM","309","RC","86905","HCPCS","facility","both","","","","663.5","663.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREENED 7","10001119437","CDM","309","RC","86905","HCPCS","facility","both","","","","749.5","749.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREENED 8","10001119439","CDM","309","RC","86905","HCPCS","facility","both","","","","849.5","849.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF ANTIGEN SCREENED 9","10001119441","CDM","309","RC","86905","HCPCS","facility","both","","","","1024","1024","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEMS AUTOANTIBODY","10001119451","CDM","310","RC","88342","HCPCS","facility","both","","","","858.5","858.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RETICULUM STAIN","10001119453","CDM","310","RC","88313","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERIODIC ACID SCHIFF STAI","10001119455","CDM","310","RC","88313","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMYLOID","10001119457","CDM","310","RC","88313","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUCICARMINE","10001119459","CDM","310","RC","88313","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACID FAST BACILLI STAIN","10001119461","CDM","310","RC","88313","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALCIAN BLUE STAIN","10001119463","CDM","310","RC","88313","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GROSS INTRAOP, 2ND SPECIM","10001119465","CDM","310","RC","88329","HCPCS","facility","both","","","","105.5","105.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GROSS, 2ND DISTINCT SPECI","10001119467","CDM","310","RC","88300","HCPCS","facility","both","","","","70.5","70.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HER2 FISH CYTGEN DNA PROB","10001119469","CDM","310","RC","88271","HCPCS","facility","both","","","","1353","1353","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOGENETICS, 25-99 REF","10001119471","CDM","310","RC","88274","HCPCS","facility","both","","","","138.5","138.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T & B CELL LYMPHOCYTES","10001119473","CDM","311","RC","88182","HCPCS","facility","both","","","","70.5","70.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY","10001119477","CDM","311","RC","88184","HCPCS","facility","both","","","","2278","2278","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOLOGY, OTHER 88161","10001119479","CDM","311","RC","88161","HCPCS","facility","both","","","","74.5","74.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BUCCAL SMEAR 88130","10001119485","CDM","311","RC","88130","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMOSOME ANAL/KAROTYPE1","10001119489","CDM","311","RC","88262","HCPCS","facility","both","","","","1373","1373","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOLOGY CENTRI 88104","10001119491","CDM","311","RC","88104","HCPCS","facility","both","","","","74.5","74.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOLOGY, VAGINAL 88151","10001119495","CDM","311","RC","88141","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FNA-CYTO HIST 88172","10001119503","CDM","311","RC","88172","HCPCS","facility","both","","","","122","122","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FNA-INTERPRET & REPORT 88","10001119507","CDM","311","RC","88173","HCPCS","facility","both","","","","129","129","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PAP SMEAR","10001119515","CDM","311","RC","88141","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MULTIPLE MYELOMA FISH/REF","10001119521","CDM","311","RC","88271","HCPCS","facility","both","","","","357","357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYMPHOMA DIAGNOSTIC PANEL","10001119523","CDM","311","RC","88189","HCPCS","facility","both","","","","114","114","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PAROXYSMAL NOCTURNAL HEMO","10001119525","CDM","311","RC","88188","HCPCS","facility","both","","","","433.5","433.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMOSOME ANALYSIS CLL/L","10001119527","CDM","311","RC","88280","HCPCS","facility","both","","","","222","222","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PNH WITH FLAER*","10001119529","CDM","311","RC","88188","HCPCS","facility","both","","","","442","442","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TISSUE CULTURE LYMPHOCYTE","10001119531","CDM","311","RC","88230","HCPCS","facility","both","","","","598.5","598.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TISSUE CULTRE SKN/SOLID B","10001119533","CDM","311","RC","88233","HCPCS","facility","both","","","","1234","1234","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMO AMNIO FLUID*","10001119535","CDM","311","RC","88235","HCPCS","facility","both","","","","406","406","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC T & B CELL LYMPHOCYTES","10001119537","CDM","311","RC","88182","HCPCS","facility","both","","","","415","415","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMOSOME ANLYSIS 2 KARY","10001119539","CDM","311","RC","88262","HCPCS","facility","both","","","","492.5","492.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMO AMNIO FLUID 1 KARY","10001119541","CDM","311","RC","88269","HCPCS","facility","both","","","","657","657","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FISH PRENATAL SCR DNA PRO","10001119543","CDM","311","RC","88271","HCPCS","facility","both","","","","531","531","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOGENETICS DNA PROBE","10001119545","CDM","311","RC","88271","HCPCS","facility","both","","","","86.5","86.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOGENETICS DNA PROBE","10001119547","CDM","311","RC","88271","HCPCS","facility","both","","","","86.5","86.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOGENETICS DNA PROBE","10001119549","CDM","311","RC","88271","HCPCS","facility","both","","","","86.5","86.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMO AMNIO FLUID ADDL K","10001119551","CDM","311","RC","88280","HCPCS","facility","both","","","","100.5","100.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMO ANALYSIS ADD HI RE","10001119553","CDM","311","RC","88289","HCPCS","facility","both","","","","598.5","598.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CML/FISH*","10001119561","CDM","311","RC","88271","HCPCS","facility","both","","","","344.5","344.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOGENETICS 100-300","10001119563","CDM","311","RC","88275","HCPCS","facility","both","","","","160","160","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOGENETICS 100-300","10001119565","CDM","311","RC","88275","HCPCS","facility","both","","","","160","160","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOGENETICS 100-300","10001119567","CDM","311","RC","88275","HCPCS","facility","both","","","","160","160","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALK FISH*","10001119569","CDM","311","RC","88275","HCPCS","facility","both","","","","390","390","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LUNG CANCER MUTATION PANE","10001119571","CDM","311","RC","88275","HCPCS","facility","both","","","","1059","1059","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC B-CELL LYMPHOMA FISH*","10001119573","CDM","311","RC","88275","HCPCS","facility","both","","","","1187.5","1187.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY*","10001119577","CDM","311","RC","88184","HCPCS","facility","both","","","","129","129","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 2ND","10001119579","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 3RD","10001119581","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 4TH","10001119583","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 5TH","10001119585","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 6TH","10001119587","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 7TH","10001119589","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 8TH","10001119591","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 9TH","10001119593","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 10TH","10001119595","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 11TH","10001119597","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 12TH","10001119599","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 13TH","10001119601","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 14TH","10001119603","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 15TH","10001119605","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 16TH","10001119607","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 17TH","10001119609","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 18TH","10001119611","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 19TH","10001119613","CDM","311","RC","88185","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DNA PLOIDY SOLID-TUMOR","10001119615","CDM","311","RC","88182","HCPCS","facility","both","","","","645.5","645.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOLOGY, OTHER 88161","10001119617","CDM","311","RC","88161","HCPCS","facility","both","","","","218.5","218.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYELOMA  DNA PROBE(FISH)*","10001119619","CDM","311","RC","88271","HCPCS","facility","both","","","","204.5","204.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BUCCAL SMEAR 88130","10001119621","CDM","311","RC","88130","HCPCS","facility","both","","","","111","111","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMOSOME ANAL/KAROTYPE1","10001119623","CDM","311","RC","88262","HCPCS","facility","both","","","","2189.5","2189.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOLOGY CENTRI 88104","10001119625","CDM","311","RC","88104","HCPCS","facility","both","","","","164.5","164.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOLOGY, VAGINAL 88151","10001119627","CDM","311","RC","88141","HCPCS","facility","both","","","","169.5","169.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FNA-CYTO HIST 88172","10001119633","CDM","311","RC","88172","HCPCS","facility","both","","","","155.5","155.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FNA-INTERPRET & REPORT 88","10001119635","CDM","311","RC","88173","HCPCS","facility","both","","","","84.5","84.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLOW CYTOMETRY 1ST","10001119637","CDM","311","RC","88184","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TISSUE CULTURE, BONE MARR","10001119639","CDM","311","RC","88237","HCPCS","facility","both","","","","508","508","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMOSOME ANALYSIS, 20-2","10001119641","CDM","311","RC","88264","HCPCS","facility","both","","","","502","502","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMOSOME KARYOTYPE STUD","10001119643","CDM","311","RC","88280","HCPCS","facility","both","","","","101.5","101.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPEC STAIN MICR GRP 1","10001119645","CDM","312","RC","88312","HCPCS","facility","both","","","","78.5","78.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HISTOCHEM - CHEM COMP GRP","10001119651","CDM","312","RC","88313","HCPCS","facility","both","","","","87","87","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOPEROXIDASE SIBLEY P","10001119653","CDM","312","RC","88342","HCPCS","facility","both","","","","262","262","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOPEROXIDASE,REFERRED","10001119655","CDM","312","RC","88342","HCPCS","facility","both","","","","262","262","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EGFR IMMUNO 88342","10001119657","CDM","312","RC","88342","HCPCS","facility","both","","","","1207","1207","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADDITIONAL CONSULT-FROZEN","10001119659","CDM","312","RC","88332","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMP CONSULT, SO REF-88","10001119663","CDM","312","RC","88325","HCPCS","facility","both","","","","667.5","667.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONSULT REF SLI 88321","10001119665","CDM","312","RC","88321","HCPCS","facility","both","","","","117","117","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONSULT NO FROZ 88329","10001119667","CDM","312","RC","88329","HCPCS","facility","both","","","","89.5","89.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GROSS PATH, LEVEL I","10001119669","CDM","312","RC","88300","HCPCS","facility","both","","","","34","34","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G&M, LEVEL II","10001119673","CDM","312","RC","88302","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G&M, LEVEL III","10001119677","CDM","312","RC","88304","HCPCS","facility","both","","","","89.5","89.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G&M LEVEL III  88304","10001119681","CDM","312","RC","88304","HCPCS","facility","both","","","","89.5","89.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G&M, LEVEL IV","10001119683","CDM","312","RC","88305","HCPCS","facility","both","","","","151.5","151.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G&M, LEVEL IV","10001119685","CDM","312","RC","88305","HCPCS","facility","both","","","","151.5","151.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G&M, LEVEL IV","10001119687","CDM","312","RC","88305","HCPCS","facility","both","","","","151.5","151.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G&M PROSTATE EA SPEC, 1-5","10001119691","CDM","312","RC","88305","HCPCS","facility","both","","","","78.5","78.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G&M PROSTATE, EA SPEC, 6","10001119693","CDM","312","RC","88305","HCPCS","facility","both","","","","74.5","74.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G&M, LEVEL V","10001119695","CDM","312","RC","88307","HCPCS","facility","both","","","","286","286","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G&M, LEVEL VI","10001119699","CDM","312","RC","88309","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TISSUE DECACIF 88311","10001119703","CDM","312","RC","88311","HCPCS","facility","both","","","","85.5","85.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONSULT W/FROZE 88331","10001119709","CDM","312","RC","88331","HCPCS","facility","both","","","","151.5","151.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PATH CONSULT SLIDES 88321","10001119711","CDM","312","RC","88321","HCPCS","facility","both","","","","75","75","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOMIC ALT OLIGO SNP ARR","10001119713","CDM","312","RC","81229","HCPCS","facility","both","","","","2905.5","2905.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ERA (PRA BILLED SEPARATE)","10001119715","CDM","312","RC","88342","HCPCS","facility","both","","","","545.5","545.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CELLSEARCH/BREASTCENTER*","10001119717","CDM","312","RC","88346","HCPCS","facility","both","","","","2790.5","2790.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRA (ERA BILLED SEPARATE)","10001119719","CDM","312","RC","88342","HCPCS","facility","both","","","","523.5","523.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DNA FLOW CYTOMETRY 88358","10001119721","CDM","312","RC","88358","HCPCS","facility","both","","","","924","924","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC B. MARROW 88305","10001119723","CDM","312","RC","88305","HCPCS","facility","both","","","","159","159","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOLOGY CONSULT MISC SO","10001119727","CDM","312","RC","88325","HCPCS","facility","both","","","","825","825","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MSI BY IHC ONLY FOR MMR*","10001119729","CDM","312","RC","88342","HCPCS","facility","both","","","","1029.5","1029.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRA","10001119731","CDM","312","RC","88342","HCPCS","facility","both","","","","621.5","621.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RENAL BX,COMPLETE CONSULT","10001119733","CDM","312","RC","88325","HCPCS","facility","both","","","","1939.5","1939.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUSCLE BX, CONSULTATION A","10001119735","CDM","312","RC","88325","HCPCS","facility","both","","","","1165.5","1165.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NERVE BX, CONSULTATION AF","10001119737","CDM","312","RC","88325","HCPCS","facility","both","","","","856","856","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WARTHIN STARRY STAIN 8831","10001119741","CDM","312","RC","88312","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRICHROME STAIN 88312","10001119743","CDM","312","RC","88313","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TYSON'S ELASTIC 88312","10001119745","CDM","312","RC","88312","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOSPHOTUNGSTIC ACID STAI","10001119747","CDM","312","RC","88312","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HISTOCHEM-CHEM COMP GRP 2","10001119749","CDM","312","RC","88313","HCPCS","facility","both","","","","273","273","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GIEMSA STAIN  88312","10001119751","CDM","312","RC","88312","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BROWN & BRENN STAIN 88312","10001119753","CDM","312","RC","88312","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPEC STAIN GROUP 1","10001119755","CDM","312","RC","88312","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HISTOCHEM - CHEM COMP GRP","10001119757","CDM","312","RC","88313","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOPEROXIDASE SIBLEY 8","10001119759","CDM","312","RC","88342","HCPCS","facility","both","","","","306.5","306.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOPEROXIDASE, ADD'L","10001119761","CDM","312","RC","88342","HCPCS","facility","both","","","","238","238","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOPEROXIDASE REFERRED","10001119765","CDM","312","RC","88342","HCPCS","facility","both","","","","306.5","306.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EGFR IMMUNO 88342","10001119767","CDM","312","RC","88342","HCPCS","facility","both","","","","1714.5","1714.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IRON STAIN  88313","10001119769","CDM","312","RC","88313","HCPCS","facility","both","","","","168.5","168.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADDITIONAL CONSULT-FROZEN","10001119773","CDM","312","RC","88332","HCPCS","facility","both","","","","114.5","114.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPRHNSV CONSULT SO REF-","10001119777","CDM","312","RC","88325","HCPCS","facility","both","","","","756","756","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONSULT REF SLIDE PREP 88","10001119779","CDM","312","RC","88323","HCPCS","facility","both","","","","604.5","604.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONSULT REF SLI88321","10001119781","CDM","312","RC","88321","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONSULT SO REF SLIDE 8832","10001119783","CDM","312","RC","88321","HCPCS","facility","both","","","","553","553","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONSULT NO FROZ88329","10001119785","CDM","312","RC","88329","HCPCS","facility","both","","","","105.5","105.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GROSS PATH, LEVEL I","10001119787","CDM","312","RC","88300","HCPCS","facility","both","","","","70.5","70.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G&M, LEVEL II","10001119789","CDM","312","RC","88302","HCPCS","facility","both","","","","123.5","123.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G& M, LEVEL III","10001119791","CDM","312","RC","88304","HCPCS","facility","both","","","","180.5","180.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G & M, LEVEL IV","10001119793","CDM","312","RC","88305","HCPCS","facility","both","","","","259.5","259.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G & M, LEVEL V","10001119797","CDM","312","RC","88307","HCPCS","facility","both","","","","341.5","341.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G & M LEVEL VI","10001119799","CDM","312","RC","88309","HCPCS","facility","both","","","","474.5","474.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC G & M LEVEL VI","10001119801","CDM","312","RC","88309","HCPCS","facility","both","","","","474.5","474.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECIAL STAIN SO","10001119803","CDM","312","RC","88312","HCPCS","facility","both","","","","359.5","359.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HER2(FISH) REFERRED","10001119805","CDM","312","RC","88368","HCPCS","facility","both","","","","1714.5","1714.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSITU HYBRIDIZATION FISH","10001119807","CDM","312","RC","88365","HCPCS","facility","both","","","","164.5","164.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOFLOURESCENCE DIRECT","10001119809","CDM","312","RC","88346","HCPCS","facility","both","","","","653.5","653.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTRN MCRSCPY 88348","10001119811","CDM","312","RC","88348","HCPCS","facility","both","","","","1881","1881","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXM/SLCT RETRIEVED ARCHIV","10001119813","CDM","312","RC","88363","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ISH FOR EBV VIRUS SO","10001119815","CDM","312","RC","88365","HCPCS","facility","both","","","","606.5","606.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TISSUE DECACIF 88311","10001119817","CDM","312","RC","88311","HCPCS","facility","both","","","","103","103","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONSULT W/FROZE 88331","10001119819","CDM","312","RC","88331","HCPCS","facility","both","","","","148","148","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARASITE STAIN 88312","10001119823","CDM","312","RC","88312","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECIAL STAIN GROUP 2","10001119825","CDM","312","RC","88313","HCPCS","facility","both","","","","50.5","50.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOHISTOCHEMISTRY","10001119827","CDM","312","RC","88342","HCPCS","facility","both","","","","107.5","107.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOFLOURESCENT STUDY","10001119829","CDM","312","RC","88347","HCPCS","facility","both","","","","101","101","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSITU HYBRIBIZATION MANU","10001119831","CDM","312","RC","88368","HCPCS","facility","both","","","","164.5","164.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOFLOURESCENT STUDY E","10001119833","CDM","312","RC","88346","HCPCS","facility","both","","","","107.5","107.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TUMOR IMMUNOHISTOCHEMISTR","10001119835","CDM","312","RC","88361","HCPCS","facility","both","","","","164.5","164.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECIAL STAIN GROUP1    8","10001119837","CDM","312","RC","88312","HCPCS","facility","both","","","","143.5","143.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECIAL STAIN GROUP 2  88","10001119839","CDM","312","RC","88313","HCPCS","facility","both","","","","143.5","143.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PATHCONSULT OUTSIDE SLIDE","10001119841","CDM","312","RC","88321","HCPCS","facility","both","","","","281","281","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PATH CONSULT W PREP 88323","10001119843","CDM","312","RC","88323","HCPCS","facility","both","","","","312","312","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPRHNSVE PATH CONSULT 8","10001119845","CDM","312","RC","88325","HCPCS","facility","both","","","","436.5","436.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOPEROXIDASE IHC  883","10001119847","CDM","312","RC","88342","HCPCS","facility","both","","","","169","169","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR VIIA 3RD 1.2 MG J7","10001119849","CDM","636","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR VIIA 4TH 1.2 MG J7","10001119851","CDM","636","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR VIIA 2.4 MG J7189/","10001119853","CDM","636","RC","","","facility","both","","","","6209.5","6209.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR VIIA 4.8 MG J7189/","10001119855","CDM","636","RC","","","facility","both","","","","12419","12419","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONSULT ON OUTSIDE X-RAY","10001119857","CDM","320","RC","76140","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WHOLE BLOOD ACQUISITION C","10001119889","CDM","390","RC","","","facility","both","","","","395.5","395.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WHOLE BLOOD IRRAD DIRECT","10001119891","CDM","390","RC","","","facility","both","","","","675","675","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WHOLE BLOOD IRRAD","10001119893","CDM","390","RC","","","facility","both","","","","453.5","453.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WHOLE BLOOD DIRECTED","10001119895","CDM","390","RC","","","facility","both","","","","484","484","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRYO ACQUISITION COST EA","10001119897","CDM","390","RC","","","facility","both","","","","122.5","122.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC LEUKOCYTE REDUCED PC","10001119899","CDM","390","RC","","","facility","both","","","","356.5","356.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC LEUKOCYTE REDUCED PCA","10001119901","CDM","390","RC","","","facility","both","","","","356.5","356.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC PC DIRECT LEUKO REDUC","10001119903","CDM","390","RC","","","facility","both","","","","530","530","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FFP ACQUISITION COST","10001119905","CDM","390","RC","","","facility","both","","","","131","131","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELET RANDOM","10001119907","CDM","390","RC","","","facility","both","","","","141.5","141.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELETS RICH PLASMA","10001119909","CDM","390","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACKED CELLS, ACQUISITION","10001119911","CDM","390","RC","","","facility","both","","","","356.5","356.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC DIRECTED","10001119913","CDM","390","RC","","","facility","both","","","","484","484","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC ADSOL","10001119915","CDM","390","RC","","","facility","both","","","","356.5","356.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WASHED CELLS RBC","10001119917","CDM","390","RC","","","facility","both","","","","476","476","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELETS RANDOM LR","10001119919","CDM","390","RC","","","facility","both","","","","82.5","82.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELETS RANDOM IRRAD","10001119921","CDM","390","RC","","","facility","both","","","","158.5","158.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELETS RANDOM LR, IRRA","10001119923","CDM","390","RC","","","facility","both","","","","198.5","198.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELET PHERESIS SDP","10001119925","CDM","390","RC","","","facility","both","","","","669","669","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELETS PHERESIS SDP LR","10001119927","CDM","390","RC","","","facility","both","","","","669","669","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELETS PHERESIS IRRAD","10001119929","CDM","390","RC","","","facility","both","","","","786","786","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELETS PHERE SDP LR IR","10001119931","CDM","390","RC","","","facility","both","","","","786","786","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELETS PHERE DIR LR IR","10001119933","CDM","390","RC","","","facility","both","","","","1061.5","1061.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC IRRADIATED DIRECT","10001119935","CDM","390","RC","","","facility","both","","","","675","675","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC IRRAD","10001119937","CDM","390","RC","","","facility","both","","","","414.5","414.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC ADSOL IRRAD","10001119939","CDM","390","RC","","","facility","both","","","","414.5","414.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC DEGLYC","10001119941","CDM","390","RC","","","facility","both","","","","594","594","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC LEUKO REDUC IRRAD","10001119943","CDM","390","RC","","","facility","both","","","","414.5","414.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC ADSOL LEUKOREDUC IRRA","10001119945","CDM","390","RC","","","facility","both","","","","414.5","414.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC PC DIRECT LEUKOREDUC","10001119947","CDM","390","RC","","","facility","both","","","","614.5","614.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GRANULOCYTES PHERESIS","10001119949","CDM","390","RC","","","facility","both","","","","5291","5291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC, LR, CMVNEG","10001119951","CDM","390","RC","","","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELETS SDP-HLA LR","10001119953","CDM","390","RC","","","facility","both","","","","831.5","831.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELETS SDP-HLA LR IRR","10001119955","CDM","390","RC","","","facility","both","","","","1109","1109","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELETS SDP LR CMVNEG,","10001119957","CDM","390","RC","","","facility","both","","","","824","824","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC LR DEGLY WASHED","10001119959","CDM","390","RC","","","facility","both","","","","754.5","754.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLATELETS SDP LR CMVNEG","10001119961","CDM","390","RC","","","facility","both","","","","619.5","619.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WHOLE BLOOD LR IRRAD","10001119963","CDM","390","RC","","","facility","both","","","","220","220","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC FROZEN DEGLY WASH LR","10001119965","CDM","390","RC","","","facility","both","","","","559","559","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC LR CMVNEG IRRAD","10001119967","CDM","390","RC","","","facility","both","","","","334.5","334.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLASMA FROZEN WITHIN 24 H","10001119969","CDM","390","RC","","","facility","both","","","","131","131","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FFP DONOR RETESTED","10001119971","CDM","390","RC","","","facility","both","","","","116","116","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT FERN TEST","10001119973","CDM","301","RC","","","facility","both","","","","32.5","32.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAPID HIV KIT","10001119975","CDM","272","RC","","","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HANDLING CHARGE 00000","10001119985","CDM","300","RC","","","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PPD/TB TEST- SUNRISE EMPL","10001119993","CDM","306","RC","","","facility","both","","","","47.5","47.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AUTO RBC ADSOL","10001120009","CDM","390","RC","","","facility","both","","","","388.5","388.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REF-PHENOTYPED UNIT ACQUI","10001120017","CDM","390","RC","","","facility","both","","","","155.5","155.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPHLEBOTOMY99195","10001120019","CDM","940","RC","99195","HCPCS","facility","both","","","","268.5","268.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UPC - ATLAS STUDY","10001120023","CDM","999","RC","","","facility","both","","","","91.5","91.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"TRICHOMONAS RAPID VAGINALIS","10001173493","CDM","306","RC","87808","HCPCS","facility","both","","","","57","57","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FETAL HEMORRHAGE","10001173652","CDM","305","RC","85461","HCPCS","facility","both","","","","99.5","99.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEP SCREEN HAAB TOTAL","10001173653","CDM","302","RC","86708","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RHEUMATOID FACTOR QT RF","10001173654","CDM","302","RC","86431","HCPCS","facility","both","","","","26","26","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FISH LOCUS SPECIFIC PROBE","10001174013","CDM","311","RC","88275","HCPCS","facility","both","","","","728","728","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PAIN MGMT PROFILE UR*","10001174014","CDM","301","RC","83986","HCPCS","facility","both","","","","87.5","87.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COCAINE & METABOLITES","10001174015","CDM","301","RC","82520","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TOXICOLOGY SCREEN, GASTRI","10001174016","CDM","301","RC","","","facility","both","","","","131","131","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR 8, VWF HUMATE-P","10001174385","CDM","636","RC","","","facility","both","","","","1.6","1.6","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HCG TUMOR MARKER QUANT","10001174626","CDM","301","RC","84702","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARBAPENEMASE RESISTANT ENTEROBACTERIACEAE","10001174628","CDM","306","RC","87081","HCPCS","facility","both","","","","57","57","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTEIN ELECTROPHORESIS, URINE","10001175084","CDM","301","RC","84166","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C-TELOPRPTIDE, SERUM","10001176627","CDM","301","RC","82523","HCPCS","facility","both","","","","113","113","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED/SURG/GYN PRIVATE","1110001","CDM","111","RC","","","facility","both","","","","3141","3141","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED/SURG/GYN PRIVATE MEDICAL NECESSITY","1110012","CDM","111","RC","","","facility","both","","","","3705","3705","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OB PRIVATE ROOM","1120001","CDM","112","RC","","","facility","both","","","","3141","3141","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED/SURG GYN-SEMI-PRIV","1210001","CDM","121","RC","","","facility","both","","","","3141","3141","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED/SURG GYN-SEMI-PRIV","1210001","CDM","121","RC","","","facility","both","","","","2769.93","2769.93","","","","","","","","","","","","","Gross Charge Type: JHH 01 MED/SURG/IMC/SSU"
"HC MED/SURG/GYN INTERMED SEMI-PRIV","1210002","CDM","121","RC","","","facility","both","","","","3591.11","3591.11","","","","","","","","","","","","","Gross Charge Type: JHH 01 MED/SURG/IMC/SSU"
"HC NEURO SEMI-PRIVATE","1210031","CDM","121","RC","","","facility","both","","","","3058.25","3058.25","","","","","","","","","","","","","Gross Charge Type: JHH 01 MED/SURG/IMC/SSU"
"HC GYNECOLOGY SEMI-PRIVATE","1210061","CDM","121","RC","","","facility","both","","","","2538.52","2538.52","","","","","","","","","","","","","Gross Charge Type: JHH 01 MED/SURG/IMC/SSU"
"HC TX MED/SURG GYN-SEMI-PRIV (FLD-40)","1215501","CDM","121","RC","","","facility","both","","","","2769.93","2769.93","","","","","","","","","","","","","Gross Charge Type: JHH 01 MED/SURG/IMC/SSU"
"HC TX MED/SURG/GYN INTERMED SEMI-PRIV (FLD-40)","1215502","CDM","121","RC","","","facility","both","","","","3591.11","3591.11","","","","","","","","","","","","","Gross Charge Type: JHH 01 MED/SURG/IMC/SSU"
"HC LOWER LEVEL OF CARE","1219901","CDM","121","RC","","","facility","both","","","","350","350","","","","","","","","","","","","","Gross Charge Type: JHH 01 MED/SURG/IMC/SSU"
"HC OB SEMI-PRIVATE ROOM","1220001","CDM","122","RC","","","facility","both","","","","3141","3141","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CATEGORY I OBSTETRICS (FLD-40)","1220091","CDM","122","RC","","","facility","both","","","","1579.71","1579.71","","","","","","","","","","","","","Gross Charge Type: JHH 04 OB"
"HC CATEGORY II OBSTETRICS (FLD-40)","1220092","CDM","122","RC","","","facility","both","","","","1943.1","1943.1","","","","","","","","","","","","","Gross Charge Type: JHH 04 OB"
"HC CATEGORY III OBSTETRICS (FLD-40)","1220093","CDM","122","RC","","","facility","both","","","","2269.36","2269.36","","","","","","","","","","","","","Gross Charge Type: JHH 04 OB"
"GENERAL PEDS ROOM DAILY","1230001","CDM","123","RC","","","facility","both","","","","3249.44","3249.44","","","","","","","","","","","","","Gross Charge Type: JHH 02 PEDIATRIC ACUTE (PED)"
"HC TX GENERAL PED ROOM DLY (FLD-40)","1235501","CDM","123","RC","","","facility","both","","","","3049.34","3049.34","","","","","","","","","","","","","Gross Charge Type: JHH 02 PEDIATRIC ACUTE (PED)"
"PSYCH ROOM DAILY","1240001","CDM","124","RC","","","facility","both","","","","2276.23","2276.23","","","","","","","","","","","","","Gross Charge Type: JHH 03 PSYCHIATRY"
"PSYCH ROOM DAILY","1240001","CDM","124","RC","","","facility","both","","","","4462","4462","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PEDIATRIC PSYCH","1240002","CDM","124","RC","","","facility","both","","","","2195.82","2195.82","","","","","","","","","","","","","Gross Charge Type: JHH 03 PSYCHIATRY"
"HC PSYCHIATRY ITU/MBU","1240003","CDM","124","RC","","","facility","both","","","","1771.3","1771.3","","","","","","","","","","","","","Gross Charge Type: JHH 03 PSYCHIATRY"
"HC PSYCHIATRY EATING/AFFECTIVE","1240004","CDM","124","RC","","","facility","both","","","","2839.47","2839.47","","","","","","","","","","","","","Gross Charge Type: JHH 03 PSYCHIATRY"
"HC PSYCHIATRY GERIATRIC/PAIN","1240006","CDM","124","RC","","","facility","both","","","","2523.9","2523.9","","","","","","","","","","","","","Gross Charge Type: JHH 03 PSYCHIATRY"
"HC PSYCH LOWER OF CARE","1249901","CDM","124","RC","","","facility","both","","","","600","600","","","","","","","","","","","","","Gross Charge Type: JHH 03 PSYCHIATRY"
"ONCOLOGY ROOM DAILY","1270001","CDM","127","RC","","","facility","both","","","","2417.09","2417.09","","","","","","","","","","","","","Gross Charge Type: JHH 13 ONCOLOGY (ONC)"
"HC PEDS ONCOLOGY ROOM DLY","1270002","CDM","127","RC","","","facility","both","","","","2417.09","2417.09","","","","","","","","","","","","","Gross Charge Type: JHH 13 ONCOLOGY (ONC)"
"HC TX ONCOLOGY ROOM DLY (FLD-40)","1275501","CDM","127","RC","","","facility","both","","","","2417.09","2417.09","","","","","","","","","","","","","Gross Charge Type: JHH 13 ONCOLOGY (ONC)"
"HC TX PEDS ONCOLOGY ROOM DLY  (FLD-40)","1275502","CDM","127","RC","","","facility","both","","","","2417.09","2417.09","","","","","","","","","","","","","Gross Charge Type: JHH 13 ONCOLOGY (ONC)"
"HC REHAB SEMI-PRIV","1280001","CDM","128","RC","","","facility","both","","","","1694.21","1694.21","","","","","","","","","","","","","Gross Charge Type: JHH 16 REHAB (RHB)"
"HC MED/SURG/GYN PRIVATE DELUXE","1410001","CDM","111","RC","","","facility","both","","","","3141","3141","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NICU LOWER LEVEL OF CARE","1709901","CDM","170","RC","","","facility","both","","","","1100","1100","","","","","","","","","","","","","Gross Charge Type: JHH 09 NICU"
"HC NEWBORN 1 ROOM DAILY","1710001","CDM","171","RC","","","facility","both","","","","522.6","522.6","","","","","","","","","","","","","Gross Charge Type: JHH 14 NURSERY"
"HC NEWBORN 1 ROOM DAILY","1710001","CDM","171","RC","","","facility","both","","","","2844","2844","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEWBORN 2 ROOM DAILY","1720001","CDM","172","RC","","","facility","both","","","","5052","5052","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEWBORN 2 ROOM DAILY","1720001","CDM","172","RC","","","facility","both","","","","2811.81","2811.81","","","","","","","","","","","","","Gross Charge Type: JHH 09 NICU"
"HC NEWBORN 3 ROOM DAILY","1730001","CDM","173","RC","","","facility","both","","","","3363.79","3363.79","","","","","","","","","","","","","Gross Charge Type: JHH 09 NICU"
"HC NEWBORN 3 ROOM DAILY","1730001","CDM","173","RC","","","facility","both","","","","7235","7235","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEWBORN 4 ROOM DAILY","1740001","CDM","174","RC","","","facility","both","","","","6151.33","6151.33","","","","","","","","","","","","","Gross Charge Type: JHH 09 NICU"
"ICU ROOM","2000001","CDM","200","RC","","","facility","both","","","","7820","7820","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"ICU ROOM","2000001","CDM","200","RC","","","facility","both","","","","3397.43","3397.43","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"HC TX ICU ROOM DLY","2005501","CDM","200","RC","","","facility","both","","","","3397.43","3397.43","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"ICU SURG ROOM DAILY","2010001","CDM","201","RC","","","facility","both","","","","3397.43","3397.43","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"ICU SURG ROOM DAILY","2010001","CDM","201","RC","","","facility","both","","","","7820","7820","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CATEGORY II ICU","2010007","CDM","201","RC","","","facility","both","","","","3568.76","3568.76","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"HC ICU VAD","2010043","CDM","201","RC","","","facility","both","","","","3709.96","3709.96","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"HC ICU CTU","2010046","CDM","201","RC","","","facility","both","","","","3126.55","3126.55","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"HC TX ICU SURG ROOM DLY (FLD-40)","2015501","CDM","201","RC","","","facility","both","","","","3397.43","3397.43","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"HC TX CATEGORY II ICU","2015507","CDM","201","RC","","","facility","both","","","","3568.76","3568.76","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"HC TX ICU VAD","2015543","CDM","201","RC","","","facility","both","","","","3709.96","3709.96","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"HC TX ICU CTU","2015546","CDM","201","RC","","","facility","both","","","","3126.55","3126.55","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"HC ICU MED ROOM DLY","2020006","CDM","202","RC","","","facility","both","","","","3397.43","3397.43","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"HC TX ICU MED ROOM DLY (FLD-40)","2025506","CDM","202","RC","","","facility","both","","","","3397.43","3397.43","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"ICU PEDS ROOM DAILY","2030001","CDM","203","RC","","","facility","both","","","","3926.08","3926.08","","","","","","","","","","","","","Gross Charge Type: JHH 08 PEDIATRIC ICU (PIC)"
"HC ICU PED INTERMEDIATE ROOM DLY","2030002","CDM","203","RC","","","facility","both","","","","3119.3","3119.3","","","","","","","","","","","","","Gross Charge Type: JHH 08 PEDIATRIC ICU (PIC)"
"HC ICU PED ONC INTERMEDIATE ROOM DLY","2030003","CDM","203","RC","","","facility","both","","","","2417.09","2417.09","","","","","","","","","","","","","Gross Charge Type: JHH 13 ONCOLOGY (ONC)"
"HC TX ICU PED ROOM DLY (FLD-40)","2035501","CDM","203","RC","","","facility","both","","","","3926.08","3926.08","","","","","","","","","","","","","Gross Charge Type: JHH 08 PEDIATRIC ICU (PIC)"
"HC TX ICU PED INTERMEDIATE ROOM DLY (FLD-40)","2035502","CDM","203","RC","","","facility","both","","","","3215.75","3215.75","","","","","","","","","","","","","Gross Charge Type: JHH 08 PEDIATRIC ICU (PIC)"
"HC TX ICU PED ONC INTERMEDIATE ROOM DLY (FLD-40)","2035503","CDM","203","RC","","","facility","both","","","","2417.09","2417.09","","","","","","","","","","","","","Gross Charge Type: JHH 13 ONCOLOGY (ONC)"
"HC PED INTERMEDIATE ROOM DAILY","2060002","CDM","206","RC","","","facility","both","","","","3119.3","3119.3","","","","","","","","","","","","","Gross Charge Type: JHH 08 PEDIATRIC ICU (PIC)"
"HC PED ONC INTERMEDIATE ROOM DAILY","2060003","CDM","206","RC","","","facility","both","","","","2417.09","2417.09","","","","","","","","","","","","","Gross Charge Type: JHH 13 ONCOLOGY (ONC)"
"ICU CARD ROOM DAILY","2100001","CDM","210","RC","","","facility","both","","","","6174","6174","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADULT CCU DAILY (FLD-40)","2100006","CDM","210","RC","","","facility","both","","","","3397.43","3397.43","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"HC TX ADULT CCU DAILY (FLD-40)","2105506","CDM","210","RC","","","facility","both","","","","3397.43","3397.43","","","","","","","","","","","","","Gross Charge Type: JHH 06 ICU"
"HC CCU CCU/INTERMEDIATE","2140001","CDM","214","RC","","","facility","both","","","","6174","6174","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADMISSION CHARGE","22100001","CDM","221","RC","","","facility","both","","","","657.74","657.74","","","","","","","","","","","","","Gross Charge Type: JHH 64 ADMISSIONS"
"HC ADMISSION CHARGE","22100001","CDM","221","RC","","","facility","both","","","","843","843","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYDRATION IV INFUSION 1ST HOUR","26000001","CDM","260","RC","96360","HCPCS","facility","both","","","","389.7","389.7","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC HYDRATION IV INFUSION 1ST HOUR","26000001","CDM","260","RC","96360","HCPCS","facility","both","","","","515.27","515.27","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HYDRATION IV INFUSION 1ST HOUR","26000001","CDM","260","RC","96360","HCPCS","facility","both","","","","297.32","297.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HYDRATION IV INFUSION 1ST HOUR","26000001","CDM","260","RC","96360","HCPCS","facility","both","","","","192.75","192.75","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HYDRATION IV INFUSION 1ST HOUR","26000001","CDM","260","RC","96360","HCPCS","facility","both","","","","978","978","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYDRATION IV INFUSION EACH ADDL HOUR","26000002","CDM","260","RC","96361","HCPCS","facility","both","","","","177","177","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYDRATION IV INFUSION EACH ADDL HOUR","26000002","CDM","260","RC","96361","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC HYDRATION IV INFUSION EACH ADDL HOUR","26000002","CDM","260","RC","96361","HCPCS","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HYDRATION IV INFUSION EACH ADDL HOUR","26000002","CDM","260","RC","96361","HCPCS","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HYDRATION IV INFUSION EACH ADDL HOUR","26000002","CDM","260","RC","96361","HCPCS","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC IV INFUSION DRUG THERAPY 1ST HOUR","26000003","CDM","260","RC","96365","HCPCS","facility","both","","","","433.7","433.7","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC IV INFUSION DRUG THERAPY 1ST HOUR","26000003","CDM","260","RC","96365","HCPCS","facility","both","","","","668.95","668.95","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC IV INFUSION DRUG THERAPY 1ST HOUR","26000003","CDM","260","RC","96365","HCPCS","facility","both","","","","1159.41","1159.41","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC IV INFUSION DRUG THERAPY 1ST HOUR","26000003","CDM","260","RC","96365","HCPCS","facility","both","","","","389.7","389.7","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC IV INFUSION DRUG THERAPY 1ST HOUR","26000003","CDM","260","RC","96365","HCPCS","facility","both","","","","1369","1369","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFUSION DRUG THERAPY EA ADDL HOUR","26000004","CDM","260","RC","96366","HCPCS","facility","both","","","","523","523","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFUSION DRUG THERAPY EA ADDL HOUR","26000004","CDM","260","RC","96366","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC INFUSION DRUG THERAPY EA ADDL HOUR","26000004","CDM","260","RC","96366","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC INFUSION DRUG THERAPY EA ADDL HOUR","26000004","CDM","260","RC","96366","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC INFUSION DRUG THERAPY EA ADDL HOUR","26000004","CDM","260","RC","96366","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC IV INFUSION, ADDL SEQ UP TO 1 HOUR","26000005","CDM","260","RC","96367","HCPCS","facility","both","","","","270","270","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION, ADDL SEQ UP TO 1 HOUR","26000005","CDM","260","RC","96367","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC IV INFUSION, ADDL SEQ UP TO 1 HOUR","26000005","CDM","260","RC","96367","HCPCS","facility","both","","","","168.65","168.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC IV INFUSION, ADDL SEQ UP TO 1 HOUR","26000005","CDM","260","RC","96367","HCPCS","facility","both","","","","260.17","260.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC IV INFUSION, ADDL SEQ UP TO 1 HOUR","26000005","CDM","260","RC","96367","HCPCS","facility","both","","","","450.86","450.86","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC IV INFUSION, CONCURRENT","26000006","CDM","260","RC","96368","HCPCS","facility","both","","","","270","270","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION, CONCURRENT","26000006","CDM","260","RC","96368","HCPCS","facility","both","","","","32.46","32.46","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC IV INFUSION, CONCURRENT","26000006","CDM","260","RC","96368","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC IV INFUSION, CONCURRENT","26000006","CDM","260","RC","96368","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC IV INFUSION, CONCURRENT","26000006","CDM","260","RC","96368","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC THER/PROPH/DIAG INJ, SC/IM","26000007","CDM","260","RC","96372","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THER/PROPH/DIAG INJ, SC/IM","26000007","CDM","260","RC","96372","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC THER/PROPH/DIAG INJ, SC/IM","26000007","CDM","260","RC","96372","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC THER/PROPH/DIAG INJ, SC/IM","26000007","CDM","260","RC","96372","HCPCS","facility","both","","","","97.42","97.42","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC THER/PROPH/DIAG INJ, SC/IM","26000007","CDM","260","RC","96372","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC THER/PROPH/DIAG INJ, IV PUSH","26000008","CDM","260","RC","96374","HCPCS","facility","both","","","","356","356","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THER/PROPH/DIAG INJ, IV PUSH","26000008","CDM","260","RC","96374","HCPCS","facility","both","","","","644.11","644.11","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC THER/PROPH/DIAG INJ, IV PUSH","26000008","CDM","260","RC","96374","HCPCS","facility","both","","","","371.65","371.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC THER/PROPH/DIAG INJ, IV PUSH","26000008","CDM","260","RC","96374","HCPCS","facility","both","","","","240.95","240.95","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC THER/PROPH/DIAG INJ, IV PUSH","26000008","CDM","260","RC","96374","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC TX/PRO/DX INJ EA ADDL SEQ, NEW","26000009","CDM","260","RC","96375","HCPCS","facility","both","","","","344","344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TX/PRO/DX INJ EA ADDL SEQ, NEW","26000009","CDM","260","RC","96375","HCPCS","facility","both","","","","97.42","97.42","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC TX/PRO/DX INJ EA ADDL SEQ, NEW","26000009","CDM","260","RC","96375","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC TX/PRO/DX INJ EA ADDL SEQ, NEW","26000009","CDM","260","RC","96375","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC TX/PRO/DX INJ EA ADDL SEQ, NEW","26000009","CDM","260","RC","96375","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC TX/PRO/DX INJ EA ADDL SEQ, SAME","26000010","CDM","260","RC","96376","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TX/PRO/DX INJ EA ADDL SEQ, SAME","26000010","CDM","260","RC","96376","HCPCS","facility","both","","","","24.07","24.07","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC TX/PRO/DX INJ EA ADDL SEQ, SAME","26000010","CDM","260","RC","96376","HCPCS","facility","both","","","","37.16","37.16","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC TX/PRO/DX INJ EA ADDL SEQ, SAME","26000010","CDM","260","RC","96376","HCPCS","facility","both","","","","64.43","64.43","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC TX/PRO/DX INJ EA ADDL SEQ, SAME","26000010","CDM","260","RC","96376","HCPCS","facility","both","","","","97.42","97.42","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC SPINE/BRAIN PUMP REFILL PHYS","26000011","CDM","260","RC","95991","HCPCS","facility","both","","","","993","993","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPINE/BRAIN PUMP REFILL PHYS","26000011","CDM","260","RC","95991","HCPCS","facility","both","","","","58.17","58.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC SPINE/BRAIN PUMP REFILL PHYS","26000011","CDM","260","RC","95991","HCPCS","facility","both","","","","30.71","30.71","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC SPINE/BRAIN PUMP REFILL PHYS","26000011","CDM","260","RC","95991","HCPCS","facility","both","","","","21.76","21.76","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC IRRIGATION OF IMPLANTED VAD","26000012","CDM","260","RC","96523","HCPCS","facility","both","","","","303","303","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IRRIGATION OF IMPLANTED VAD","26000012","CDM","260","RC","96523","HCPCS","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC IRRIGATION OF IMPLANTED VAD","26000012","CDM","260","RC","96523","HCPCS","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC IRRIGATION OF IMPLANTED VAD","26000012","CDM","260","RC","96523","HCPCS","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC IRRIGATION OF IMPLANTED VAD","26000012","CDM","260","RC","96523","HCPCS","facility","both","","","","97.42","97.42","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC REFILL/MAINT PORTABLE PUMP","26000049","CDM","260","RC","96521","HCPCS","facility","both","","","","144.56","144.56","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC REFILL/MAINT PORTABLE PUMP","26000049","CDM","260","RC","96521","HCPCS","facility","both","","","","222.98","222.98","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC REFILL/MAINT PORTABLE PUMP","26000049","CDM","260","RC","96521","HCPCS","facility","both","","","","386.48","386.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC REFILL/MAINT PORTABLE PUMP","26000049","CDM","260","RC","96521","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC REFILL/MAINT PORTABLE PUMP","26000049","CDM","260","RC","96521","HCPCS","facility","both","","","","1862","1862","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REFILL & MAINTENANCE IMPLANT PUMP/RESERVOIR - DRUG DLVR SYSTEMIC","26000050","CDM","260","RC","96522","HCPCS","facility","both","","","","903","903","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REFILL & MAINTENANCE IMPLANT PUMP/RESERVOIR - DRUG DLVR SYSTEMIC","26000050","CDM","260","RC","96522","HCPCS","facility","both","","","","519.62","519.62","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC REFILL & MAINTENANCE IMPLANT PUMP/RESERVOIR - DRUG DLVR SYSTEMIC","26000050","CDM","260","RC","96522","HCPCS","facility","both","","","","144.56","144.56","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC REFILL & MAINTENANCE IMPLANT PUMP/RESERVOIR - DRUG DLVR SYSTEMIC","26000050","CDM","260","RC","96522","HCPCS","facility","both","","","","222.98","222.98","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC REFILL & MAINTENANCE IMPLANT PUMP/RESERVOIR - DRUG DLVR SYSTEMIC","26000050","CDM","260","RC","96522","HCPCS","facility","both","","","","386.48","386.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC REFILL & MAINTENANCE IMPLANT PUMP/RESERVOIR - DRUG DLVR SPINAL/BRAIN","26000051","CDM","260","RC","95990","HCPCS","facility","both","","","","889","889","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLICATION OF ON-BODY INJECTOR FOR TIMED SUBQ INJECTION","26000052","CDM","260","RC","96377","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC APPLICATION OF ON-BODY INJECTOR FOR TIMED SUBQ INJECTION","26000052","CDM","260","RC","96377","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC APPLICATION OF ON-BODY INJECTOR FOR TIMED SUBQ INJECTION","26000052","CDM","260","RC","96377","HCPCS","facility","both","","","","97.42","97.42","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC APPLICATION OF ON-BODY INJECTOR FOR TIMED SUBQ INJECTION","26000052","CDM","260","RC","96377","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC APPLICATION OF ON-BODY INJECTOR FOR TIMED SUBQ INJECTION","26000052","CDM","260","RC","96377","HCPCS","facility","both","","","","251","251","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 04/16/2021 HC IV INFUSION, BAMLANIVIMAB XXXX, INCLUDES INFUSION AND POST ADMINISTRATION","26000053","CDM","771","RC","","","facility","both","","","","309.6","309.6","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 04/16/2021 HC IV INFUSION, BAMLANIVIMAB XXXX, INCLUDES INFUSION AND POST ADMINISTRATION","26000053","CDM","771","RC","","","facility","both","","","","825","825","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 4/1/2025 HC IV INFUSION, CASIRIVIMAB & IMDEVIMAB, INCL INFUSION & POST ADM MONITOR","26000054","CDM","771","RC","","","facility","both","","","","1043","1043","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 4/1/2025 HC IV INFUSION, CASIRIVIMAB & IMDEVIMAB, INCL INFUSION & POST ADM MONITOR","26000054","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 4/1/2025 HC IV INFUSION, CASIRIVIMAB & IMDEVIMAB, INCL INFUSION & POST ADM MONITOR","26000054","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 4/1/2025 HC IV INFUSION, CASIRIVIMAB & IMDEVIMAB, INCL INFUSION & POST ADM MONITOR","26000054","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 4/1/2025 HC IV INFUSION, BAMLANIVIMAB AND ETESEVIMAB, INCLUDES INFUSION AND POST ADMIN MONITORING","26000055","CDM","771","RC","","","facility","both","","","","1043","1043","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 4/1/2025 HC IV INFUSION, BAMLANIVIMAB AND ETESEVIMAB, INCLUDES INFUSION AND POST ADMIN MONITORING","26000055","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 4/1/2025 HC IV INFUSION, BAMLANIVIMAB AND ETESEVIMAB, INCLUDES INFUSION AND POST ADMIN MONITORING","26000055","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 4/1/2025 HC IV INFUSION, BAMLANIVIMAB AND ETESEVIMAB, INCLUDES INFUSION AND POST ADMIN MONITORING","26000055","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 4/1/2025 HC IV INFUS/SUBSQ INJ, CASIRIVIMAB & IMDEVIMAB W/POST ADM MONITOR, REPEAT DOSES","26000056","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 4/1/2025 HC IV INFUS/SUBSQ INJ, CASIRIVIMAB & IMDEVIMAB W/POST ADM MONITOR, REPEAT DOSES","26000056","CDM","771","RC","","","facility","both","","","","1024","1024","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 4/1/2025 HC IV INFUS/SUBSQ INJ, CASIRIVIMAB & IMDEVIMAB W/POST ADM MONITOR, REPEAT DOSES","26000056","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 4/1/2025 HC IV INFUS/SUBSQ INJ, CASIRIVIMAB & IMDEVIMAB W/POST ADM MONITOR, REPEAT DOSES","26000056","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HYDRATION IV INFUSION 1ST HOUR","26091101","CDM","260","RC","96360","HCPCS","facility","both","","","","484","484","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYDRATION IV INFUSION EACH ADDL HOUR","26091102","CDM","260","RC","96361","HCPCS","facility","both","","","","87","87","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION DRUG THERAPY 1ST HOUR LEVEL 1","26091103","CDM","260","RC","96365","HCPCS","facility","both","","","","485","485","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION DRUG THERAPY 1ST HOUR LEVEL 2","26091104","CDM","260","RC","96365","HCPCS","facility","both","","","","638","638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION DRUG THERAPY HOURS LEVEL 3","26091105","CDM","260","RC","96365","HCPCS","facility","both","","","","638","638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION DRUG THERAPY 1ST HOUR LEVEL 3","26091106","CDM","260","RC","96365","HCPCS","facility","both","","","","750","750","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFUSION DRUG THERAPY EA ADDL HOUR LEVEL 1","26091107","CDM","260","RC","96366","HCPCS","facility","both","","","","87","87","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFUSION DRUG THERAPY EA ADDL HOUR LEVEL 2","26091108","CDM","260","RC","96366","HCPCS","facility","both","","","","191","191","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION, ADDL SEQ 0.5 HOUR LEVEL 1","26091109","CDM","260","RC","96367","HCPCS","facility","both","","","","43.5","43.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION, ADDL SEQ UP TO 1 HOUR LEVEL 1","26091110","CDM","260","RC","96367","HCPCS","facility","both","","","","87","87","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION, ADDL SEQ 0.5 HOUR LEVEL 2","26091111","CDM","260","RC","96367","HCPCS","facility","both","","","","96","96","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION, ADDL SEQ UP TO 1 HOUR LEVEL 2","26091112","CDM","260","RC","96367","HCPCS","facility","both","","","","191","191","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION, CONCURRENT LEVEL 1","26091113","CDM","260","RC","96368","HCPCS","facility","both","","","","87","87","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION, CONCURRENT LEVEL 2","26091114","CDM","260","RC","96368","HCPCS","facility","both","","","","191","191","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION, CONCURRENT LEVEL 3","26091115","CDM","260","RC","96368","HCPCS","facility","both","","","","226","226","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THER/PROPH/DIAG INJ, SC/IM","26091116","CDM","260","RC","96372","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THER/PROPH/DIAG INJ, IV PUSH","26091117","CDM","260","RC","96374","HCPCS","facility","both","","","","176","176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TX/PRO/DX INJ EA ADDL SEQ, NEW DRUG 1","26091118","CDM","260","RC","96375","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TX/PRO/DX INJ EA ADDL SEQ, NEW DRUG 2","26091119","CDM","260","RC","96375","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TX/PRO/DX INJ EA ADDL SEQ, NEW DRUG 3","26091120","CDM","260","RC","96375","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TX/PRO/DX INJ EA ADDL SEQ, SAME","26091121","CDM","260","RC","96376","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IRRIGATION OF IMPLANTED VAD","26091122","CDM","260","RC","96523","HCPCS","facility","both","","","","117","117","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IRRIGATION OF IMPLANTED VAD","26091123","CDM","260","RC","96523","HCPCS","facility","both","","","","117","117","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HYDRATION IV INFUSION ADDL 0.5 HOUR","26091124","CDM","260","RC","96361","HCPCS","facility","both","","","","58.5","58.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION DRUG THERAPY 0.5 HOUR LEVEL 1","26091125","CDM","260","RC","96365","HCPCS","facility","both","","","","442","442","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IV INFUSION DRUG THERAPY 0.5 HOUR LEVEL 2","26091126","CDM","260","RC","","","facility","both","","","","543","543","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HC IV INFUSION, ADDL SEQ UP TO 1 HOUR LEVEL 3","26091129","CDM","260","RC","96367","HCPCS","facility","both","","","","226","226","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITIAL, STANDARD, MONAURAL, ITC","27000060","CDM","270","RC","","","facility","both","","","","1700","1700","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITIAL, STANDARD, BINAURAL, ITC","27000061","CDM","270","RC","","","facility","both","","","","3400","3400","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, STANDARD, MONAURAL, CIC","27000062","CDM","270","RC","","","facility","both","","","","1700","1700","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, STANDARD, MONAURAL, RITE","27000063","CDM","270","RC","","","facility","both","","","","1800","1800","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, ADVANCED, MONAURAL, ITE","27000064","CDM","270","RC","","","facility","both","","","","2450","2450","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, ADVANCED, MONAURAL, CIC","27000065","CDM","270","RC","","","facility","both","","","","2450","2450","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, ADVANCED, BINAURAL CIC","27000066","CDM","270","RC","","","facility","both","","","","4900","4900","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, PREMIUM, MONAURAL BTE","27000067","CDM","270","RC","","","facility","both","","","","3350","3350","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, PREMIUM, MONAURAL CIC","27000068","CDM","270","RC","","","facility","both","","","","3275","3275","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RECEIVER","27000069","CDM","990","RC","","","facility","both","","","","95","95","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCKET TALKER","27000070","CDM","990","RC","","","facility","both","","","","168","168","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID, MONAURAL, IN THE EAR (ITE)","27000071","CDM","270","RC","","","facility","both","","","","1700","1700","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID, MONAURAL, IN THE CANAL (ITC)","27000072","CDM","270","RC","","","facility","both","","","","1700","1700","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID, MONAURAL,BEHIND THE EAR (BTE)","27000073","CDM","270","RC","","","facility","both","","","","1750","1750","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID, BINAURAL, ITE/ITE","27000074","CDM","270","RC","","","facility","both","","","","3400","3400","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID, BINAURAL, ITE/ITC","27000075","CDM","270","RC","","","facility","both","","","","3400","3400","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID, BINAURAL, ITE/BTE","27000076","CDM","270","RC","","","facility","both","","","","3500","3500","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID, BINAURAL, ITC/ITC","27000077","CDM","270","RC","","","facility","both","","","","3400","3400","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID, BINAURAL, ITC/BTE","27000078","CDM","270","RC","","","facility","both","","","","3500","3500","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID, BINAURAL, BTE/BTE","27000079","CDM","270","RC","","","facility","both","","","","3500","3500","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, BASIC MONAURAL, CIC","27000155","CDM","270","RC","","","facility","both","","","","1100","1100","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, BASIC MONAURAL, ITC","27000156","CDM","270","RC","","","facility","both","","","","1100","1100","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, BASIC MONAURAL, ITE","27000157","CDM","270","RC","","","facility","both","","","","1100","1100","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, BASIC MONAURAL, BTE","27000158","CDM","270","RC","","","facility","both","","","","1125","1125","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, BASIC MONAURAL, RITE","27000159","CDM","270","RC","","","facility","both","","","","1250","1250","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, BASIC BINAURAL, CIC","27000160","CDM","270","RC","","","facility","both","","","","2200","2200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, BASIC BINAURAL, ITC","27000161","CDM","270","RC","","","facility","both","","","","2200","2200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, BASIC BINAURAL, ITE","27000162","CDM","270","RC","","","facility","both","","","","2200","2200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, BASIC BINAURAL, BTE","27000163","CDM","270","RC","","","facility","both","","","","2250","2250","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DIGITAL, BASIC BINAURAL, RITE","27000164","CDM","270","RC","","","facility","both","","","","2500","2500","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THUMB BRACE","27080000","CDM","270","RC","","","facility","both","","","","28.5","28.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HAND HELPER EXERCISER","27080001","CDM","270","RC","","","facility","both","","","","18.5","18.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LORDOLOC BACK BRACE","27080002","CDM","270","RC","","","facility","both","","","","84","84","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FINGER SPLINT, EXTEND-IT","27080003","CDM","270","RC","","","facility","both","","","","21","21","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WRIST SPLINT, FUTURO","27080004","CDM","270","RC","","","facility","both","","","","43","43","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FINGER SPLINT, OVAL EIGHT","27080005","CDM","270","RC","","","facility","both","","","","19.5","19.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VAG STIM SENSOR","27080006","CDM","270","RC","","","facility","both","","","","76","76","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THUMB SPLINT, MICROWAVABL","27080007","CDM","270","RC","","","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HAND SPLINT","27080009","CDM","270","RC","","","facility","both","","","","76.75","76.75","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HAND SPLINT, PREMOLDED","27080010","CDM","270","RC","","","facility","both","","","","71.5","71.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERABAND FLEXBAR","27080011","CDM","270","RC","","","facility","both","","","","38","38","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THUMB SUPPORT, AIR SOFT","27080012","CDM","270","RC","","","facility","both","","","","55.5","55.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NASAL CANNULA","27080014","CDM","270","RC","","","facility","both","","","","6","6","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HIGH HUMIDITY O2 THERAPY  (SUPPLY)","27080016","CDM","270","RC","","","facility","both","","","","254","254","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PEAK FLOW RATE (SUPPLY)","27080017","CDM","270","RC","","","facility","both","","","","51.5","51.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MDI SPACER","27080019","CDM","270","RC","","","facility","both","","","","24.75","24.75","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID MISCELLANEOUS","27080020","CDM","270","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL,  ADVANCED, MONAURAL, ITC","27080021","CDM","270","RC","","","facility","both","","","","2450","2450","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, PREMIUM, MONAURAL, ITC","27080022","CDM","270","RC","","","facility","both","","","","3275","3275","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL,  STANDARD MONAURAL, ITE","27080023","CDM","270","RC","","","facility","both","","","","1700","1700","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, ADVANCED, MONAURAL, BTE","27080024","CDM","270","RC","","","facility","both","","","","2550","2550","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, MONAURAL, BTE .5, BETTER","27080025","CDM","270","RC","","","facility","both","","","","2450","2450","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, ADVANCED,  MONAURAL, BTE, RITE","27080026","CDM","270","RC","","","facility","both","","","","2650","2650","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, PREMIUM, MONAURAL, BTE, RITE","27080027","CDM","270","RC","","","facility","both","","","","3400","3400","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL,  STANDARD MONAURAL, BTE","27080028","CDM","270","RC","","","facility","both","","","","1750","1750","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, MONAURAL, BTE, GOOD 0.5","27080029","CDM","270","RC","","","facility","both","","","","1700","1700","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITIAL, STANDARD BINAURAL, CIC","27080030","CDM","270","RC","","","facility","both","","","","3400","3400","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, PREMIUM, BINAURAL, CIC","27080031","CDM","270","RC","","","facility","both","","","","6550","6550","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, ADVANCED,  BINAURAL, ITC","27080032","CDM","270","RC","","","facility","both","","","","4900","4900","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, PREMIUM, BINAURAL, ITC","27080033","CDM","270","RC","","","facility","both","","","","6550","6550","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, ADVANCED, BINAURAL, ITE","27080034","CDM","270","RC","","","facility","both","","","","4900","4900","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, PREMIUM, BINAURAL, ITE","27080035","CDM","270","RC","","","facility","both","","","","6550","6550","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, STANDARD BINAURAL, ITE","27080036","CDM","270","RC","","","facility","both","","","","3400","3400","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, STANDARD BINAURAL, BTE","27080037","CDM","270","RC","","","facility","both","","","","3500","3500","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, BINAURAL, BTE, GOOD, 0.5","27080038","CDM","270","RC","","","facility","both","","","","3400","3400","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, STANDARD BINAURAL, BTE, RITE (RECEIVER IN THE EAR)","27080039","CDM","270","RC","","","facility","both","","","","3600","3600","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, ADVANCED, BINAURAL, BTE","27080040","CDM","270","RC","","","facility","both","","","","5100","5100","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, BINAURAL, BTE .5, BETTER","27080041","CDM","270","RC","","","facility","both","","","","4900","4900","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, ADVANCED, BINAURAL, BTE, RITE","27080042","CDM","270","RC","","","facility","both","","","","5300","5300","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, PREMIUM, BINAURAL, BTE","27080044","CDM","270","RC","","","facility","both","","","","6700","6700","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA, DIGITAL, PREMIUM, BINAURAL, BTE, RITE","27080045","CDM","270","RC","","","facility","both","","","","6800","6800","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EAR MOLD/INSERT NON DISP, EA","27080046","CDM","270","RC","","","facility","both","","","","96","96","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BATTERY FOR HEARING DEVICE, EA","27080047","CDM","270","RC","","","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BATTERY FOR HEARING DEVICE, BOX","27080048","CDM","270","RC","","","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID SUPPLY/ACCESSORIES NOS","27080049","CDM","270","RC","","","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALD FM/DM TRANSMITTER","27080050","CDM","270","RC","","","facility","both","","","","1000","1000","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALD FM/DM RECEIVER, NOS","27080051","CDM","270","RC","","","facility","both","","","","1150","1150","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY FORCEPS","27280001","CDM","272","RC","","","facility","both","","","","800","800","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOLOGY BRUSH","27280002","CDM","272","RC","","","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WANG NEEDLE","27280003","CDM","272","RC","","","facility","both","","","","371","371","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ARTERIAL SAMPLNG TRAY","27280004","CDM","272","RC","","","facility","both","","","","68","68","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MICROBRUSH","27280006","CDM","272","RC","","","facility","both","","","","68.75","68.75","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SMALL AQUAPLAST MASK 1.6","27291101","CDM","272","RC","","","facility","both","","","","64","64","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARGE AQUAPLAST MASK 2.4","27291102","CDM","272","RC","","","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MEDIUM VAGINAL DILATOR 29","27291103","CDM","272","RC","","","facility","both","","","","23","23","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARGE VAGINAL DILATOR 35M","27291104","CDM","272","RC","","","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACCUFORM HEAD/NECK SUPPORT","27291105","CDM","272","RC","27291105","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARGE ALPHA CRADLE","27291106","CDM","272","RC","","","facility","both","","","","114","114","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SMALL ALPHA CRADLE","27291107","CDM","272","RC","","","facility","both","","","","103","103","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID VENDOR REPAIR LEVEL 1","27300050","CDM","990","RC","","","facility","both","","","","263","263","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID VENDOR REPAIR LEVEL 2","27300051","CDM","990","RC","","","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID VENDOR REPAIR LEVEL 3","27300052","CDM","990","RC","","","facility","both","","","","373","373","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC WIDEX WARRANTY","27300053","CDM","990","RC","27300053","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID VENDOR REPAIR LEVEL 4","27300054","CDM","990","RC","","","facility","both","","","","441","441","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RECHARGEABLE BATTERY","27300055","CDM","270","RC","","","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RECHARGEABLE BATTERY CASE","27300056","CDM","270","RC","","","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OTICON WARRANTY/EAR","27380001","CDM","990","RC","","","facility","both","","","","210","210","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHONAK OR RESOUND WARRANT","27380002","CDM","990","RC","","","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IN-OFFICE WARRANTY","27380003","CDM","990","RC","","","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRACHYTX, NON-STRANDED, P-103, PER SOURCE","27846001","CDM","278","RC","","","facility","both","","","","122.18","122.18","","","","","","","","","","","","","Gross Charge Type: JHH 67 MEDICATIONS EAP CONVERTING TO ERX IN WILLOW IN 2017 OPTIMIZATION"
"HC BRACHYTX, NS NON-HDRIR-192, PER SOURCE","27846002","CDM","278","RC","","","facility","both","","","","427.63","427.63","","","","","","","","","","","","","Gross Charge Type: JHH 67 MEDICATIONS EAP CONVERTING TO ERX IN WILLOW IN 2017 OPTIMIZATION"
"HC BRACHYTX, NON-STRANDED, I-125, PER SOURCE","27846003","CDM","278","RC","","","facility","both","","","","806.38","806.38","","","","","","","","","","","","","Gross Charge Type: JHH 67 MEDICATIONS EAP CONVERTING TO ERX IN WILLOW IN 2017 OPTIMIZATION"
"HC BRACHYTX NON STR HDR IR-192, PER SOURCE","27846004","CDM","278","RC","","","facility","both","","","","1294","1294","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRACHYTX NON STR HDR IR-192, PER SOURCE","27846004","CDM","278","RC","","","facility","both","","","","568.55","568.55","","","","","","","","","","","","","Gross Charge Type: JHH 67 MEDICATIONS EAP CONVERTING TO ERX IN WILLOW IN 2017 OPTIMIZATION"
"HC HOSP GRADE ELEC BREAST PUMP","29100001","CDM","291","RC","","","facility","both","","","","95","95","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROUTINE VENIPUNCTURE","30000001","CDM","300","RC","36415","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: LAB-NAVERIS, CAREDX ALLOSURE, AND SEMA4 GENOMICX CLIENT FEE SCHEDULE"
"HC ROUTINE VENIPUNCTURE","30000001","CDM","300","RC","36415","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ROUTINE VENIPUNCTURE","30000001","CDM","300","RC","36415","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: LAB-INVITAE GENETICS CLIENT FEE SCHEDULE"
"HC ROUTINE VENIPUNCTURE","30000001","CDM","300","RC","36415","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ROUTINE VENIPUNCTURE","30000001","CDM","300","RC","36415","HCPCS","facility","both","","","","39","39","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ROUTINE VENIPUNCTURE","30000001","CDM","300","RC","36415","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: LAB-NATERA AND NXGEN MDX CLIENT FEE SCHEDULE"
"HC ROUTINE VENIPUNCTURE","30000001","CDM","300","RC","36415","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: LAB-LABCORP AND QUEST CLIENT FEE SCHEDULE"
"HC ROUTINE VENIPUNCTURE","30000001","CDM","300","RC","36415","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC ROUTINE VENIPUNCTURE","30000001","CDM","300","RC","36415","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ROUTINE VENIPUNCTURE","30000001","CDM","300","RC","36415","HCPCS","facility","both","","","","3","3","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC CAPILLARY BLOOD DRAW","30000002","CDM","300","RC","36416","HCPCS","facility","both","","","","41.76","41.76","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CAPILLARY BLOOD DRAW","30000002","CDM","300","RC","36416","HCPCS","facility","both","","","","39","39","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRAW BLOOD OFF VENOUS DEVICE","30000003","CDM","300","RC","36591","HCPCS","facility","both","","","","1077","1077","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRAW BLOOD OFF VENOUS DEVICE","30000003","CDM","300","RC","36591","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC DRAW BLOOD OFF VENOUS DEVICE","30000003","CDM","300","RC","36591","HCPCS","facility","both","","","","192.75","192.75","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC DRAW BLOOD OFF VENOUS DEVICE","30000003","CDM","300","RC","36591","HCPCS","facility","both","","","","515.27","515.27","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC DRAW BLOOD OFF VENOUS DEVICE","30000003","CDM","300","RC","36591","HCPCS","facility","both","","","","297.32","297.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC METABOLIC PANEL TOTAL CA","30000004","CDM","301","RC","80048","HCPCS","facility","both","","","","29.47","29.47","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC METABOLIC PANEL TOTAL CA","30000004","CDM","301","RC","80048","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC METABOLIC PANEL TOTAL CA","30000004","CDM","301","RC","80048","HCPCS","facility","both","","","","8.46","8.46","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC METABOLIC PANEL TOTAL CA","30000004","CDM","301","RC","80048","HCPCS","facility","both","","","","313","313","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC METABOLIC PANEL TOTAL CA","30000004","CDM","301","RC","80048","HCPCS","facility","both","","","","23.03","23.03","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC METABOLIC PANEL TOTAL CA","30000004","CDM","301","RC","80048","HCPCS","facility","both","","","","24","24","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPREHENSIVE METABOLIC PANEL","30000005","CDM","301","RC","80053","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPREHENSIVE METABOLIC PANEL","30000005","CDM","301","RC","80053","HCPCS","facility","both","","","","366","366","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPREHENSIVE METABOLIC PANEL","30000005","CDM","301","RC","80053","HCPCS","facility","both","","","","10.56","10.56","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC COMPREHENSIVE METABOLIC PANEL","30000005","CDM","301","RC","80053","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC COMPREHENSIVE METABOLIC PANEL","30000005","CDM","301","RC","80053","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPREHENSIVE METABOLIC PANEL","30000005","CDM","301","RC","80053","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COMPREHENSIVE METABOLIC PANEL","30000005","CDM","301","RC","80053","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC RENAL FUNCTION PANEL","30000006","CDM","301","RC","80069","HCPCS","facility","both","","","","24","24","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RENAL FUNCTION PANEL","30000006","CDM","301","RC","80069","HCPCS","facility","both","","","","32.16","32.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RENAL FUNCTION PANEL","30000006","CDM","301","RC","80069","HCPCS","facility","both","","","","25.12","25.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RENAL FUNCTION PANEL","30000006","CDM","301","RC","80069","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC RENAL FUNCTION PANEL","30000006","CDM","301","RC","80069","HCPCS","facility","both","","","","8.68","8.68","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC RENAL FUNCTION PANEL","30000006","CDM","301","RC","80069","HCPCS","facility","both","","","","292","292","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEPATIC FUNCTION PANEL","30000007","CDM","301","RC","80076","HCPCS","facility","both","","","","29.47","29.47","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEPATIC FUNCTION PANEL","30000007","CDM","301","RC","80076","HCPCS","facility","both","","","","23.03","23.03","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEPATIC FUNCTION PANEL","30000007","CDM","301","RC","80076","HCPCS","facility","both","","","","24","24","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPATIC FUNCTION PANEL","30000007","CDM","301","RC","80076","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC HEPATIC FUNCTION PANEL","30000007","CDM","301","RC","80076","HCPCS","facility","both","","","","289","289","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GH SUPPRESSION PANEL","30000008","CDM","301","RC","80430","HCPCS","facility","both","","","","293.09","293.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GH SUPPRESSION PANEL","30000008","CDM","301","RC","80430","HCPCS","facility","both","","","","375.15","375.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GH SUPPRESSION PANEL","30000008","CDM","301","RC","80430","HCPCS","facility","both","","","","268.5","268.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GH SUPPRESSION PANEL","30000008","CDM","301","RC","80430","HCPCS","facility","both","","","","1165","1165","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CARNITINE QUAN EA","30000009","CDM","301","RC","82379","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CARNITINE QUAN EA","30000009","CDM","301","RC","82379","HCPCS","facility","both","","","","650","650","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CARNITINE QUAN EA","30000009","CDM","301","RC","82379","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CARNITINE QUAN EA","30000009","CDM","301","RC","82379","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHLORIDE; OTHER","30000010","CDM","301","RC","82438","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHLORIDE; OTHER","30000010","CDM","301","RC","82438","HCPCS","facility","both","","","","22","22","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHLORIDE; OTHER","30000010","CDM","301","RC","82438","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHLORIDE; OTHER","30000010","CDM","301","RC","82438","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VERY LONG FATTY ACID CHAINS","30000011","CDM","301","RC","82726","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VERY LONG FATTY ACID CHAINS","30000011","CDM","301","RC","82726","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VERY LONG FATTY ACID CHAINS","30000011","CDM","301","RC","82726","HCPCS","facility","both","","","","213","213","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF IGE","30000012","CDM","301","RC","82785","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF IGE","30000012","CDM","301","RC","82785","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF IGE","30000012","CDM","301","RC","82785","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY OF IGE","30000012","CDM","301","RC","82785","HCPCS","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INSULIN; TOTAL","30000013","CDM","301","RC","83525","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC INSULIN; TOTAL","30000013","CDM","301","RC","83525","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC INSULIN; TOTAL","30000013","CDM","301","RC","83525","HCPCS","facility","both","","","","472","472","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INSULIN; TOTAL","30000013","CDM","301","RC","83525","HCPCS","facility","both","","","","11.43","11.43","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC INSULIN; TOTAL","30000013","CDM","301","RC","83525","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INSULIN; TOTAL","30000013","CDM","301","RC","83525","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TESTOSTERONE; TOTAL","30000014","CDM","301","RC","84403","HCPCS","facility","both","","","","36.5","36.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TESTOSTERONE; TOTAL","30000014","CDM","301","RC","84403","HCPCS","facility","both","","","","550","550","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TESTOSTERONE; TOTAL","30000014","CDM","301","RC","84403","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TESTOSTERONE; TOTAL","30000014","CDM","301","RC","84403","HCPCS","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC TESTOSTERONE; TOTAL","30000014","CDM","301","RC","84403","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TESTOSTERONE; TOTAL","30000014","CDM","301","RC","84403","HCPCS","facility","both","","","","25.81","25.81","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC T3; REVERSE","30000015","CDM","301","RC","84482","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC T3; REVERSE","30000015","CDM","301","RC","84482","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC T3; REVERSE","30000015","CDM","301","RC","84482","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC T3; REVERSE","30000015","CDM","301","RC","84482","HCPCS","facility","both","","","","196","196","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FETAL HGB SCREENING TEST","30000016","CDM","305","RC","85461","HCPCS","facility","both","","","","66.5","66.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FETAL HGB SCREENING TEST","30000016","CDM","305","RC","85461","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FETAL HGB SCREENING TEST","30000016","CDM","305","RC","85461","HCPCS","facility","both","","","","134","134","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FETAL HGB SCREENING TEST","30000016","CDM","305","RC","85461","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SICKLING OF RBC REDUCTION","30000017","CDM","305","RC","85660","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SICKLING OF RBC REDUCTION","30000017","CDM","305","RC","85660","HCPCS","facility","both","","","","38.5","38.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SICKLING OF RBC REDUCTION","30000017","CDM","305","RC","85660","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SICKLING OF RBC REDUCTION","30000017","CDM","305","RC","85660","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALLERG SP IGE; QUAN OR SEMIQUAN","30000018","CDM","302","RC","86003","HCPCS","facility","both","","","","272","272","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALLERG SP IGE; QUAN OR SEMIQUAN","30000018","CDM","302","RC","86003","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALLERG SP IGE; QUAN OR SEMIQUAN","30000018","CDM","302","RC","86003","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALLERG SP IGE; QUAN OR SEMIQUAN","30000018","CDM","302","RC","86003","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB ID; LEUKOCYTE AB","30000019","CDM","300","RC","86021","HCPCS","facility","both","","","","1211","1211","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB ID; LEUKOCYTE AB","30000019","CDM","300","RC","86021","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB ID; LEUKOCYTE AB","30000019","CDM","300","RC","86021","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COLD AGGLUTININ; SCREEN","30000020","CDM","302","RC","86156","HCPCS","facility","both","","","","34.84","34.84","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COLD AGGLUTININ; SCREEN","30000020","CDM","302","RC","86156","HCPCS","facility","both","","","","27.22","27.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COLD AGGLUTININ; SCREEN","30000020","CDM","302","RC","86156","HCPCS","facility","both","","","","194","194","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COLD AGGLUTININ; SCREEN","30000020","CDM","302","RC","86156","HCPCS","facility","both","","","","25.5","25.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COLD AGGLUTININ; TITER","30000021","CDM","300","RC","86157","HCPCS","facility","both","","","","57","57","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COLD AGGLUTININ; TITER","30000021","CDM","300","RC","86157","HCPCS","facility","both","","","","69.66","69.66","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COLD AGGLUTININ; TITER","30000021","CDM","300","RC","86157","HCPCS","facility","both","","","","54.43","54.43","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COLD AGGLUTININ; TITER","30000021","CDM","300","RC","86157","HCPCS","facility","both","","","","194","194","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ID; GEL QUAL; EA AB/AG","30000022","CDM","302","RC","86331","HCPCS","facility","both","","","","24","24","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ID; GEL QUAL; EA AB/AG","30000022","CDM","302","RC","86331","HCPCS","facility","both","","","","50.91","50.91","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ID; GEL QUAL; EA AB/AG","30000022","CDM","302","RC","86331","HCPCS","facility","both","","","","39.77","39.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ID; GEL QUAL; EA AB/AG","30000022","CDM","302","RC","86331","HCPCS","facility","both","","","","67","67","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LYMPHOCYTE MITOGEN RESPONSE","30000023","CDM","302","RC","86353","HCPCS","facility","both","","","","206.33","206.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LYMPHOCYTE MITOGEN RESPONSE","30000023","CDM","302","RC","86353","HCPCS","facility","both","","","","161.19","161.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LYMPHOCYTE MITOGEN RESPONSE","30000023","CDM","302","RC","86353","HCPCS","facility","both","","","","580","580","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NITROBLUE TETRAZOLIUM DYE TEST","30000024","CDM","302","RC","86384","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NITROBLUE TETRAZOLIUM DYE TEST","30000024","CDM","302","RC","86384","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC NITROBLUE TETRAZOLIUM DYE TEST","30000024","CDM","302","RC","86384","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NITROBLUE TETRAZOLIUM DYE TEST","30000024","CDM","302","RC","86384","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HEMOPHILUS INFLUENZA","30000025","CDM","302","RC","86684","HCPCS","facility","both","","","","188","188","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HEMOPHILUS INFLUENZA","30000025","CDM","302","RC","86684","HCPCS","facility","both","","","","98.39","98.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HEMOPHILUS INFLUENZA","30000025","CDM","302","RC","86684","HCPCS","facility","both","","","","125.95","125.95","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HEMOPHILUS INFLUENZA","30000025","CDM","302","RC","86684","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HIV-2","30000026","CDM","302","RC","86702","HCPCS","facility","both","","","","55.5","55.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HIV-2","30000026","CDM","302","RC","86702","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HIV-2","30000026","CDM","302","RC","86702","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HIV-2","30000026","CDM","302","RC","86702","HCPCS","facility","both","","","","230","230","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HIV-2","30000026","CDM","302","RC","86702","HCPCS","facility","both","","","","40.5","40.5","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC RBC AB ELUTION EA","30000027","CDM","300","RC","86860","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC AB ELUTION EA","30000027","CDM","300","RC","86860","HCPCS","facility","both","","","","278","278","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC AB ELUTION EA","30000027","CDM","300","RC","86860","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RBC AB ELUTION EA","30000027","CDM","300","RC","86860","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB ID RBC EA PANEL EA TECHN","30000028","CDM","300","RC","86870","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB ID RBC EA PANEL EA TECHN","30000028","CDM","300","RC","86870","HCPCS","facility","both","","","","884","884","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB ID RBC EA PANEL EA TECHN","30000028","CDM","300","RC","86870","HCPCS","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB ID RBC EA PANEL EA TECHN","30000028","CDM","300","RC","86870","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COOMBS; DIRECT","30000029","CDM","300","RC","86880","HCPCS","facility","both","","","","9","9","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC COOMBS; DIRECT","30000029","CDM","300","RC","86880","HCPCS","facility","both","","","","185","185","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COOMBS; DIRECT","30000029","CDM","300","RC","86880","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COOMBS; DIRECT","30000029","CDM","300","RC","86880","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COOMBS; DIRECT","30000029","CDM","300","RC","86880","HCPCS","facility","both","","","","16.5","16.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COOMBS TEST INDIRECT TITER","30000030","CDM","300","RC","86886","HCPCS","facility","both","","","","57","57","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COOMBS TEST INDIRECT TITER","30000030","CDM","300","RC","86886","HCPCS","facility","both","","","","85.75","85.75","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COOMBS TEST INDIRECT TITER","30000030","CDM","300","RC","86886","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COOMBS TEST INDIRECT TITER","30000030","CDM","300","RC","86886","HCPCS","facility","both","","","","32","32","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC COOMBS TEST INDIRECT TITER","30000030","CDM","300","RC","86886","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD TYPING; ABO","30000031","CDM","300","RC","86900","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLOOD TYPING; ABO","30000031","CDM","300","RC","86900","HCPCS","facility","both","","","","190","190","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD TYPING; ABO","30000031","CDM","300","RC","86900","HCPCS","facility","both","","","","13","13","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BLOOD TYPING; ABO","30000031","CDM","300","RC","86900","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLOOD TYPING; ABO","30000031","CDM","300","RC","86900","HCPCS","facility","both","","","","7","7","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC BLOOD TYPING; RH D","30000032","CDM","300","RC","86901","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLOOD TYPING; RH D","30000032","CDM","300","RC","86901","HCPCS","facility","both","","","","135","135","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD TYPING; RH D","30000032","CDM","300","RC","86901","HCPCS","facility","both","","","","18","18","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BLOOD TYPING; RH D","30000032","CDM","300","RC","86901","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLOOD TYPE ANTIGEN DONOR EA","30000033","CDM","300","RC","86902","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLOOD TYPE ANTIGEN DONOR EA","30000033","CDM","300","RC","86902","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BLOOD TYPE ANTIGEN DONOR EA","30000033","CDM","300","RC","86902","HCPCS","facility","both","","","","449","449","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD TYPE ANTIGEN DONOR EA","30000033","CDM","300","RC","86902","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLD TYPE; RBC AG NOT ABO/RHD","30000034","CDM","300","RC","86905","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BLD TYPE; RBC AG NOT ABO/RHD","30000034","CDM","300","RC","86905","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLD TYPE; RBC AG NOT ABO/RHD","30000034","CDM","300","RC","86905","HCPCS","facility","both","","","","449","449","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLD TYPE; RBC AG NOT ABO/RHD","30000034","CDM","300","RC","86905","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLD TYPE; RBC AG NOT ABO/RHD","30000034","CDM","300","RC","86905","HCPCS","facility","both","","","","17","17","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC BLD TYPE; RH PHENOTYPE","30000035","CDM","300","RC","86906","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BLD TYPE; RH PHENOTYPE","30000035","CDM","300","RC","86906","HCPCS","facility","both","","","","159","159","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLD TYPE; RH PHENOTYPE","30000035","CDM","300","RC","86906","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLD TYPE; RH PHENOTYPE","30000035","CDM","300","RC","86906","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COMPATIBILITY TEST ANTIGLOB","30000036","CDM","300","RC","86922","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COMPATIBILITY TEST ANTIGLOB","30000036","CDM","300","RC","86922","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPATIBILITY TEST ANTIGLOB","30000036","CDM","300","RC","86922","HCPCS","facility","both","","","","254","254","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPATIBILITY TEST ANTIGLOB","30000036","CDM","300","RC","86922","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPATIBILITY TEST ELECTRIC","30000037","CDM","300","RC","86923","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPATIBILITY TEST ELECTRIC","30000037","CDM","300","RC","86923","HCPCS","facility","both","","","","420","420","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPATIBILITY TEST ELECTRIC","30000037","CDM","300","RC","86923","HCPCS","facility","both","","","","12.56","12.56","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPATIBILITY TEST ELECTRIC","30000037","CDM","300","RC","86923","HCPCS","facility","both","","","","16.08","16.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IRRADIATE BLD PRODUCT EA UNIT","30000038","CDM","300","RC","86945","HCPCS","facility","both","","","","160","160","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IRRADIATE BLD PRODUCT EA UNIT","30000038","CDM","300","RC","86945","HCPCS","facility","both","","","","321","321","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IRRADIATE BLD PRODUCT EA UNIT","30000038","CDM","300","RC","86945","HCPCS","facility","both","","","","167.48","167.48","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IRRADIATE BLD PRODUCT EA UNIT","30000038","CDM","300","RC","86945","HCPCS","facility","both","","","","214.37","214.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VOL REDUCTION OF BLOOD/PROD","30000039","CDM","300","RC","86960","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VOL REDUCTION OF BLOOD/PROD","30000039","CDM","300","RC","86960","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VOL REDUCTION OF BLOOD/PROD","30000039","CDM","300","RC","86960","HCPCS","facility","both","","","","420","420","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VOL REDUCTION OF BLOOD/PROD","30000039","CDM","300","RC","86960","HCPCS","facility","both","","","","422","422","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VOL REDUCTION OF BLOOD/PROD","30000039","CDM","300","RC","86960","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC POOL PLATELETS OR BLD PRODUCT","30000040","CDM","300","RC","86965","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC POOL PLATELETS OR BLD PRODUCT","30000040","CDM","300","RC","86965","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC POOL PLATELETS OR BLD PRODUCT","30000040","CDM","300","RC","86965","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC POOL PLATELETS OR BLD PRODUCT","30000040","CDM","300","RC","86965","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PRETREAT RBC; ENZYMES","30000041","CDM","300","RC","86971","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PRETREAT RBC; ENZYMES","30000041","CDM","300","RC","86971","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PRETREAT RBC; ENZYMES","30000041","CDM","300","RC","86971","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PRETREAT RBC; ENZYMES","30000041","CDM","300","RC","86971","HCPCS","facility","both","","","","449","449","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SPLIT BLD PRODUCT EA UNIT","30000042","CDM","300","RC","86985","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SPLIT BLD PRODUCT EA UNIT","30000042","CDM","300","RC","86985","HCPCS","facility","both","","","","281","281","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SPLIT BLD PRODUCT EA UNIT","30000042","CDM","300","RC","86985","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SPLIT BLD PRODUCT EA UNIT","30000042","CDM","300","RC","86985","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DONATH-LANDSTEINER TEST","30000043","CDM","300","RC","86999","HCPCS","facility","both","","","","81","81","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AUTO RED CELL PROCESS FEE","30000044","CDM","300","RC","86999","HCPCS","facility","both","","","","161","161","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DIFF CELL COUNT NOT BLOOD","30000045","CDM","300","RC","89051","HCPCS","facility","both","","","","145","145","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DIFF CELL COUNT NOT BLOOD","30000045","CDM","300","RC","89051","HCPCS","facility","both","","","","5.6","5.6","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC DIFF CELL COUNT NOT BLOOD","30000045","CDM","300","RC","89051","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DIFF CELL COUNT NOT BLOOD","30000045","CDM","300","RC","89051","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DIFF CELL COUNT NOT BLOOD","30000045","CDM","300","RC","89051","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SEMEN ANAL STRICT CRITERIA","30000046","CDM","300","RC","89322","HCPCS","facility","both","","","","229","229","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SEMEN ANAL STRICT CRITERIA","30000046","CDM","300","RC","89322","HCPCS","facility","both","","","","60.71","60.71","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SEMEN ANAL STRICT CRITERIA","30000046","CDM","300","RC","89322","HCPCS","facility","both","","","","77.71","77.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEUKOREDUCTION","30000047","CDM","300","RC","86999","HCPCS","facility","both","","","","115.14","115.14","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LEUKOREDUCTION","30000047","CDM","300","RC","86999","HCPCS","facility","both","","","","765","765","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEUKOREDUCTION","30000047","CDM","300","RC","86999","HCPCS","facility","both","","","","147.37","147.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEUKOREDUCTION","30000047","CDM","300","RC","86999","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TRICH. VAGINALIS AMP PROBE","30000048","CDM","306","RC","87661","HCPCS","facility","both","","","","120.59","120.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRICH. VAGINALIS AMP PROBE","30000048","CDM","306","RC","87661","HCPCS","facility","both","","","","94.2","94.2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TRICH. VAGINALIS AMP PROBE","30000048","CDM","306","RC","87661","HCPCS","facility","both","","","","71","71","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TRICH. VAGINALIS AMP PROBE","30000048","CDM","306","RC","87661","HCPCS","facility","both","","","","1482","1482","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NFCT DS CHRNC HCV 6 ASSAYS (153)","30000049","CDM","300","RC","81596","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NFCT DS CHRNC HCV 6 ASSAYS (153)","30000049","CDM","300","RC","81596","HCPCS","facility","both","","","","320.29","320.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NFCT DS CHRNC HCV 6 ASSAYS (153)","30000049","CDM","300","RC","81596","HCPCS","facility","both","","","","295","295","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC NFCT DS CHRNC HCV 6 ASSAYS (153)","30000049","CDM","300","RC","81596","HCPCS","facility","both","","","","409.98","409.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AUTOLOG BLOOD PREDEPOSITED","30000100","CDM","300","RC","86890","HCPCS","facility","both","","","","561","561","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPATIBILITY TEST INCUBATE","30000101","CDM","300","RC","86921","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPATIBILITY TEST INCUBATE","30000101","CDM","300","RC","86921","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COMPATIBILITY TEST INCUBATE","30000101","CDM","300","RC","86921","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPATIBILITY TEST INCUBATE","30000101","CDM","300","RC","86921","HCPCS","facility","both","","","","254","254","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PRETREAT RBC; CHEM OR DRUGS","30000102","CDM","300","RC","86970","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PRETREAT RBC; CHEM OR DRUGS","30000102","CDM","300","RC","86970","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PRETREAT RBC; CHEM OR DRUGS","30000102","CDM","300","RC","86970","HCPCS","facility","both","","","","127","127","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PRETREAT RBC; CHEM OR DRUGS","30000102","CDM","300","RC","86970","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SERUM PRETX; RC ABSORPT","30000103","CDM","300","RC","86978","HCPCS","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SERUM PRETX; RC ABSORPT","30000103","CDM","300","RC","86978","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SERUM PRETX; RC ABSORPT","30000103","CDM","300","RC","86978","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SERUM PRETX; RC ABSORPT","30000103","CDM","300","RC","86978","HCPCS","facility","both","","","","223","223","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BILIRUBIN TOTAL TRANSCUT","30000104","CDM","300","RC","88720","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FECAL LEUKO CNT QUAL/SEMIQUAN","30000105","CDM","300","RC","89055","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FECAL LEUKO CNT QUAL/SEMIQUAN","30000105","CDM","300","RC","89055","HCPCS","facility","both","","","","9","9","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FECAL LEUKO CNT QUAL/SEMIQUAN","30000105","CDM","300","RC","89055","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FECAL LEUKO CNT QUAL/SEMIQUAN","30000105","CDM","300","RC","89055","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC EXAM SYNOVIAL FLUID CRYSTALS","30000106","CDM","300","RC","89060","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC EXAM SYNOVIAL FLUID CRYSTALS","30000106","CDM","300","RC","89060","HCPCS","facility","both","","","","29","29","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC EXAM SYNOVIAL FLUID CRYSTALS","30000106","CDM","300","RC","89060","HCPCS","facility","both","","","","159","159","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC EXAM SYNOVIAL FLUID CRYSTALS","30000106","CDM","300","RC","89060","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PSA SCREENING","30000107","CDM","301","RC","","","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AUTOLOG BLOOD OP SALVAGE","30000108","CDM","300","RC","86891","HCPCS","facility","both","","","","1406.82","1406.82","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AUTOLOG BLOOD OP SALVAGE","30000108","CDM","300","RC","86891","HCPCS","facility","both","","","","1077","1077","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AUTOLOG BLOOD OP SALVAGE","30000108","CDM","300","RC","86891","HCPCS","facility","both","","","","1099.06","1099.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MEAT FIBERS FECES","30000109","CDM","300","RC","89160","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MEAT FIBERS FECES","30000109","CDM","300","RC","89160","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLD TYPE; AG SCRN W PT SERUM","30000125","CDM","300","RC","86904","HCPCS","facility","both","","","","81","81","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLD TYPE; AG SCRN W PT SERUM","30000125","CDM","300","RC","86904","HCPCS","facility","both","","","","32.16","32.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLD TYPE; AG SCRN W PT SERUM","30000125","CDM","300","RC","86904","HCPCS","facility","both","","","","25.12","25.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HAMS; AUTO SCRN EA","30000127","CDM","300","RC","86940","HCPCS","facility","both","","","","477","477","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FETAL SCREEN","30000128","CDM","300","RC","86941","HCPCS","facility","both","","","","216","216","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FETAL SCREEN","30000128","CDM","300","RC","86941","HCPCS","facility","both","","","","37.68","37.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FETAL SCREEN","30000128","CDM","300","RC","86941","HCPCS","facility","both","","","","48.24","48.24","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FETAL SCREEN","30000128","CDM","300","RC","86941","HCPCS","facility","both","","","","88.5","88.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PRETREAT RBC; DGS","30000129","CDM","300","RC","86972","HCPCS","facility","both","","","","1457","1457","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SERUM PRETX; DILUTION","30000130","CDM","300","RC","86976","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SERUM PRETX; DILUTION","30000130","CDM","300","RC","86976","HCPCS","facility","both","","","","104","104","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SERUM PRETX; DILUTION","30000130","CDM","300","RC","86976","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SERUM PRETX; DILUTION","30000130","CDM","300","RC","86976","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SERUM PRETX; INHIBITOR INCUBATE","30000131","CDM","300","RC","86977","HCPCS","facility","both","","","","27.5","27.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SERUM PRETX; INHIBITOR INCUBATE","30000131","CDM","300","RC","86977","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SERUM PRETX; INHIBITOR INCUBATE","30000131","CDM","300","RC","86977","HCPCS","facility","both","","","","804","804","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SERUM PRETX; INHIBITOR INCUBATE","30000131","CDM","300","RC","86977","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SECRETIONS FAT STAIN","30000132","CDM","300","RC","89125","HCPCS","facility","both","","","","64","64","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC N EOSINOPHIL SMEAR","30000133","CDM","300","RC","89190","HCPCS","facility","both","","","","111","111","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CULTURE OOCYTE(S)/EMBRYO(S) < 4 DAYS","30000134","CDM","300","RC","89250","HCPCS","facility","both","","","","1989","1989","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSIST EMBRYO HATCH MICROTECH","30000135","CDM","300","RC","89253","HCPCS","facility","both","","","","404","404","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OOCYTE ID FOLLICULAR FLUID","30000136","CDM","300","RC","89254","HCPCS","facility","both","","","","1989","1989","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC EMBRYO TRANSFER PREP","30000137","CDM","300","RC","89255","HCPCS","facility","both","","","","404","404","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SPERM ID FROM ASP","30000138","CDM","300","RC","89257","HCPCS","facility","both","","","","404","404","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CRYOPRESERVATION EMBRYO(S)","30000139","CDM","300","RC","89258","HCPCS","facility","both","","","","3081","3081","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CRYOPRESERVATION; SPERM","30000140","CDM","300","RC","89259","HCPCS","facility","both","","","","683","683","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SPERM ISOLATION; SIMPLE PREP","30000141","CDM","300","RC","89260","HCPCS","facility","both","","","","404","404","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SPERM ISOLATION; CMPLX PREP","30000142","CDM","300","RC","89261","HCPCS","facility","both","","","","683","683","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SPERM ID FROM TESTIS FRESH/CRYOPRESERVE","30000143","CDM","300","RC","89264","HCPCS","facility","both","","","","1989","1989","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC EXT OOCYTE(S)/EMBRYO(S) CULTURE 4-7 DAYS","30000144","CDM","300","RC","89272","HCPCS","facility","both","","","","1989","1989","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSIST OOCYTE FERTILIZ <= 10 OO","30000145","CDM","300","RC","89280","HCPCS","facility","both","","","","3081","3081","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSIST OOCYTE FERTILIZ >10 OO","30000146","CDM","300","RC","89281","HCPCS","facility","both","","","","1989","1989","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BX OOCYTE POLAR BODY <= 5 EMBRY","30000147","CDM","300","RC","89290","HCPCS","facility","both","","","","1989","1989","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BX OOCYTE POLAR BODY > 5 EMBRY","30000148","CDM","300","RC","89291","HCPCS","facility","both","","","","1989","1989","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SEMEN; PRESENCE & MOTILITY","30000149","CDM","300","RC","89300","HCPCS","facility","both","","","","134","134","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SEMEN; MOTILITY & COUNT","30000150","CDM","300","RC","89310","HCPCS","facility","both","","","","128","128","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SEMEN; MOTILITY & COUNT","30000150","CDM","300","RC","89310","HCPCS","facility","both","","","","29.31","29.31","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SEMEN; MOTILITY & COUNT","30000150","CDM","300","RC","89310","HCPCS","facility","both","","","","37.52","37.52","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SEMEN ANAL VOL/COUNT/MOT","30000151","CDM","300","RC","89320","HCPCS","facility","both","","","","77.71","77.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SEMEN ANAL VOL/COUNT/MOT","30000151","CDM","300","RC","89320","HCPCS","facility","both","","","","180","180","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SEMEN ANAL VOL/COUNT/MOT","30000151","CDM","300","RC","89320","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC SEMEN ANAL VOL/COUNT/MOT","30000151","CDM","300","RC","89320","HCPCS","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SEMEN ANAL VOL/COUNT/MOT","30000151","CDM","300","RC","89320","HCPCS","facility","both","","","","60.71","60.71","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SEMEN ANAL SPERM DETECTION","30000152","CDM","300","RC","89321","HCPCS","facility","both","","","","37.52","37.52","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SEMEN ANAL SPERM DETECTION","30000152","CDM","300","RC","89321","HCPCS","facility","both","","","","232","232","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SEMEN ANAL SPERM DETECTION","30000152","CDM","300","RC","89321","HCPCS","facility","both","","","","29.31","29.31","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SEMEN ANAL SPERM DETECTION","30000152","CDM","300","RC","89321","HCPCS","facility","both","","","","34","34","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SPERM ANTIBODIES","30000153","CDM","300","RC","89325","HCPCS","facility","both","","","","396","396","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RETROGRADE EJACULATION ANAL","30000154","CDM","300","RC","89331","HCPCS","facility","both","","","","29.31","29.31","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RETROGRADE EJACULATION ANAL","30000154","CDM","300","RC","89331","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RETROGRADE EJACULATION ANAL","30000154","CDM","300","RC","89331","HCPCS","facility","both","","","","37.52","37.52","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STORAGE/YEAR; EMBRYO(S)","30000155","CDM","300","RC","89342","HCPCS","facility","both","","","","683","683","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STORAGE/YEAR; SPERM/SEMEN","30000156","CDM","300","RC","89343","HCPCS","facility","both","","","","404","404","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THAW CRYOPRESERVED; EMBRYO(S)","30000157","CDM","300","RC","89352","HCPCS","facility","both","","","","1989","1989","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THAW CRYOPRESERVED; SPERM/ALIQUOT","30000158","CDM","300","RC","89353","HCPCS","facility","both","","","","404","404","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SPECIMEN HANDLING OFFICE-LAB","30000159","CDM","300","RC","99000","HCPCS","facility","both","","","","285.6","285.6","","","","","","","","","","","","","Gross Charge Type: HB JHH DONOR BILLING CLIENT FSC"
"HC LAB ONE-WAY ALLOW PRORATED TRIP","30000161","CDM","300","RC","","","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TRANCSCUTANEOUS CARBOXYHB","30000162","CDM","300","RC","88740","HCPCS","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (70)","30000163","CDM","300","RC","83520","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (70)","30000163","CDM","300","RC","83520","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY, NOS PART OF PANEL","30000164","CDM","300","RC","83520","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY, NOS PART OF PANEL","30000164","CDM","300","RC","83520","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUNOASSAY, NOS PART OF PANEL","30000164","CDM","300","RC","83520","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY, NOS PART OF PANEL","30000164","CDM","300","RC","83520","HCPCS","facility","both","","","","86","86","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (25)","30000165","CDM","300","RC","83520","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (25)","30000165","CDM","300","RC","83520","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (25)","30000165","CDM","300","RC","83520","HCPCS","facility","both","","","","99","99","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (25)","30000165","CDM","300","RC","83520","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (35)","30000166","CDM","300","RC","83520","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (35)","30000166","CDM","300","RC","83520","HCPCS","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (35)","30000166","CDM","300","RC","83520","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (35)","30000166","CDM","300","RC","83520","HCPCS","facility","both","","","","140","140","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (40)","30000167","CDM","300","RC","83520","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (40)","30000167","CDM","300","RC","83520","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (40)","30000167","CDM","300","RC","83520","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (40)","30000167","CDM","300","RC","83520","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (90)","30000168","CDM","300","RC","83520","HCPCS","facility","both","","","","241.17","241.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (90)","30000168","CDM","300","RC","83520","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (90)","30000168","CDM","300","RC","83520","HCPCS","facility","both","","","","188.41","188.41","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (100)","30000169","CDM","300","RC","83520","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (100)","30000169","CDM","300","RC","83520","HCPCS","facility","both","","","","155","155","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (100)","30000169","CDM","300","RC","83520","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (115)","30000170","CDM","300","RC","83520","HCPCS","facility","both","","","","342","342","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (115)","30000170","CDM","300","RC","83520","HCPCS","facility","both","","","","240.74","240.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (115)","30000170","CDM","300","RC","83520","HCPCS","facility","both","","","","203","203","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (115)","30000170","CDM","300","RC","83520","HCPCS","facility","both","","","","308.16","308.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (190)","30000171","CDM","300","RC","83520","HCPCS","facility","both","","","","397.75","397.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (190)","30000171","CDM","300","RC","83520","HCPCS","facility","both","","","","365","365","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (190)","30000171","CDM","300","RC","83520","HCPCS","facility","both","","","","509.13","509.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (550)","30000172","CDM","300","RC","83520","HCPCS","facility","both","","","","1151.39","1151.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (550)","30000172","CDM","300","RC","83520","HCPCS","facility","both","","","","1473.81","1473.81","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (550)","30000172","CDM","300","RC","83520","HCPCS","facility","both","","","","860","860","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (980)","30000173","CDM","300","RC","83520","HCPCS","facility","both","","","","2051.57","2051.57","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (980)","30000173","CDM","300","RC","83520","HCPCS","facility","both","","","","2626.06","2626.06","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (170)","30000174","CDM","300","RC","83520","HCPCS","facility","both","","","","505","505","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (170)","30000174","CDM","300","RC","83520","HCPCS","facility","both","","","","355.88","355.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (170)","30000174","CDM","300","RC","83520","HCPCS","facility","both","","","","455.54","455.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (170)","30000174","CDM","300","RC","83520","HCPCS","facility","both","","","","285","285","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (65)","30000175","CDM","300","RC","83520","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (65)","30000175","CDM","300","RC","83520","HCPCS","facility","both","","","","113","113","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (65)","30000175","CDM","300","RC","83520","HCPCS","facility","both","","","","136.07","136.07","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (65)","30000175","CDM","300","RC","83520","HCPCS","facility","both","","","","174.17","174.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (45)","30000176","CDM","300","RC","83520","HCPCS","facility","both","","","","130","130","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (45)","30000176","CDM","300","RC","83520","HCPCS","facility","both","","","","178","178","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (45)","30000176","CDM","300","RC","83520","HCPCS","facility","both","","","","120.59","120.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (45)","30000176","CDM","300","RC","83520","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (45)","30000176","CDM","300","RC","83520","HCPCS","facility","both","","","","94.2","94.2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED HEMAT/COAG  PROC (255)","30000177","CDM","305","RC","85999","HCPCS","facility","both","","","","683.3","683.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED HEMAT/COAG  PROC (255)","30000177","CDM","305","RC","85999","HCPCS","facility","both","","","","533.83","533.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED TRANSFUSION MED  PROC (425)","30000178","CDM","300","RC","86999","HCPCS","facility","both","","","","889.71","889.71","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED TRANSFUSION MED  PROC (425)","30000178","CDM","300","RC","86999","HCPCS","facility","both","","","","1138.86","1138.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (240)","30000179","CDM","300","RC","83520","HCPCS","facility","both","","","","405","405","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (240)","30000179","CDM","300","RC","83520","HCPCS","facility","both","","","","643.12","643.12","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (240)","30000179","CDM","300","RC","83520","HCPCS","facility","both","","","","713","713","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (240)","30000179","CDM","300","RC","83520","HCPCS","facility","both","","","","502.42","502.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (130)","30000180","CDM","300","RC","83520","HCPCS","facility","both","","","","272.15","272.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (130)","30000180","CDM","300","RC","83520","HCPCS","facility","both","","","","240","240","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (130)","30000180","CDM","300","RC","83520","HCPCS","facility","both","","","","386","386","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (130)","30000180","CDM","300","RC","83520","HCPCS","facility","both","","","","348.35","348.35","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"DEAC 12/31/2023 HC HOSPITAL OUTPATIENT CLINIC-COVID-19 SPEC COLLECT NON-MARYLAND","30000181","CDM","300","RC","","","facility","both","","","","95","95","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB","30000184","CDM","300","RC","83520","HCPCS","facility","both","","","","397.75","397.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB","30000184","CDM","300","RC","83520","HCPCS","facility","both","","","","565","565","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB","30000184","CDM","300","RC","83520","HCPCS","facility","both","","","","509.13","509.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IAD BY NUCLEIC ACID (DNA OR RNA); BORRELIA MIYAMOTOI, APT (41)","30001856","CDM","300","RC","87478","HCPCS","facility","both","","","","116","116","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IAD BY NUCLEIC ACID (DNA OR RNA); BORRELIA MIYAMOTOI, APT (41)","30001856","CDM","300","RC","87478","HCPCS","facility","both","","","","85.83","85.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IAD BY NUCLEIC ACID (DNA OR RNA); BORRELIA MIYAMOTOI, APT (41)","30001856","CDM","300","RC","87478","HCPCS","facility","both","","","","109.87","109.87","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY, NOT OTHERWISE SPECIFIED(12)","30001858","CDM","300","RC","83520","HCPCS","facility","both","","","","25.12","25.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY, NOT OTHERWISE SPECIFIED(12)","30001858","CDM","300","RC","83520","HCPCS","facility","both","","","","32.16","32.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY, NOT OTHERWISE SPECIFIED(12)","30001858","CDM","300","RC","83520","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOASSAY, NOT OTHERWISE SPECIFIED(32)","30001859","CDM","300","RC","83520","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOASSAY, NOT OTHERWISE SPECIFIED(32)","30001859","CDM","300","RC","83520","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY, NOT OTHERWISE SPECIFIED(32)","30001859","CDM","300","RC","83520","HCPCS","facility","both","","","","85.75","85.75","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY QUANT NOS NONAB (184)","30001860","CDM","300","RC","83520","HCPCS","facility","both","","","","458","458","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (184)","30001860","CDM","300","RC","83520","HCPCS","facility","both","","","","493.05","493.05","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY QUANT NOS NONAB (184)","30001860","CDM","300","RC","83520","HCPCS","facility","both","","","","385.19","385.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC H.PYLORI + CLARITHRO RESIST, PCR, F","30001861","CDM","300","RC","87513","HCPCS","facility","both","","","","123.26","123.26","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC H.PYLORI + CLARITHRO RESIST, PCR, F","30001861","CDM","300","RC","87513","HCPCS","facility","both","","","","96.3","96.3","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FACTOR XIII QUEST","30060007","CDM","300","RC","85290","HCPCS","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FACTOR XIII QUEST","30060007","CDM","300","RC","85290","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FACTOR XIII QUEST","30060007","CDM","300","RC","85290","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LYME(B.BURGDORFERI)PCR,CSF QST","30060011","CDM","300","RC","87476","HCPCS","facility","both","","","","116","116","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYME(B.BURGDORFERI)PCR,CSF QST","30060011","CDM","300","RC","87476","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LYME(B.BURGDORFERI)PCR,CSF QST","30060011","CDM","300","RC","87476","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC POCT AUTOM URINALYSIS WO MICRO","30070001","CDM","307","RC","81003","HCPCS","facility","both","","","","124","124","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC POCT AUTOM URINALYSIS WO MICRO","30070001","CDM","307","RC","81003","HCPCS","facility","both","","","","124","124","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT OCCULT BLD FECES 1-3 TESTS","30070002","CDM","301","RC","82272","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT OCCULT BLD FECES 1-3 TESTS","30070002","CDM","301","RC","82272","HCPCS","facility","both","","","","7.11","7.11","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC POCT OCCULT BLD FECES 1-3 TESTS","30070002","CDM","301","RC","82272","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC POCT ASSAY PH BODY FLUID NOS","30070003","CDM","301","RC","83986","HCPCS","facility","both","","","","13","13","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT ASSAY PH BODY FLUID NOS","30070003","CDM","301","RC","83986","HCPCS","facility","both","","","","13","13","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC POCT ASSAY PH BODY FLUID NOS","30070003","CDM","301","RC","83986","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC POCT URINE HCG VISUAL COLOR","30070004","CDM","307","RC","81025","HCPCS","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT URINE HCG VISUAL COLOR","30070004","CDM","307","RC","81025","HCPCS","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC POCT URINE HCG VISUAL COLOR","30070004","CDM","307","RC","81025","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC POCT URINE HCG VISUAL COLOR","30070004","CDM","307","RC","81025","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC POCT CREATININE; BLOOD","30070005","CDM","301","RC","82565","HCPCS","facility","both","","","","192","192","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC POCT CREATININE; BLOOD","30070005","CDM","301","RC","82565","HCPCS","facility","both","","","","192","192","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT SMEAR - INFECTIOUS WET MOUNT","30070006","CDM","306","RC","87210","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC POCT SMEAR - INFECTIOUS WET MOUNT","30070006","CDM","306","RC","87210","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC POCT SMEAR - INFECTIOUS WET MOUNT","30070006","CDM","306","RC","87210","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT GLUCOSE; BLOOD REAGENT STRIP","30070007","CDM","301","RC","82948","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC POCT GLUCOSE; BLOOD REAGENT STRIP","30070007","CDM","301","RC","82948","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC POCT GLUCOSE; BLOOD REAGENT STRIP","30070007","CDM","301","RC","82948","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT FERN TEST","30070008","CDM","301","RC","","","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POCT FERN TEST","30070008","CDM","301","RC","","","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC POCT FERN TEST","30070008","CDM","301","RC","","","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TRANSCUTANEOUS BILIRUBIN","30070009","CDM","300","RC","88720","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TRANSCUTANEOUS BILIRUBIN","30070009","CDM","300","RC","88720","HCPCS","facility","both","","","","127","127","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LAB CHEMISTRY","30100000","CDM","301","RC","","","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LAB CHEMISTRY","30100000","CDM","301","RC","","","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LAB CHEMISTRY","30100000","CDM","301","RC","","","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ELECTROLYTE PANEL","30100001","CDM","301","RC","80051","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ELECTROLYTE PANEL","30100001","CDM","301","RC","80051","HCPCS","facility","both","","","","280","280","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ELECTROLYTE PANEL","30100001","CDM","301","RC","80051","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC ELECTROLYTE PANEL","30100001","CDM","301","RC","80051","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ELECTROLYTE PANEL","30100001","CDM","301","RC","80051","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ELECTROLYTE PANEL","30100001","CDM","301","RC","80051","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC LIPID PANEL","30100002","CDM","301","RC","80061","HCPCS","facility","both","","","","50.91","50.91","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LIPID PANEL","30100002","CDM","301","RC","80061","HCPCS","facility","both","","","","13.39","13.39","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC LIPID PANEL","30100002","CDM","301","RC","80061","HCPCS","facility","both","","","","36","36","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LIPID PANEL","30100002","CDM","301","RC","80061","HCPCS","facility","both","","","","18","18","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC LIPID PANEL","30100002","CDM","301","RC","80061","HCPCS","facility","both","","","","39.77","39.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LIPID PANEL","30100002","CDM","301","RC","80061","HCPCS","facility","both","","","","514","514","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LIPID PANEL","30100002","CDM","301","RC","80061","HCPCS","facility","both","","","","22","22","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AMIKACIN","30100003","CDM","301","RC","80150","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AMIKACIN","30100003","CDM","301","RC","80150","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AMIKACIN","30100003","CDM","301","RC","80150","HCPCS","facility","both","","","","460","460","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AMIKACIN","30100003","CDM","301","RC","80150","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AMITRIPTYLINE","30100004","CDM","301","RC","80152","HCPCS","facility","both","","","","298.5","298.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BENZODIAZEPINES, 1-12","30100005","CDM","301","RC","80346","HCPCS","facility","both","","","","392","392","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BENZODIAZEPINES, 1-12","30100005","CDM","301","RC","80346","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BENZODIAZEPINES, 1-12","30100005","CDM","301","RC","80346","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BENZODIAZEPINES, 1-12","30100005","CDM","301","RC","80346","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CARBAMAZEPINE; TOTAL","30100006","CDM","301","RC","80156","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CARBAMAZEPINE; TOTAL","30100006","CDM","301","RC","80156","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CARBAMAZEPINE; TOTAL","30100006","CDM","301","RC","80156","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC CARBAMAZEPINE; TOTAL","30100006","CDM","301","RC","80156","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CARBAMAZEPINE; TOTAL","30100006","CDM","301","RC","80156","HCPCS","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CARBAMAZEPINE; FREE","30100007","CDM","301","RC","80157","HCPCS","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CARBAMAZEPINE; FREE","30100007","CDM","301","RC","80157","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CARBAMAZEPINE; FREE","30100007","CDM","301","RC","80157","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CARBAMAZEPINE; FREE","30100007","CDM","301","RC","80157","HCPCS","facility","both","","","","50.75","50.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYCLOSPORINE","30100008","CDM","301","RC","80158","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYCLOSPORINE","30100008","CDM","301","RC","80158","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYCLOSPORINE","30100008","CDM","301","RC","80158","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYCLOSPORINE","30100008","CDM","301","RC","80158","HCPCS","facility","both","","","","379","379","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DESIPRAMINE","30100009","CDM","301","RC","80160","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DIGOXIN QUANTITATIVE","30100010","CDM","301","RC","80162","HCPCS","facility","both","","","","564","564","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DIGOXIN QUANTITATIVE","30100010","CDM","301","RC","80162","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DIGOXIN QUANTITATIVE","30100010","CDM","301","RC","80162","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC DIGOXIN QUANTITATIVE","30100010","CDM","301","RC","80162","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DIGOXIN QUANTITATIVE","30100010","CDM","301","RC","80162","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DIPROPYLACETIC ACID","30100011","CDM","301","RC","80164","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DIPROPYLACETIC ACID","30100011","CDM","301","RC","80164","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DIPROPYLACETIC ACID","30100011","CDM","301","RC","80164","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC DIPROPYLACETIC ACID","30100011","CDM","301","RC","80164","HCPCS","facility","both","","","","367","367","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DIPROPYLACETIC ACID","30100011","CDM","301","RC","80164","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENTAMICIN","30100012","CDM","301","RC","80170","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GENTAMICIN","30100012","CDM","301","RC","80170","HCPCS","facility","both","","","","692","692","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GENTAMICIN","30100012","CDM","301","RC","80170","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GENTAMICIN","30100012","CDM","301","RC","80170","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HALOPERIDOL ASSAY","30100013","CDM","301","RC","80173","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HALOPERIDOL ASSAY","30100013","CDM","301","RC","80173","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HALOPERIDOL ASSAY","30100013","CDM","301","RC","80173","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HALOPERIDOL ASSAY","30100013","CDM","301","RC","80173","HCPCS","facility","both","","","","217","217","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMIPRAMINE","30100014","CDM","301","RC","80174","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LIDOCAINE","30100015","CDM","301","RC","80176","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LIDOCAINE","30100015","CDM","301","RC","80176","HCPCS","facility","both","","","","419","419","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LIDOCAINE","30100015","CDM","301","RC","80176","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LIDOCAINE","30100015","CDM","301","RC","80176","HCPCS","facility","both","","","","66","66","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LITHIUM","30100016","CDM","301","RC","80178","HCPCS","facility","both","","","","221","221","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LITHIUM","30100016","CDM","301","RC","80178","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC LITHIUM","30100016","CDM","301","RC","80178","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LITHIUM","30100016","CDM","301","RC","80178","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LITHIUM","30100016","CDM","301","RC","80178","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NORTRIPTYLINE","30100017","CDM","301","RC","80182","HCPCS","facility","both","","","","324.5","324.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PHENOBARBITAL","30100018","CDM","301","RC","80184","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHENOBARBITAL","30100018","CDM","301","RC","80184","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PHENOBARBITAL","30100018","CDM","301","RC","80184","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PHENOBARBITAL","30100018","CDM","301","RC","80184","HCPCS","facility","both","","","","367","367","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PHENYTOIN; TOTAL","30100019","CDM","301","RC","80185","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PHENYTOIN; TOTAL","30100019","CDM","301","RC","80185","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHENYTOIN; TOTAL","30100019","CDM","301","RC","80185","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PHENYTOIN; TOTAL","30100019","CDM","301","RC","80185","HCPCS","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PHENYTOIN; FREE","30100020","CDM","301","RC","80186","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PHENYTOIN; FREE","30100020","CDM","301","RC","80186","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHENYTOIN; FREE","30100020","CDM","301","RC","80186","HCPCS","facility","both","","","","259","259","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PHENYTOIN; FREE","30100020","CDM","301","RC","80186","HCPCS","facility","both","","","","99","99","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PRIMIDONE","30100021","CDM","301","RC","80188","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PRIMIDONE","30100021","CDM","301","RC","80188","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PRIMIDONE","30100021","CDM","301","RC","80188","HCPCS","facility","both","","","","66","66","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PRIMIDONE","30100021","CDM","301","RC","80188","HCPCS","facility","both","","","","458","458","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROCAINAMIDE W METABOLITES","30100022","CDM","301","RC","80192","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROCAINAMIDE W METABOLITES","30100022","CDM","301","RC","80192","HCPCS","facility","both","","","","722","722","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROCAINAMIDE W METABOLITES","30100022","CDM","301","RC","80192","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROCAINAMIDE W METABOLITES","30100022","CDM","301","RC","80192","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUINIDINE","30100023","CDM","301","RC","80194","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUINIDINE","30100023","CDM","301","RC","80194","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUINIDINE","30100023","CDM","301","RC","80194","HCPCS","facility","both","","","","34.38","34.38","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUINIDINE","30100023","CDM","301","RC","80194","HCPCS","facility","both","","","","593","593","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF SIROLIMUS","30100024","CDM","301","RC","80195","HCPCS","facility","both","","","","452","452","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF SIROLIMUS","30100024","CDM","301","RC","80195","HCPCS","facility","both","","","","75","75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY OF SIROLIMUS","30100024","CDM","301","RC","80195","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF SIROLIMUS","30100024","CDM","301","RC","80195","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SALICYLATE","30100025","CDM","301","RC","80196","HCPCS","facility","both","","","","117.5","117.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TACROLIMUS","30100026","CDM","301","RC","80197","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TACROLIMUS","30100026","CDM","301","RC","80197","HCPCS","facility","both","","","","13.73","13.73","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC TACROLIMUS","30100026","CDM","301","RC","80197","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TACROLIMUS","30100026","CDM","301","RC","80197","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TACROLIMUS","30100026","CDM","301","RC","80197","HCPCS","facility","both","","","","742","742","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THEOPHYLLINE","30100027","CDM","301","RC","80198","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC THEOPHYLLINE","30100027","CDM","301","RC","80198","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC THEOPHYLLINE","30100027","CDM","301","RC","80198","HCPCS","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THEOPHYLLINE","30100027","CDM","301","RC","80198","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TOBRAMYCIN","30100028","CDM","301","RC","80200","HCPCS","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TOBRAMYCIN","30100028","CDM","301","RC","80200","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TOBRAMYCIN","30100028","CDM","301","RC","80200","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TOBRAMYCIN","30100028","CDM","301","RC","80200","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TOPIRAMATE","30100029","CDM","301","RC","80201","HCPCS","facility","both","","","","54","54","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TOPIRAMATE","30100029","CDM","301","RC","80201","HCPCS","facility","both","","","","343","343","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TOPIRAMATE","30100029","CDM","301","RC","80201","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TOPIRAMATE","30100029","CDM","301","RC","80201","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VANCOMYCIN","30100030","CDM","301","RC","80202","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VANCOMYCIN","30100030","CDM","301","RC","80202","HCPCS","facility","both","","","","13.54","13.54","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC VANCOMYCIN","30100030","CDM","301","RC","80202","HCPCS","facility","both","","","","493","493","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VANCOMYCIN","30100030","CDM","301","RC","80202","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VANCOMYCIN","30100030","CDM","301","RC","80202","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DABIGATRAN ASSAY","30100031","CDM","301","RC","80299","HCPCS","facility","both","","","","204","204","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DABIGATRAN ASSAY","30100031","CDM","301","RC","80299","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DABIGATRAN ASSAY","30100031","CDM","301","RC","80299","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACETAZOLAMIDE (DIAMOX)","30100032","CDM","301","RC","80299","HCPCS","facility","both","","","","204","204","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ACETAZOLAMIDE (DIAMOX)","30100032","CDM","301","RC","80299","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACETAZOLAMIDE (DIAMOX)","30100032","CDM","301","RC","80299","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BUPROPION","30100033","CDM","301","RC","80299","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BUPROPION","30100033","CDM","301","RC","80299","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BUPROPION","30100033","CDM","301","RC","80299","HCPCS","facility","both","","","","331","331","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ZONISAMIDE","30100034","CDM","301","RC","80299","HCPCS","facility","both","","","","204","204","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ATAZANAVIR LEVEL SERUM","30100035","CDM","301","RC","80299","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ATAZANAVIR LEVEL SERUM","30100035","CDM","301","RC","80299","HCPCS","facility","both","","","","198.87","198.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ATAZANAVIR LEVEL SERUM","30100035","CDM","301","RC","80299","HCPCS","facility","both","","","","254.57","254.57","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ATAZANAVIR LEVEL SERUM","30100035","CDM","301","RC","80299","HCPCS","facility","both","","","","204","204","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ITRACONAZOLE, HPLC","30100036","CDM","301","RC","80299","HCPCS","facility","both","","","","204","204","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ITRACONAZOLE, HPLC","30100036","CDM","301","RC","80299","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ITRACONAZOLE, HPLC","30100036","CDM","301","RC","80299","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC KALETRA, QUANTITATION","30100037","CDM","301","RC","80299","HCPCS","facility","both","","","","204","204","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC KALETRA, QUANTITATION","30100037","CDM","301","RC","80299","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KALETRA, QUANTITATION","30100037","CDM","301","RC","80299","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATION OF DRUG NES","30100038","CDM","301","RC","80299","HCPCS","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AUTOM URINE DIP W MICRO","30100039","CDM","307","RC","81001","HCPCS","facility","both","","","","160","160","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AUTOM URINE DIP W MICRO","30100039","CDM","307","RC","81001","HCPCS","facility","both","","","","18.84","18.84","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AUTOM URINE DIP W MICRO","30100039","CDM","307","RC","81001","HCPCS","facility","both","","","","11.5","11.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AUTOM URINE DIP W MICRO","30100039","CDM","307","RC","81001","HCPCS","facility","both","","","","15.91","15.91","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AUTOM URINE DIP W MICRO","30100039","CDM","307","RC","81001","HCPCS","facility","both","","","","3.17","3.17","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC AUTOM URINE DIP W MICRO","30100039","CDM","307","RC","81001","HCPCS","facility","both","","","","24.11","24.11","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AUTOM URINE DIP W MICRO","30100039","CDM","307","RC","81001","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC N-AUTOM URINALYS WO MICRO","30100040","CDM","307","RC","81002","HCPCS","facility","both","","","","6.5","6.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC N-AUTOM URINALYS WO MICRO","30100040","CDM","307","RC","81002","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC N-AUTOM URINALYS WO MICRO","30100040","CDM","307","RC","81002","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC N-AUTOM URINALYS WO MICRO","30100040","CDM","307","RC","81002","HCPCS","facility","both","","","","36","36","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AUTOM URINALYSIS WO MICRO","30100041","CDM","307","RC","81003","HCPCS","facility","both","","","","6","6","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AUTOM URINALYSIS WO MICRO","30100041","CDM","307","RC","81003","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AUTOM URINALYSIS WO MICRO","30100041","CDM","307","RC","81003","HCPCS","facility","both","","","","5.5","5.5","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AUTOM URINALYSIS WO MICRO","30100041","CDM","307","RC","81003","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AUTOM URINALYSIS WO MICRO","30100041","CDM","307","RC","81003","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AUTOM URINALYSIS WO MICRO","30100041","CDM","307","RC","81003","HCPCS","facility","both","","","","124","124","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URINALYSIS; QUAL NOT IA","30100042","CDM","307","RC","81005","HCPCS","facility","both","","","","46.5","46.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC URINALYSIS; QUAL NOT IA","30100042","CDM","307","RC","81005","HCPCS","facility","both","","","","24.11","24.11","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC URINALYSIS; QUAL NOT IA","30100042","CDM","307","RC","81005","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URINALYSIS; QUAL NOT IA","30100042","CDM","307","RC","81005","HCPCS","facility","both","","","","18.84","18.84","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC URINALYSIS - MICRO ONLY","30100043","CDM","307","RC","81015","HCPCS","facility","both","","","","124","124","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URINALYSIS - MICRO ONLY","30100043","CDM","307","RC","81015","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC URINALYSIS - MICRO ONLY","30100043","CDM","307","RC","81015","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC URINALYSIS - MICRO ONLY","30100043","CDM","307","RC","81015","HCPCS","facility","both","","","","9","9","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ACETAMINOPHEN","30100044","CDM","301","RC","82003","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUANT SERUM ACETONES/KETONES","30100045","CDM","301","RC","82010","HCPCS","facility","both","","","","186","186","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUANT SERUM ACETONES/KETONES","30100045","CDM","301","RC","82010","HCPCS","facility","both","","","","27.22","27.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANT SERUM ACETONES/KETONES","30100045","CDM","301","RC","82010","HCPCS","facility","both","","","","37","37","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANT SERUM ACETONES/KETONES","30100045","CDM","301","RC","82010","HCPCS","facility","both","","","","34.84","34.84","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACETYLCHOLINESTERASE","30100046","CDM","301","RC","82013","HCPCS","facility","both","","","","132","132","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ACETYLCHOLINESTERASE","30100046","CDM","301","RC","82013","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACETYLCHOLINESTERASE","30100046","CDM","301","RC","82013","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACYLCARNITINES; QUAN","30100047","CDM","301","RC","82017","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ACYLCARNITINES; QUAN","30100047","CDM","301","RC","82017","HCPCS","facility","both","","","","272.15","272.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACYLCARNITINES; QUAN","30100047","CDM","301","RC","82017","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ACYLCARNITINES; QUAN","30100047","CDM","301","RC","82017","HCPCS","facility","both","","","","348.35","348.35","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACTH","30100048","CDM","301","RC","82024","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACTH","30100048","CDM","301","RC","82024","HCPCS","facility","both","","","","59","59","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC ACTH","30100048","CDM","301","RC","82024","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACTH","30100048","CDM","301","RC","82024","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ACTH","30100048","CDM","301","RC","82024","HCPCS","facility","both","","","","928","928","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF SERUM ALBUMIN","30100049","CDM","301","RC","82040","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF SERUM ALBUMIN","30100049","CDM","301","RC","82040","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF SERUM ALBUMIN","30100049","CDM","301","RC","82040","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF SERUM ALBUMIN","30100049","CDM","301","RC","82040","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY OF SERUM ALBUMIN","30100049","CDM","301","RC","82040","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC ALBUMIN; QUAN","30100050","CDM","301","RC","82042","HCPCS","facility","both","","","","37.75","37.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALBUMIN; QUAN","30100050","CDM","301","RC","82042","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALBUMIN; QUAN","30100050","CDM","301","RC","82042","HCPCS","facility","both","","","","62","62","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALBUMIN; QUAN","30100050","CDM","301","RC","82042","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALBUMIN; URINE QUANT","30100051","CDM","301","RC","82043","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALBUMIN; URINE QUANT","30100051","CDM","301","RC","82043","HCPCS","facility","both","","","","166","166","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALBUMIN; URINE QUANT","30100051","CDM","301","RC","82043","HCPCS","facility","both","","","","36","36","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALBUMIN; URINE QUANT","30100051","CDM","301","RC","82043","HCPCS","facility","both","","","","5.78","5.78","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC ALBUMIN; URINE QUANT","30100051","CDM","301","RC","82043","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ETHANOL (ALCOHOL); NOT BREATH","30100052","CDM","301","RC","82055","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALDOSTERONE","30100053","CDM","301","RC","82088","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALDOSTERONE","30100053","CDM","301","RC","82088","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALDOSTERONE","30100053","CDM","301","RC","82088","HCPCS","facility","both","","","","790","790","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALDOSTERONE","30100053","CDM","301","RC","82088","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALPHA-FETOPROTEIN SERUM","30100054","CDM","301","RC","82105","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALPHA-FETOPROTEIN SERUM","30100054","CDM","301","RC","82105","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALPHA-FETOPROTEIN SERUM","30100054","CDM","301","RC","82105","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALPHA-FETOPROTEIN SERUM","30100054","CDM","301","RC","82105","HCPCS","facility","both","","","","394","394","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALPHA-FETOPROTEIN AMNIOTIC","30100055","CDM","301","RC","82106","HCPCS","facility","both","","","","393","393","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALPHA-FETOPROTEIN AMNIOTIC","30100055","CDM","301","RC","82106","HCPCS","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALPHA-FETOPROTEIN AMNIOTIC","30100055","CDM","301","RC","82106","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALPHA-FETOPROTEIN AMNIOTIC","30100055","CDM","301","RC","82106","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AMINO ACIDS; MULTI QUAL EA","30100056","CDM","301","RC","82128","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AMINO ACIDS; MULTI QUAL EA","30100056","CDM","301","RC","82128","HCPCS","facility","both","","","","164","164","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AMINO ACIDS; MULTI QUAL EA","30100056","CDM","301","RC","82128","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AMINO ACIDS 6/>  QUAN EA","30100057","CDM","301","RC","82139","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AMINO ACIDS 6/>  QUAN EA","30100057","CDM","301","RC","82139","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AMINO ACIDS 6/>  QUAN EA","30100057","CDM","301","RC","82139","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AMINO ACIDS 6/>  QUAN EA","30100057","CDM","301","RC","82139","HCPCS","facility","both","","","","161","161","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AMMONIA","30100058","CDM","301","RC","82140","HCPCS","facility","both","","","","301","301","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AMMONIA","30100058","CDM","301","RC","82140","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AMMONIA","30100058","CDM","301","RC","82140","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AMMONIA","30100058","CDM","301","RC","82140","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AMYLASE","30100059","CDM","301","RC","82150","HCPCS","facility","both","","","","16.08","16.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AMYLASE","30100059","CDM","301","RC","82150","HCPCS","facility","both","","","","27.5","27.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AMYLASE","30100059","CDM","301","RC","82150","HCPCS","facility","both","","","","6","6","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AMYLASE","30100059","CDM","301","RC","82150","HCPCS","facility","both","","","","6.48","6.48","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC AMYLASE","30100059","CDM","301","RC","82150","HCPCS","facility","both","","","","176","176","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AMYLASE","30100059","CDM","301","RC","82150","HCPCS","facility","both","","","","12.56","12.56","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASCORBIC ACID BLOOD","30100060","CDM","301","RC","82180","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASCORBIC ACID BLOOD","30100060","CDM","301","RC","82180","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASCORBIC ACID BLOOD","30100060","CDM","301","RC","82180","HCPCS","facility","both","","","","47.5","47.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASCORBIC ACID BLOOD","30100060","CDM","301","RC","82180","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BARBITURATES","30100061","CDM","301","RC","80345","HCPCS","facility","both","","","","718","718","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BARBITURATES","30100061","CDM","301","RC","80345","HCPCS","facility","both","","","","31.5","31.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BARBITURATES","30100061","CDM","301","RC","80345","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BARBITURATES","30100061","CDM","301","RC","80345","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BETA-2 MICROGLOBULIN","30100062","CDM","301","RC","82232","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BETA-2 MICROGLOBULIN","30100062","CDM","301","RC","82232","HCPCS","facility","both","","","","64","64","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BETA-2 MICROGLOBULIN","30100062","CDM","301","RC","82232","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BETA-2 MICROGLOBULIN","30100062","CDM","301","RC","82232","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TOTAL BILIRUBIN","30100063","CDM","301","RC","82247","HCPCS","facility","both","","","","12.56","12.56","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TOTAL BILIRUBIN","30100063","CDM","301","RC","82247","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC TOTAL BILIRUBIN","30100063","CDM","301","RC","82247","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC TOTAL BILIRUBIN","30100063","CDM","301","RC","82247","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TOTAL BILIRUBIN","30100063","CDM","301","RC","82247","HCPCS","facility","both","","","","16.08","16.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TOTAL BILIRUBIN","30100063","CDM","301","RC","82247","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DIRECT BILIRUBIN","30100064","CDM","301","RC","82248","HCPCS","facility","both","","","","16.08","16.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DIRECT BILIRUBIN","30100064","CDM","301","RC","82248","HCPCS","facility","both","","","","5.02","5.02","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC DIRECT BILIRUBIN","30100064","CDM","301","RC","82248","HCPCS","facility","both","","","","20.5","20.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DIRECT BILIRUBIN","30100064","CDM","301","RC","82248","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC DIRECT BILIRUBIN","30100064","CDM","301","RC","82248","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DIRECT BILIRUBIN","30100064","CDM","301","RC","82248","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC DIRECT BILIRUBIN","30100064","CDM","301","RC","82248","HCPCS","facility","both","","","","12.56","12.56","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OCCULT BLOOD FECES","30100065","CDM","301","RC","82270","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OCCULT BLOOD FECES","30100065","CDM","301","RC","82270","HCPCS","facility","both","","","","13","13","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC OCCULT BLOOD FECES","30100065","CDM","301","RC","82270","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OCCULT BLOOD FECES","30100065","CDM","301","RC","82270","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OCCULT BLD FHG QUAL 1-3","30100066","CDM","301","RC","82274","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC OCCULT BLD FHG QUAL 1-3","30100066","CDM","301","RC","82274","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OCCULT BLD FHG QUAL 1-3","30100066","CDM","301","RC","82274","HCPCS","facility","both","","","","15.92","15.92","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC OCCULT BLD FHG QUAL 1-3","30100066","CDM","301","RC","82274","HCPCS","facility","both","","","","189","189","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OCCULT BLD FHG QUAL 1-3","30100066","CDM","301","RC","82274","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CADMIUM","30100067","CDM","301","RC","82300","HCPCS","facility","both","","","","275","275","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CADMIUM","30100067","CDM","301","RC","82300","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CADMIUM","30100067","CDM","301","RC","82300","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CADMIUM","30100067","CDM","301","RC","82300","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VITAMIN D 25 HYDROXY","30100068","CDM","301","RC","82306","HCPCS","facility","both","","","","29.6","29.6","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC VITAMIN D 25 HYDROXY","30100068","CDM","301","RC","82306","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VITAMIN D 25 HYDROXY","30100068","CDM","301","RC","82306","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VITAMIN D 25 HYDROXY","30100068","CDM","301","RC","82306","HCPCS","facility","both","","","","84","84","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VITAMIN D 25 HYDROXY","30100068","CDM","301","RC","82306","HCPCS","facility","both","","","","23","23","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC VITAMIN D 25 HYDROXY","30100068","CDM","301","RC","82306","HCPCS","facility","both","","","","776","776","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CALCITONIN","30100069","CDM","301","RC","82308","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CALCITONIN","30100069","CDM","301","RC","82308","HCPCS","facility","both","","","","48.5","48.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CALCITONIN","30100069","CDM","301","RC","82308","HCPCS","facility","both","","","","552","552","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CALCITONIN","30100069","CDM","301","RC","82308","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CALCIUM; TOTAL","30100070","CDM","301","RC","82310","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CALCIUM; TOTAL","30100070","CDM","301","RC","82310","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CALCIUM; TOTAL","30100070","CDM","301","RC","82310","HCPCS","facility","both","","","","5.16","5.16","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC CALCIUM; TOTAL","30100070","CDM","301","RC","82310","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC CALCIUM; TOTAL","30100070","CDM","301","RC","82310","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CALCIUM; TOTAL","30100070","CDM","301","RC","82310","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC CALCIUM; TOTAL","30100070","CDM","301","RC","82310","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CALCIUM; IONIZED","30100071","CDM","301","RC","82330","HCPCS","facility","both","","","","207","207","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CALCIUM; IONIZED","30100071","CDM","301","RC","82330","HCPCS","facility","both","","","","13.68","13.68","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC CALCIUM; IONIZED","30100071","CDM","301","RC","82330","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CALCIUM; IONIZED","30100071","CDM","301","RC","82330","HCPCS","facility","both","","","","41","41","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CALCIUM; IONIZED","30100071","CDM","301","RC","82330","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CALCIUM; IONIZED","30100071","CDM","301","RC","82330","HCPCS","facility","both","","","","21","21","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC CALCIUM; URINE QUAN TIMED","30100072","CDM","301","RC","82340","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CALCIUM; URINE QUAN TIMED","30100072","CDM","301","RC","82340","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CALCIUM; URINE QUAN TIMED","30100072","CDM","301","RC","82340","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CALCIUM; URINE QUAN TIMED","30100072","CDM","301","RC","82340","HCPCS","facility","both","","","","73","73","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STONE; IR SPECTROSCOPY","30100073","CDM","301","RC","82365","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STONE; IR SPECTROSCOPY","30100073","CDM","301","RC","82365","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC STONE; IR SPECTROSCOPY","30100073","CDM","301","RC","82365","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STONE; IR SPECTROSCOPY","30100073","CDM","301","RC","82365","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CARBON DIOXIDE (CO2)","30100074","CDM","301","RC","82374","HCPCS","facility","both","","","","132","132","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CARBON DIOXIDE (CO2)","30100074","CDM","301","RC","82374","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CARBON DIOXIDE (CO2)","30100074","CDM","301","RC","82374","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CARBON DIOXIDE (CO2)","30100074","CDM","301","RC","82374","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CARBON DIOXIDE (CO2)","30100074","CDM","301","RC","82374","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC ASSAY CARBOXYHB QUANT","30100075","CDM","301","RC","82375","HCPCS","facility","both","","","","390","390","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY CARBOXYHB QUANT","30100075","CDM","301","RC","82375","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY CARBOXYHB QUANT","30100075","CDM","301","RC","82375","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY CARBOXYHB QUANT","30100075","CDM","301","RC","82375","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CEA","30100076","CDM","301","RC","82378","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CEA","30100076","CDM","301","RC","82378","HCPCS","facility","both","","","","486","486","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CEA","30100076","CDM","301","RC","82378","HCPCS","facility","both","","","","66","66","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CEA","30100076","CDM","301","RC","82378","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHLORIDE; BLOOD","30100077","CDM","301","RC","82435","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHLORIDE; BLOOD","30100077","CDM","301","RC","82435","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHLORIDE; BLOOD","30100077","CDM","301","RC","82435","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC CHLORIDE; BLOOD","30100077","CDM","301","RC","82435","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHLORIDE; BLOOD","30100077","CDM","301","RC","82435","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHLORIDE; URINE","30100078","CDM","301","RC","82436","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHLORIDE; URINE","30100078","CDM","301","RC","82436","HCPCS","facility","both","","","","22","22","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHLORIDE; URINE","30100078","CDM","301","RC","82436","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHLORIDE; URINE","30100078","CDM","301","RC","82436","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SERUM/WB TOT CHOLEST","30100079","CDM","301","RC","82465","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC SERUM/WB TOT CHOLEST","30100079","CDM","301","RC","82465","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SERUM/WB TOT CHOLEST","30100079","CDM","301","RC","82465","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SERUM/WB TOT CHOLEST","30100079","CDM","301","RC","82465","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SERUM/WB TOT CHOLEST","30100079","CDM","301","RC","82465","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SERUM/WB TOT CHOLEST","30100079","CDM","301","RC","82465","HCPCS","facility","both","","","","6","6","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC MUCOPOLYSACCHARIDE(MPS) TLC","30100080","CDM","301","RC","82489","HCPCS","facility","both","","","","416","416","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CATHARTIC LAXATIVE STOOL SCR","30100081","CDM","301","RC","82489","HCPCS","facility","both","","","","414.5","414.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUAL THIN LYR CHROMATOGR NES","30100082","CDM","301","RC","82489","HCPCS","facility","both","","","","163","163","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC C CHROMATOGR QUAN ANALYT NES","30100083","CDM","301","RC","82491","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC C CHROMATOGR QUAN ANALYT NES","30100083","CDM","301","RC","82491","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC C CHROMATOGR QUAN ANALYT NES","30100083","CDM","301","RC","82491","HCPCS","facility","both","","","","160","160","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC C CHROMATOGR QUAN ANALYT NES","30100083","CDM","301","RC","82491","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC C CHROMOTOGR QUAN; MULTI ANALY","30100084","CDM","301","RC","82492","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC C CHROMOTOGR QUAN; MULTI ANALY","30100084","CDM","301","RC","82492","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC C CHROMOTOGR QUAN; MULTI ANALY","30100084","CDM","301","RC","82492","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC C CHROMOTOGR QUAN; MULTI ANALY","30100084","CDM","301","RC","82492","HCPCS","facility","both","","","","298.5","298.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROMIUM","30100085","CDM","301","RC","82495","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHROMIUM","30100085","CDM","301","RC","82495","HCPCS","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROMIUM","30100085","CDM","301","RC","82495","HCPCS","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHROMIUM","30100085","CDM","301","RC","82495","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COLLAGEN CROSS LINKS","30100086","CDM","301","RC","82523","HCPCS","facility","both","","","","88","88","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COLLAGEN CROSS LINKS","30100086","CDM","301","RC","82523","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COLLAGEN CROSS LINKS","30100086","CDM","301","RC","82523","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COLLAGEN CROSS LINKS","30100086","CDM","301","RC","82523","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COLLAGEN CROSS LINKS","30100086","CDM","301","RC","82523","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC COPPER","30100087","CDM","301","RC","82525","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COPPER","30100087","CDM","301","RC","82525","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COPPER","30100087","CDM","301","RC","82525","HCPCS","facility","both","","","","82.69","82.69","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COPPER","30100087","CDM","301","RC","82525","HCPCS","facility","both","","","","334","334","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CORTICOSTERONE","30100088","CDM","301","RC","82528","HCPCS","facility","both","","","","266","266","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CORTICOSTERONE","30100088","CDM","301","RC","82528","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CORTICOSTERONE","30100088","CDM","301","RC","82528","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CORTISOL; FREE","30100089","CDM","301","RC","82530","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CORTISOL; FREE","30100089","CDM","301","RC","82530","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CORTISOL; FREE","30100089","CDM","301","RC","82530","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CORTISOL; FREE","30100089","CDM","301","RC","82530","HCPCS","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CORTISOL; TOTAL","30100090","CDM","301","RC","82533","HCPCS","facility","both","","","","32","32","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC CORTISOL; TOTAL","30100090","CDM","301","RC","82533","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CORTISOL; TOTAL","30100090","CDM","301","RC","82533","HCPCS","facility","both","","","","64","64","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CORTISOL; TOTAL","30100090","CDM","301","RC","82533","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CORTISOL; TOTAL","30100090","CDM","301","RC","82533","HCPCS","facility","both","","","","348","348","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CC/MS; QUAN SS & MP","30100091","CDM","301","RC","82542","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CC/MS; QUAN SS & MP","30100091","CDM","301","RC","82542","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CC/MS; QUAN SS & MP","30100091","CDM","301","RC","82542","HCPCS","facility","both","","","","195","195","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CC/MS; QUAN SS & MP","30100091","CDM","301","RC","82542","HCPCS","facility","both","","","","356","356","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CC/MS - SGL ANALYTE QUAN","30100092","CDM","301","RC","82543","HCPCS","facility","both","","","","159","159","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CC/MS - SGL ANALYTE QUAN","30100092","CDM","301","RC","82543","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CC/MS - SGL ANALYTE QUAN","30100092","CDM","301","RC","82543","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CC/MS - MULTI ANALYTES QUAN","30100093","CDM","301","RC","82544","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CC/MS - MULTI ANALYTES QUAN","30100093","CDM","301","RC","82544","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CC/MS - MULTI ANALYTES QUAN","30100093","CDM","301","RC","82544","HCPCS","facility","both","","","","159","159","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CPK; TOTAL","30100094","CDM","301","RC","82550","HCPCS","facility","both","","","","12.56","12.56","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CPK; TOTAL","30100094","CDM","301","RC","82550","HCPCS","facility","both","","","","16.08","16.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CPK; TOTAL","30100094","CDM","301","RC","82550","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CPK; TOTAL","30100094","CDM","301","RC","82550","HCPCS","facility","both","","","","6","6","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC CPK; TOTAL","30100094","CDM","301","RC","82550","HCPCS","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CPK: MB FRACTION ONLY","30100095","CDM","301","RC","82553","HCPCS","facility","both","","","","16","16","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC CPK: MB FRACTION ONLY","30100095","CDM","301","RC","82553","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CPK: MB FRACTION ONLY","30100095","CDM","301","RC","82553","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CPK: MB FRACTION ONLY","30100095","CDM","301","RC","82553","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CPK: MB FRACTION ONLY","30100095","CDM","301","RC","82553","HCPCS","facility","both","","","","316","316","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CREATININE; BLOOD","30100096","CDM","301","RC","82565","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CREATININE; BLOOD","30100096","CDM","301","RC","82565","HCPCS","facility","both","","","","203","203","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CREATININE; BLOOD","30100096","CDM","301","RC","82565","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CREATININE; BLOOD","30100096","CDM","301","RC","82565","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC CREATININE; BLOOD","30100096","CDM","301","RC","82565","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CREATININE; BLOOD","30100096","CDM","301","RC","82565","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC CREATININE; NOT BLOOD","30100097","CDM","301","RC","82570","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CREATININE; NOT BLOOD","30100097","CDM","301","RC","82570","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CREATININE; NOT BLOOD","30100097","CDM","301","RC","82570","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CREATININE; NOT BLOOD","30100097","CDM","301","RC","82570","HCPCS","facility","both","","","","7","7","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC CREATININE; NOT BLOOD","30100097","CDM","301","RC","82570","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CREATININE; NOT BLOOD","30100097","CDM","301","RC","82570","HCPCS","facility","both","","","","7","7","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC CREATININE; CLEARANCE","30100098","CDM","301","RC","82575","HCPCS","facility","both","","","","207","207","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CREATININE; CLEARANCE","30100098","CDM","301","RC","82575","HCPCS","facility","both","","","","25.12","25.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CREATININE; CLEARANCE","30100098","CDM","301","RC","82575","HCPCS","facility","both","","","","32.16","32.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CREATININE; CLEARANCE","30100098","CDM","301","RC","82575","HCPCS","facility","both","","","","22.5","22.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CRYOFIBRINOGEN","30100099","CDM","301","RC","82585","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CRYOFIBRINOGEN","30100099","CDM","301","RC","82585","HCPCS","facility","both","","","","37.52","37.52","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CRYOFIBRINOGEN","30100099","CDM","301","RC","82585","HCPCS","facility","both","","","","142","142","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CRYOFIBRINOGEN","30100099","CDM","301","RC","82585","HCPCS","facility","both","","","","29.31","29.31","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CRYOGLOBULIN - QUAL/SEMI QUAN","30100100","CDM","301","RC","82595","HCPCS","facility","both","","","","26.5","26.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CRYOGLOBULIN - QUAL/SEMI QUAN","30100100","CDM","301","RC","82595","HCPCS","facility","both","","","","29.31","29.31","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CRYOGLOBULIN - QUAL/SEMI QUAN","30100100","CDM","301","RC","82595","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CRYOGLOBULIN - QUAL/SEMI QUAN","30100100","CDM","301","RC","82595","HCPCS","facility","both","","","","37.52","37.52","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VITAMIN B-12 LEVEL","30100101","CDM","301","RC","82607","HCPCS","facility","both","","","","15.08","15.08","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC VITAMIN B-12 LEVEL","30100101","CDM","301","RC","82607","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VITAMIN B-12 LEVEL","30100101","CDM","301","RC","82607","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VITAMIN B-12 LEVEL","30100101","CDM","301","RC","82607","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VITAMIN B-12 LEVEL","30100101","CDM","301","RC","82607","HCPCS","facility","both","","","","444","444","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VITAMIN B-12 LEVEL","30100101","CDM","301","RC","82607","HCPCS","facility","both","","","","22","22","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC CYSTATIN C","30100102","CDM","301","RC","82610","HCPCS","facility","both","","","","162","162","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYSTATIN C","30100102","CDM","301","RC","82610","HCPCS","facility","both","","","","77","77","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYSTATIN C","30100102","CDM","301","RC","82610","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYSTATIN C","30100102","CDM","301","RC","82610","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VIT D 1 25-DIHYDROXY","30100103","CDM","301","RC","82652","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VIT D 1 25-DIHYDROXY","30100103","CDM","301","RC","82652","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VIT D 1 25-DIHYDROXY","30100103","CDM","301","RC","82652","HCPCS","facility","both","","","","1040","1040","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VIT D 1 25-DIHYDROXY","30100103","CDM","301","RC","82652","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VIT D 1 25-DIHYDROXY","30100103","CDM","301","RC","82652","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC PANCREATIC ELASTASE FECAL","30100104","CDM","301","RC","82656","HCPCS","facility","both","","","","310","310","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PANCREATIC ELASTASE FECAL","30100104","CDM","301","RC","82656","HCPCS","facility","both","","","","509.13","509.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PANCREATIC ELASTASE FECAL","30100104","CDM","301","RC","82656","HCPCS","facility","both","","","","397.75","397.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PANCREATIC ELASTASE FECAL","30100104","CDM","301","RC","82656","HCPCS","facility","both","","","","242","242","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENZYME ACTIVITY BC; NOT RA, EACH SPECIMEN","30100105","CDM","301","RC","82657","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ENZYME ACTIVITY BC; NOT RA, EACH SPECIMEN","30100105","CDM","301","RC","82657","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ENZYME ACTIVITY BC; NOT RA, EACH SPECIMEN","30100105","CDM","301","RC","82657","HCPCS","facility","both","","","","335","335","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ENZYME ACTIVITY BC; NOT RA, EACH SPECIMEN","30100105","CDM","301","RC","82657","HCPCS","facility","both","","","","962","962","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ESTRADIOL; TOTAL","30100106","CDM","301","RC","82670","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC ESTRADIOL; TOTAL","30100106","CDM","301","RC","82670","HCPCS","facility","both","","","","205","205","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ESTRADIOL; TOTAL","30100106","CDM","301","RC","82670","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ESTRADIOL; TOTAL","30100106","CDM","301","RC","82670","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ESTRADIOL; TOTAL","30100106","CDM","301","RC","82670","HCPCS","facility","both","","","","550","550","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ESTRIOL UNCONJUGATED","30100107","CDM","301","RC","82677","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ESTRIOL UNCONJUGATED","30100107","CDM","301","RC","82677","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ESTRIOL UNCONJUGATED","30100107","CDM","301","RC","82677","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ESTRIOL UNCONJUGATED","30100107","CDM","301","RC","82677","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FAT/LIPIDS FECES; QUAN","30100108","CDM","301","RC","82710","HCPCS","facility","both","","","","432","432","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FAT/LIPIDS FECES; QUAN","30100108","CDM","301","RC","82710","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FAT/LIPIDS FECES; QUAN","30100108","CDM","301","RC","82710","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FAT/LIPIDS FECES; QUAN","30100108","CDM","301","RC","82710","HCPCS","facility","both","","","","36.75","36.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FERRITIN","30100109","CDM","301","RC","82728","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FERRITIN","30100109","CDM","301","RC","82728","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FERRITIN","30100109","CDM","301","RC","82728","HCPCS","facility","both","","","","13.63","13.63","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC FERRITIN","30100109","CDM","301","RC","82728","HCPCS","facility","both","","","","408","408","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FERRITIN","30100109","CDM","301","RC","82728","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC FERRITIN","30100109","CDM","301","RC","82728","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FETAL FIBRONECTIN CV SEMIQUAN","30100110","CDM","301","RC","82731","HCPCS","facility","both","","","","1060","1060","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FETAL FIBRONECTIN CV SEMIQUAN","30100110","CDM","301","RC","82731","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FETAL FIBRONECTIN CV SEMIQUAN","30100110","CDM","301","RC","82731","HCPCS","facility","both","","","","366.35","366.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FETAL FIBRONECTIN CV SEMIQUAN","30100110","CDM","301","RC","82731","HCPCS","facility","both","","","","468.94","468.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FOLIC ACID; SERUM","30100111","CDM","301","RC","82746","HCPCS","facility","both","","","","14.7","14.7","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC FOLIC ACID; SERUM","30100111","CDM","301","RC","82746","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FOLIC ACID; SERUM","30100111","CDM","301","RC","82746","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FOLIC ACID; SERUM","30100111","CDM","301","RC","82746","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FOLIC ACID; SERUM","30100111","CDM","301","RC","82746","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC FOLIC ACID; SERUM","30100111","CDM","301","RC","82746","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FOLIC ACID; RBC","30100112","CDM","301","RC","82747","HCPCS","facility","both","","","","293","293","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FOLIC ACID; RBC","30100112","CDM","301","RC","82747","HCPCS","facility","both","","","","88","88","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FOLIC ACID; RBC","30100112","CDM","301","RC","82747","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FOLIC ACID; RBC","30100112","CDM","301","RC","82747","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FRUCTOSE SEMEN","30100113","CDM","301","RC","82757","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FRUCTOSE SEMEN","30100113","CDM","301","RC","82757","HCPCS","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FRUCTOSE SEMEN","30100113","CDM","301","RC","82757","HCPCS","facility","both","","","","82.5","82.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FRUCTOSE SEMEN","30100113","CDM","301","RC","82757","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY IGA/IGD/IGG/IGM EACH","30100114","CDM","301","RC","82784","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY IGA/IGD/IGG/IGM EACH","30100114","CDM","301","RC","82784","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC ASSAY IGA/IGD/IGG/IGM EACH","30100114","CDM","301","RC","82784","HCPCS","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY IGA/IGD/IGG/IGM EACH","30100114","CDM","301","RC","82784","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY IGA/IGD/IGG/IGM EACH","30100114","CDM","301","RC","82784","HCPCS","facility","both","","","","147","147","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IGG 1 2 3 OR 4 EACH","30100115","CDM","301","RC","82787","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IGG 1 2 3 OR 4 EACH","30100115","CDM","301","RC","82787","HCPCS","facility","both","","","","207","207","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IGG 1 2 3 OR 4 EACH","30100115","CDM","301","RC","82787","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLOOD GAS MIXED WO O2 SAT","30100116","CDM","301","RC","82803","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BLOOD GAS MIXED WO O2 SAT","30100116","CDM","301","RC","82803","HCPCS","facility","both","","","","448","448","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD GAS MIXED WO O2 SAT","30100116","CDM","301","RC","82803","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLOOD GAS MIXED WO O2 SAT","30100116","CDM","301","RC","82803","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLOOD GASES W/02 SATURATION","30100117","CDM","301","RC","82805","HCPCS","facility","both","","","","336","336","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD GASES W/02 SATURATION","30100117","CDM","301","RC","82805","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BLOOD GASES W/02 SATURATION","30100117","CDM","301","RC","82805","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLOOD GASES W/02 SATURATION","30100117","CDM","301","RC","82805","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLOOD GASES O2 SAT ONLY","30100118","CDM","301","RC","82810","HCPCS","facility","both","","","","240","240","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD GASES O2 SAT ONLY","30100118","CDM","301","RC","82810","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLOOD GASES O2 SAT ONLY","30100118","CDM","301","RC","82810","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLOOD GASES O2 SAT ONLY","30100118","CDM","301","RC","82810","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEMOGLOBIN-OXYGEN AFFINITY","30100119","CDM","301","RC","82820","HCPCS","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEMOGLOBIN-OXYGEN AFFINITY","30100119","CDM","301","RC","82820","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEMOGLOBIN-OXYGEN AFFINITY","30100119","CDM","301","RC","82820","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEMOGLOBIN-OXYGEN AFFINITY","30100119","CDM","301","RC","82820","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GLUCOSE BODY FLUID NOT BLOOD","30100120","CDM","301","RC","82945","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC GLUCOSE BODY FLUID NOT BLOOD","30100120","CDM","301","RC","82945","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GLUCOSE BODY FLUID NOT BLOOD","30100120","CDM","301","RC","82945","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GLUCOSE BODY FLUID NOT BLOOD","30100120","CDM","301","RC","82945","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GLUCOSE BODY FLUID NOT BLOOD","30100120","CDM","301","RC","82945","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GLUCOSE; QUAN BLOOD","30100121","CDM","301","RC","82947","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GLUCOSE; QUAN BLOOD","30100121","CDM","301","RC","82947","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC GLUCOSE; QUAN BLOOD","30100121","CDM","301","RC","82947","HCPCS","facility","both","","","","3.93","3.93","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC GLUCOSE; QUAN BLOOD","30100121","CDM","301","RC","82947","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC GLUCOSE; QUAN BLOOD","30100121","CDM","301","RC","82947","HCPCS","facility","both","","","","11","11","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GLUCOSE; QUAN BLOOD","30100121","CDM","301","RC","82947","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GLUCOSE; QUAN BLOOD","30100121","CDM","301","RC","82947","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GLUCOSE; POST GLUCOSE DOSE","30100122","CDM","301","RC","82950","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GLUCOSE; POST GLUCOSE DOSE","30100122","CDM","301","RC","82950","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GLUCOSE; POST GLUCOSE DOSE","30100122","CDM","301","RC","82950","HCPCS","facility","both","","","","11","11","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GLUCOSE; POST GLUCOSE DOSE","30100122","CDM","301","RC","82950","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECM","30100123","CDM","301","RC","82951","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECM","30100123","CDM","301","RC","82951","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECM","30100123","CDM","301","RC","82951","HCPCS","facility","both","","","","16","16","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GLUCOSE TOLERANCE TEST (GTT) 3 SPECM","30100123","CDM","301","RC","82951","HCPCS","facility","both","","","","240","240","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GTT-ADDED SAMPLES","30100124","CDM","301","RC","82952","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GTT-ADDED SAMPLES","30100124","CDM","301","RC","82952","HCPCS","facility","both","","","","11","11","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GTT-ADDED SAMPLES","30100124","CDM","301","RC","82952","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GTT-ADDED SAMPLES","30100124","CDM","301","RC","82952","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GLUTAMINE","30100125","CDM","301","RC","82975","HCPCS","facility","both","","","","126.5","126.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GLUTAMYLTRANSFERASE GAMMA","30100126","CDM","301","RC","82977","HCPCS","facility","both","","","","382","382","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GLUTAMYLTRANSFERASE GAMMA","30100126","CDM","301","RC","82977","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GLUTAMYLTRANSFERASE GAMMA","30100126","CDM","301","RC","82977","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC GLUTAMYLTRANSFERASE GAMMA","30100126","CDM","301","RC","82977","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GLUTAMYLTRANSFERASE GAMMA","30100126","CDM","301","RC","82977","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GLUTAMYLTRANSFERASE GAMMA","30100126","CDM","301","RC","82977","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC GROWTH HORMONE HUMAN","30100127","CDM","301","RC","83003","HCPCS","facility","both","","","","550","550","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GROWTH HORMONE HUMAN","30100127","CDM","301","RC","83003","HCPCS","facility","both","","","","85.75","85.75","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GROWTH HORMONE HUMAN","30100127","CDM","301","RC","83003","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GROWTH HORMONE HUMAN","30100127","CDM","301","RC","83003","HCPCS","facility","both","","","","62","62","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HAPTOGLOBIN; QUAN","30100128","CDM","301","RC","83010","HCPCS","facility","both","","","","392","392","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HAPTOGLOBIN; QUAN","30100128","CDM","301","RC","83010","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HAPTOGLOBIN; QUAN","30100128","CDM","301","RC","83010","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HAPTOGLOBIN; QUAN","30100128","CDM","301","RC","83010","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEAVY METAL; QUAN","30100129","CDM","301","RC","83018","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEAVY METAL; QUAN","30100129","CDM","301","RC","83018","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEAVY METAL; QUAN","30100129","CDM","301","RC","83018","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEAVY METAL; QUAN","30100129","CDM","301","RC","83018","HCPCS","facility","both","","","","72.5","72.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HGB FRACT & QUAN; EP","30100130","CDM","301","RC","83020","HCPCS","facility","both","","","","59.5","59.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HGB FRACT & QUAN; EP","30100130","CDM","301","RC","83020","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HGB FRACT & QUAN; EP","30100130","CDM","301","RC","83020","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HGB FRACT & QUAN; EP","30100130","CDM","301","RC","83020","HCPCS","facility","both","","","","394","394","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HGB CHROMATOGRAPHY","30100131","CDM","301","RC","83021","HCPCS","facility","both","","","","213","213","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HGB CHROMATOGRAPHY","30100131","CDM","301","RC","83021","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HGB CHROMATOGRAPHY","30100131","CDM","301","RC","83021","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HGB CHROMATOGRAPHY","30100131","CDM","301","RC","83021","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HGB; FETAL CHEMICAL","30100132","CDM","301","RC","83030","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HGB; FETAL CHEMICAL","30100132","CDM","301","RC","83030","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HGB; FETAL CHEMICAL","30100132","CDM","301","RC","83030","HCPCS","facility","both","","","","258","258","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HGB; FETAL CHEMICAL","30100132","CDM","301","RC","83030","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HGB; FETAL QUAL","30100133","CDM","301","RC","83033","HCPCS","facility","both","","","","41","41","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HGB; FETAL QUAL","30100133","CDM","301","RC","83033","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HGB; FETAL QUAL","30100133","CDM","301","RC","83033","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HGB; FETAL QUAL","30100133","CDM","301","RC","83033","HCPCS","facility","both","","","","68","68","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GLYCOSYLATED HEMOGLOBIN TEST","30100134","CDM","301","RC","83036","HCPCS","facility","both","","","","292","292","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GLYCOSYLATED HEMOGLOBIN TEST","30100134","CDM","301","RC","83036","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC GLYCOSYLATED HEMOGLOBIN TEST","30100134","CDM","301","RC","83036","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GLYCOSYLATED HEMOGLOBIN TEST","30100134","CDM","301","RC","83036","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GLYCOSYLATED HEMOGLOBIN TEST","30100134","CDM","301","RC","83036","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GLYCOSYLATED HEMOGLOBIN TEST","30100134","CDM","301","RC","83036","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC GLYCOSYLATED HEMOGLOBIN TEST","30100134","CDM","301","RC","83036","HCPCS","facility","both","","","","9.71","9.71","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC HBG; METHEMOGLOBIN QUAN","30100135","CDM","301","RC","83050","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HBG; METHEMOGLOBIN QUAN","30100135","CDM","301","RC","83050","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HBG; METHEMOGLOBIN QUAN","30100135","CDM","301","RC","83050","HCPCS","facility","both","","","","60.5","60.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HBG; METHEMOGLOBIN QUAN","30100135","CDM","301","RC","83050","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEMOGLOBIN; UNSTABLE SCREEN","30100136","CDM","301","RC","83068","HCPCS","facility","both","","","","26","26","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEMOGLOBIN; UNSTABLE SCREEN","30100136","CDM","301","RC","83068","HCPCS","facility","both","","","","34.84","34.84","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEMOGLOBIN; UNSTABLE SCREEN","30100136","CDM","301","RC","83068","HCPCS","facility","both","","","","27.22","27.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEMOGLOBIN; UNSTABLE SCREEN","30100136","CDM","301","RC","83068","HCPCS","facility","both","","","","54","54","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEMOSIDERIN; QUAL","30100137","CDM","301","RC","83070","HCPCS","facility","both","","","","134","134","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEMOSIDERIN; QUAL","30100137","CDM","301","RC","83070","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEMOSIDERIN; QUAL","30100137","CDM","301","RC","83070","HCPCS","facility","both","","","","25.07","25.07","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEMOSIDERIN; QUAL","30100137","CDM","301","RC","83070","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC B-HEXOSAMINIDASE EA ASSAY","30100138","CDM","301","RC","83080","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC B-HEXOSAMINIDASE EA ASSAY","30100138","CDM","301","RC","83080","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC B-HEXOSAMINIDASE EA ASSAY","30100138","CDM","301","RC","83080","HCPCS","facility","both","","","","223.25","223.25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC B-HEXOSAMINIDASE EA ASSAY","30100138","CDM","301","RC","83080","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF HOMOCYSTINE","30100139","CDM","301","RC","83090","HCPCS","facility","both","","","","523","523","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF HOMOCYSTINE","30100139","CDM","301","RC","83090","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF HOMOCYSTINE","30100139","CDM","301","RC","83090","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF HOMOCYSTINE","30100139","CDM","301","RC","83090","HCPCS","facility","both","","","","76","76","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC 5-HIAA","30100140","CDM","301","RC","83497","HCPCS","facility","both","","","","36","36","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC 5-HIAA","30100140","CDM","301","RC","83497","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC 5-HIAA","30100140","CDM","301","RC","83497","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC 5-HIAA","30100140","CDM","301","RC","83497","HCPCS","facility","both","","","","327","327","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUNOASSAY NONANTIBODY","30100141","CDM","301","RC","83516","HCPCS","facility","both","","","","298","298","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUNOASSAY NONANTIBODY","30100141","CDM","301","RC","83516","HCPCS","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUNOASSAY NONANTIBODY","30100141","CDM","301","RC","83516","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY NONANTIBODY","30100141","CDM","301","RC","83516","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RIA NONANTIBODY","30100142","CDM","301","RC","83519","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RIA NONANTIBODY","30100142","CDM","301","RC","83519","HCPCS","facility","both","","","","240","240","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RIA NONANTIBODY","30100142","CDM","301","RC","83519","HCPCS","facility","both","","","","234","234","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RIA NONANTIBODY","30100142","CDM","301","RC","83519","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY QUANT NOS NONAB (20)","30100143","CDM","301","RC","83520","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (20)","30100143","CDM","301","RC","83520","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY QUANT NOS NONAB (20)","30100143","CDM","301","RC","83520","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY QUANT NOS NONAB (20)","30100143","CDM","301","RC","83520","HCPCS","facility","both","","","","79","79","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (25)","30100144","CDM","301","RC","83520","HCPCS","facility","both","","","","99","99","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (25)","30100144","CDM","301","RC","83520","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY QUANT NOS NONAB (25)","30100144","CDM","301","RC","83520","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY QUANT NOS NONAB (25)","30100144","CDM","301","RC","83520","HCPCS","facility","both","","","","51.78","51.78","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CAFFEINE,SERUM","30100145","CDM","301","RC","83520","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GROWTH HORMONE BINDING PROTEIN","30100146","CDM","301","RC","83520","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SUBSTANCE P","30100147","CDM","301","RC","83520","HCPCS","facility","both","","","","128.62","128.62","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SUBSTANCE P","30100147","CDM","301","RC","83520","HCPCS","facility","both","","","","100.48","100.48","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INTERLEUKIN 1 BETA","30100148","CDM","301","RC","83520","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INTERLEUKIN 1 BETA","30100148","CDM","301","RC","83520","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROTHROMBIN FRAGMENT 1.2","30100149","CDM","301","RC","83520","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROTHROMBIN FRAGMENT 1.2","30100149","CDM","301","RC","83520","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROTHROMBIN FRAGMENT 1.2","30100149","CDM","301","RC","83520","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PROTHROMBIN FRAGMENT 1.2","30100149","CDM","301","RC","83520","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (80)","30100150","CDM","301","RC","83520","HCPCS","facility","both","","","","340","340","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (80)","30100150","CDM","301","RC","83520","HCPCS","facility","both","","","","214.37","214.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY QUANT NOS NONAB (80)","30100150","CDM","301","RC","83520","HCPCS","facility","both","","","","167.48","167.48","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INTERLEUKIN-2, CIRCULATING","30100151","CDM","301","RC","83520","HCPCS","facility","both","","","","177.94","177.94","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INTERLEUKIN-2, CIRCULATING","30100151","CDM","301","RC","83520","HCPCS","facility","both","","","","227.77","227.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INTERLEUKIN-2, CIRCULATING","30100151","CDM","301","RC","83520","HCPCS","facility","both","","","","145","145","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ADAMSTS 13 ANTIBODY","30100152","CDM","301","RC","83520","HCPCS","facility","both","","","","117.9","117.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ADAMSTS 13 ANTIBODY","30100152","CDM","301","RC","83520","HCPCS","facility","both","","","","92.11","92.11","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (94)","30100153","CDM","301","RC","83520","HCPCS","facility","both","","","","251.88","251.88","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (94)","30100153","CDM","301","RC","83520","HCPCS","facility","both","","","","196.78","196.78","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (94)","30100153","CDM","301","RC","83520","HCPCS","facility","both","","","","372","372","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (94)","30100153","CDM","301","RC","83520","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HACA ASSESSMENT","30100154","CDM","301","RC","83520","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HACA ASSESSMENT","30100154","CDM","301","RC","83520","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RNA POLYMERASE I-III IGG","30100155","CDM","301","RC","83520","HCPCS","facility","both","","","","284.05","284.05","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RNA POLYMERASE I-III IGG","30100155","CDM","301","RC","83520","HCPCS","facility","both","","","","205","205","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RNA POLYMERASE I-III IGG","30100155","CDM","301","RC","83520","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RNA POLYMERASE I-III IGG","30100155","CDM","301","RC","83520","HCPCS","facility","both","","","","221.9","221.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 2/8/2017 HC MAG ISM IGM AB EIA","30100156","CDM","301","RC","83520","HCPCS","facility","both","","","","233.8","233.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"DEAC 2/8/2017 HC MAG ISM IGM AB EIA","30100156","CDM","301","RC","83520","HCPCS","facility","both","","","","268.91","268.91","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SMALL FIBER AXONAL PROFILE","30100157","CDM","301","RC","83520","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SMALL FIBER AXONAL PROFILE","30100157","CDM","301","RC","83520","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SMALL FIBER AXONAL PROFILE","30100157","CDM","301","RC","83520","HCPCS","facility","both","","","","259.4","259.4","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HU RECOMBX ANTIBODY TEST","30100158","CDM","301","RC","83520","HCPCS","facility","both","","","","330","330","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HU RECOMBX ANTIBODY TEST","30100158","CDM","301","RC","83520","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HU RECOMBX ANTIBODY TEST","30100158","CDM","301","RC","83520","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY QUANT NOS NONAB (180)","30100159","CDM","301","RC","83520","HCPCS","facility","both","","","","534","534","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (180)","30100159","CDM","301","RC","83520","HCPCS","facility","both","","","","376.81","376.81","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY QUANT NOS NONAB (180)","30100159","CDM","301","RC","83520","HCPCS","facility","both","","","","308.75","308.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (180)","30100159","CDM","301","RC","83520","HCPCS","facility","both","","","","482.33","482.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SULFATIDE ANTIBODY TEST","30100160","CDM","301","RC","83520","HCPCS","facility","both","","","","67","67","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SULFATIDE ANTIBODY TEST","30100160","CDM","301","RC","83520","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SULFATIDE ANTIBODY TEST","30100160","CDM","301","RC","83520","HCPCS","facility","both","","","","495.74","495.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SULFATIDE ANTIBODY TEST","30100160","CDM","301","RC","83520","HCPCS","facility","both","","","","387.29","387.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FACTOR H AUTOANTIBODIES","30100161","CDM","301","RC","83520","HCPCS","facility","both","","","","397.75","397.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FACTOR H AUTOANTIBODIES","30100161","CDM","301","RC","83520","HCPCS","facility","both","","","","509.13","509.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI IGA, TRANSFUSION MED","30100162","CDM","301","RC","83520","HCPCS","facility","both","","","","576.13","576.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI IGA, TRANSFUSION MED","30100162","CDM","301","RC","83520","HCPCS","facility","both","","","","450.09","450.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI IGA, TRANSFUSION MED","30100162","CDM","301","RC","83520","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GANGLIONIC NACHR ANTIBODY","30100163","CDM","301","RC","83520","HCPCS","facility","both","","","","471.02","471.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GANGLIONIC NACHR ANTIBODY","30100163","CDM","301","RC","83520","HCPCS","facility","both","","","","602.93","602.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VGKC ANTIBODY TEST","30100164","CDM","301","RC","83520","HCPCS","facility","both","","","","502","502","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VGKC ANTIBODY TEST","30100164","CDM","301","RC","83520","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VGKC ANTIBODY TEST","30100164","CDM","301","RC","83520","HCPCS","facility","both","","","","616.32","616.32","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VGKC ANTIBODY TEST","30100164","CDM","301","RC","83520","HCPCS","facility","both","","","","481.49","481.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CO-GM1 TRIAD AUTOANTIBODY","30100165","CDM","301","RC","83520","HCPCS","facility","both","","","","460","460","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CO-GM1 TRIAD AUTOANTIBODY","30100165","CDM","301","RC","83520","HCPCS","facility","both","","","","629.72","629.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CO-GM1 TRIAD AUTOANTIBODY","30100165","CDM","301","RC","83520","HCPCS","facility","both","","","","491.96","491.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IBD GENERATION II","30100166","CDM","301","RC","83520","HCPCS","facility","both","","","","750.3","750.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IBD GENERATION II","30100166","CDM","301","RC","83520","HCPCS","facility","both","","","","586.16","586.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACHR/MUSK REFLEX ANTIBODY","30100167","CDM","301","RC","83520","HCPCS","facility","both","","","","1109.52","1109.52","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACHR/MUSK REFLEX ANTIBODY","30100167","CDM","301","RC","83520","HCPCS","facility","both","","","","1420.21","1420.21","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACHR/MUSK REFLEX ANTIBODY","30100167","CDM","301","RC","83520","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOSPHO-TAU/AB42 CSF ANAL","30100168","CDM","301","RC","83520","HCPCS","facility","both","","","","1112.06","1112.06","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHOSPHO-TAU/AB42 CSF ANAL","30100168","CDM","301","RC","83520","HCPCS","facility","both","","","","868.77","868.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MUSK QUANTITATIVE ANTIBODY","30100169","CDM","301","RC","83520","HCPCS","facility","both","","","","931.58","931.58","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MUSK QUANTITATIVE ANTIBODY","30100169","CDM","301","RC","83520","HCPCS","facility","both","","","","1192.45","1192.45","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CO-GM1 QUATTRO ANTIBODIES (4)","30100170","CDM","301","RC","83520","HCPCS","facility","both","","","","270","270","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CO-GM1 QUATTRO ANTIBODIES (4)","30100170","CDM","301","RC","83520","HCPCS","facility","both","","","","1339.83","1339.83","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CO-GM1 QUATTRO ANTIBODIES (4)","30100170","CDM","301","RC","83520","HCPCS","facility","both","","","","1046.72","1046.72","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACHR/MUSK QUANTITATIVE AB","30100171","CDM","301","RC","83520","HCPCS","facility","both","","","","1109.52","1109.52","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACHR/MUSK QUANTITATIVE AB","30100171","CDM","301","RC","83520","HCPCS","facility","both","","","","1420.21","1420.21","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOTOR NEUROPATHY PRO-COMP","30100172","CDM","301","RC","83520","HCPCS","facility","both","","","","1607.79","1607.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOTOR NEUROPATHY PRO-COMP","30100172","CDM","301","RC","83520","HCPCS","facility","both","","","","1256.06","1256.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PARANEOPLASTIC PROFILE","30100173","CDM","301","RC","83520","HCPCS","facility","both","","","","1946.89","1946.89","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PARANEOPLASTIC PROFILE","30100173","CDM","301","RC","83520","HCPCS","facility","both","","","","2492.07","2492.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PARANEOPLASTIC PROFILE","30100173","CDM","301","RC","83520","HCPCS","facility","both","","","","592","592","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IRON","30100175","CDM","301","RC","83540","HCPCS","facility","both","","","","6.47","6.47","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC IRON","30100175","CDM","301","RC","83540","HCPCS","facility","both","","","","18","18","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IRON","30100175","CDM","301","RC","83540","HCPCS","facility","both","","","","12.56","12.56","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IRON","30100175","CDM","301","RC","83540","HCPCS","facility","both","","","","16.08","16.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IRON","30100175","CDM","301","RC","83540","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC IRON","30100175","CDM","301","RC","83540","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LACTATE","30100176","CDM","301","RC","83605","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC LACTATE","30100176","CDM","301","RC","83605","HCPCS","facility","both","","","","308","308","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LACTATE","30100176","CDM","301","RC","83605","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LACTATE","30100176","CDM","301","RC","83605","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LACTATE","30100176","CDM","301","RC","83605","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LACTATE DEHYDROGENASE","30100177","CDM","301","RC","83615","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LACTATE DEHYDROGENASE","30100177","CDM","301","RC","83615","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LACTATE DEHYDROGENASE","30100177","CDM","301","RC","83615","HCPCS","facility","both","","","","15.5","15.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LACTATE DEHYDROGENASE","30100177","CDM","301","RC","83615","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC LACTATE DEHYDROGENASE","30100177","CDM","301","RC","83615","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC LACTATE DEHYDROGENASE","30100177","CDM","301","RC","83615","HCPCS","facility","both","","","","254","254","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LACTOFERRIN FECAL (QUAL)","30100178","CDM","301","RC","83630","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LACTOFERRIN FECAL (QUAL)","30100178","CDM","301","RC","83630","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LACTOFERRIN FECAL (QUAL)","30100178","CDM","301","RC","83630","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LACTOFERRIN FECAL (QUAL)","30100178","CDM","301","RC","83630","HCPCS","facility","both","","","","240","240","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEAD","30100179","CDM","301","RC","83655","HCPCS","facility","both","","","","12.11","12.11","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC LEAD","30100179","CDM","301","RC","83655","HCPCS","facility","both","","","","432","432","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEAD","30100179","CDM","301","RC","83655","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEAD","30100179","CDM","301","RC","83655","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LEAD","30100179","CDM","301","RC","83655","HCPCS","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FETAL LUNG - FLUORESC POLARIZ","30100180","CDM","301","RC","83663","HCPCS","facility","both","","","","224","224","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FETAL LUNG - LB DENSITY","30100181","CDM","301","RC","83664","HCPCS","facility","both","","","","226","226","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FETAL LUNG - LB DENSITY","30100181","CDM","301","RC","83664","HCPCS","facility","both","","","","67","67","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FETAL LUNG - LB DENSITY","30100181","CDM","301","RC","83664","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FETAL LUNG - LB DENSITY","30100181","CDM","301","RC","83664","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LIPASE","30100182","CDM","301","RC","83690","HCPCS","facility","both","","","","180","180","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LIPASE","30100182","CDM","301","RC","83690","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LIPASE","30100182","CDM","301","RC","83690","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LIPASE","30100182","CDM","301","RC","83690","HCPCS","facility","both","","","","22","22","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LIPASE","30100182","CDM","301","RC","83690","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC ASSAY OF LIPOPROTEIN(A)","30100183","CDM","301","RC","83695","HCPCS","facility","both","","","","325.7","325.7","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ASSAY OF LIPOPROTEIN(A)","30100183","CDM","301","RC","83695","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY OF LIPOPROTEIN(A)","30100183","CDM","301","RC","83695","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF LIPOPROTEIN(A)","30100183","CDM","301","RC","83695","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF LIPOPROTEIN(A)","30100183","CDM","301","RC","83695","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF LIPOPROTEIN(A)","30100183","CDM","301","RC","83695","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC LIPOPROTEIN BLD HR FRACTION","30100184","CDM","301","RC","83701","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LIPOPROTEIN BLD HR FRACTION","30100184","CDM","301","RC","83701","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LIPOPROTEIN BLD HR FRACTION","30100184","CDM","301","RC","83701","HCPCS","facility","both","","","","78","78","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LIPOPROTEIN BLD BY NMR","30100185","CDM","301","RC","83704","HCPCS","facility","both","","","","328","328","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LIPOPROTEIN BLD BY NMR","30100185","CDM","301","RC","83704","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LIPOPROTEIN BLD BY NMR","30100185","CDM","301","RC","83704","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LIPOPROTEIN BLD BY NMR","30100185","CDM","301","RC","83704","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LIPOPROTEIN; HDL","30100186","CDM","301","RC","83718","HCPCS","facility","both","","","","408","408","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LIPOPROTEIN; HDL","30100186","CDM","301","RC","83718","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LIPOPROTEIN; HDL","30100186","CDM","301","RC","83718","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LIPOPROTEIN; HDL","30100186","CDM","301","RC","83718","HCPCS","facility","both","","","","6","6","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC LIPOPROTEIN; HDL","30100186","CDM","301","RC","83718","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY OF BLOOD LIPOPROTEIN LDL","30100187","CDM","301","RC","83721","HCPCS","facility","both","","","","406","406","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF BLOOD LIPOPROTEIN LDL","30100187","CDM","301","RC","83721","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF BLOOD LIPOPROTEIN LDL","30100187","CDM","301","RC","83721","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF BLOOD LIPOPROTEIN LDL","30100187","CDM","301","RC","83721","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY OF BLOOD LIPOPROTEIN LDL","30100187","CDM","301","RC","83721","HCPCS","facility","both","","","","10.5","10.5","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC MAGNESIUM","30100188","CDM","301","RC","83735","HCPCS","facility","both","","","","219","219","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MAGNESIUM","30100188","CDM","301","RC","83735","HCPCS","facility","both","","","","12.56","12.56","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MAGNESIUM","30100188","CDM","301","RC","83735","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MAGNESIUM","30100188","CDM","301","RC","83735","HCPCS","facility","both","","","","16.08","16.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MAGNESIUM","30100188","CDM","301","RC","83735","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC MAGNESIUM","30100188","CDM","301","RC","83735","HCPCS","facility","both","","","","15.91","15.91","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC MAGNESIUM","30100188","CDM","301","RC","83735","HCPCS","facility","both","","","","6.7","6.7","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC QUALIT MASS SPECT EA SPECIM","30100189","CDM","301","RC","83788","HCPCS","facility","both","","","","75","75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUALIT MASS SPECT EA SPECIM","30100189","CDM","301","RC","83788","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUALIT MASS SPECT EA SPECIM","30100189","CDM","301","RC","83788","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUALIT MASS SPECT EA SPECIM","30100189","CDM","301","RC","83788","HCPCS","facility","both","","","","471.5","471.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MASS SPECTROMETRY QUAL/QUAN, EA SPECIMEN","30100190","CDM","301","RC","83789","HCPCS","facility","both","","","","24.11","24.11","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC MASS SPECTROMETRY QUAL/QUAN, EA SPECIMEN","30100190","CDM","301","RC","83789","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MASS SPECTROMETRY QUAL/QUAN, EA SPECIMEN","30100190","CDM","301","RC","83789","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MASS SPECTROMETRY QUAL/QUAN, EA SPECIMEN","30100190","CDM","301","RC","83789","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MASS SPECTROMETRY QUAL/QUAN, EA SPECIMEN","30100190","CDM","301","RC","83789","HCPCS","facility","both","","","","216","216","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC METANEPHRINES","30100191","CDM","301","RC","83835","HCPCS","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC METANEPHRINES","30100191","CDM","301","RC","83835","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC METANEPHRINES","30100191","CDM","301","RC","83835","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC METANEPHRINES","30100191","CDM","301","RC","83835","HCPCS","facility","both","","","","48","48","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC METHEMALBUMIN","30100192","CDM","301","RC","83857","HCPCS","facility","both","","","","128","128","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MUCOPOLYSACCH ACID; QUAN","30100193","CDM","301","RC","83864","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MUCOPOLYSACCH ACID; QUAN","30100193","CDM","301","RC","83864","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MUCOPOLYSACCH ACID; QUAN","30100193","CDM","301","RC","83864","HCPCS","facility","both","","","","522","522","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MUCOPOLYSACCH ACID; SCREEN","30100194","CDM","301","RC","83866","HCPCS","facility","both","","","","78.5","78.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MYOGLOBIN","30100195","CDM","301","RC","83874","HCPCS","facility","both","","","","226","226","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MYOGLOBIN","30100195","CDM","301","RC","83874","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MYOGLOBIN","30100195","CDM","301","RC","83874","HCPCS","facility","both","","","","51.75","51.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MYOGLOBIN","30100195","CDM","301","RC","83874","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NATRIURETIC PEPTIDE","30100196","CDM","301","RC","83880","HCPCS","facility","both","","","","768","768","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NATRIURETIC PEPTIDE","30100196","CDM","301","RC","83880","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NATRIURETIC PEPTIDE","30100196","CDM","301","RC","83880","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NATRIURETIC PEPTIDE","30100196","CDM","301","RC","83880","HCPCS","facility","both","","","","96","96","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC NATRIURETIC PEPTIDE","30100196","CDM","301","RC","83880","HCPCS","facility","both","","","","39.26","39.26","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC NATRIURETIC PEPTIDE","30100196","CDM","301","RC","83880","HCPCS","facility","both","","","","48","48","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC NUCLEIC ACID HIGH RESOLUTE","30100220","CDM","301","RC","83909","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOM SYNDROME DNA","30100229","CDM","301","RC","83912","HCPCS","facility","both","","","","2905.5","2905.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HHT KNOWN FAMILIAL MUTATION","30100239","CDM","301","RC","83912","HCPCS","facility","both","","","","498.5","498.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ACADM EXON 11 SEQUENCING","30100248","CDM","301","RC","83912","HCPCS","facility","both","","","","861.5","861.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC C-KIT MUTATION ANALYSIS","30100273","CDM","301","RC","83912","HCPCS","facility","both","","","","1742.5","1742.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SPINAL MUSCULAR ATROPHY DNA","30100278","CDM","301","RC","83912","HCPCS","facility","both","","","","477.5","477.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HI RESOLUTION HLA DNA (A,B,C)","30100279","CDM","301","RC","83912","HCPCS","facility","both","","","","69.5","69.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SCA5 SELECT EXON DNA TEST","30100280","CDM","301","RC","83912","HCPCS","facility","both","","","","887.5","887.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANTLEY BIXLER-LIKE SYNDROME","30100281","CDM","301","RC","83912","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AAT6 GENE ASSAY","30100282","CDM","301","RC","83912","HCPCS","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC T CELL ENGRAFTMENT FOLLOWUP","30100294","CDM","301","RC","83912","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SH3TC2 DNA SEQUENCING TEST","30100295","CDM","301","RC","83912","HCPCS","facility","both","","","","163","163","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC KCNJ11(CH) DNA SEQUENCING","30100298","CDM","301","RC","83912","HCPCS","facility","both","","","","212.5","212.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CORONAL SYNOSTOSIS DNA","30100299","CDM","301","RC","83912","HCPCS","facility","both","","","","130","130","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RAPID RFLP FOR BMT FOLLOW-UP","30100304","CDM","301","RC","83912","HCPCS","facility","both","","","","43","43","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PREIFFER SYNDROME","30100309","CDM","301","RC","83912","HCPCS","facility","both","","","","284.5","284.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IGVH MUTATION ANALYSIS (CLL)","30100310","CDM","301","RC","83912","HCPCS","facility","both","","","","285.5","285.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TMP1 GENE TEST TROPOMYSIN","30100314","CDM","301","RC","83912","HCPCS","facility","both","","","","363","363","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FAM AMYOTROPHIC LAT SCHLERO","30100316","CDM","301","RC","83912","HCPCS","facility","both","","","","300.5","300.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SURFAC PROTEIN C DEFICIENCY","30100318","CDM","301","RC","83912","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LOEYS-DIETZ TYPE 1C GENE SMAD3","30100323","CDM","301","RC","83912","HCPCS","facility","both","","","","212.5","212.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NPM 1 PANEL","30100331","CDM","301","RC","83912","HCPCS","facility","both","","","","42.5","42.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DEMYELINAT NEUROPATHY PROFILE","30100332","CDM","301","RC","83912","HCPCS","facility","both","","","","95.5","95.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF NUCLEOTIDASE","30100412","CDM","301","RC","83915","HCPCS","facility","both","","","","314","314","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF NUCLEOTIDASE","30100412","CDM","301","RC","83915","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF NUCLEOTIDASE","30100412","CDM","301","RC","83915","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF NUCLEOTIDASE","30100412","CDM","301","RC","83915","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC OLIGOCLONAL BANDS","30100413","CDM","301","RC","83916","HCPCS","facility","both","","","","642","642","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OLIGOCLONAL BANDS","30100413","CDM","301","RC","83916","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OLIGOCLONAL BANDS","30100413","CDM","301","RC","83916","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OLIGOCLONAL BANDS","30100413","CDM","301","RC","83916","HCPCS","facility","both","","","","80.5","80.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ORGANIC ACIDS EA SPECIMEN","30100414","CDM","301","RC","83918","HCPCS","facility","both","","","","196","196","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUANTITATIVE ORGANIC ACIDS EA SPECIMEN","30100414","CDM","301","RC","83918","HCPCS","facility","both","","","","261.68","261.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ORGANIC ACIDS EA SPECIMEN","30100414","CDM","301","RC","83918","HCPCS","facility","both","","","","334.96","334.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANTITATIVE ORGANIC ACIDS EA SPECIMEN","30100414","CDM","301","RC","83918","HCPCS","facility","both","","","","145","145","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ORGANIC ACID  SINGLE QUANTITATIVE","30100415","CDM","301","RC","83921","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ORGANIC ACID  SINGLE QUANTITATIVE","30100415","CDM","301","RC","83921","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ORGANIC ACID  SINGLE QUANTITATIVE","30100415","CDM","301","RC","83921","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ORGANIC ACID  SINGLE QUANTITATIVE","30100415","CDM","301","RC","83921","HCPCS","facility","both","","","","197","197","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OPIATES 1 OR MORE","30100416","CDM","301","RC","80361","HCPCS","facility","both","","","","258","258","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OPIATES 1 OR MORE","30100416","CDM","301","RC","80361","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OPIATES 1 OR MORE","30100416","CDM","301","RC","80361","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLOOD OSMOLALITY","30100417","CDM","301","RC","83930","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLOOD OSMOLALITY","30100417","CDM","301","RC","83930","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLOOD OSMOLALITY","30100417","CDM","301","RC","83930","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BLOOD OSMOLALITY","30100417","CDM","301","RC","83930","HCPCS","facility","both","","","","124","124","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OSMOLALITY; URINE","30100418","CDM","301","RC","83935","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC OSMOLALITY; URINE","30100418","CDM","301","RC","83935","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OSMOLALITY; URINE","30100418","CDM","301","RC","83935","HCPCS","facility","both","","","","36.5","36.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC OSMOLALITY; URINE","30100418","CDM","301","RC","83935","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OSMOLALITY; URINE","30100418","CDM","301","RC","83935","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PARATHORMONE","30100419","CDM","301","RC","83970","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PARATHORMONE","30100419","CDM","301","RC","83970","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PARATHORMONE","30100419","CDM","301","RC","83970","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PARATHORMONE","30100419","CDM","301","RC","83970","HCPCS","facility","both","","","","41.28","41.28","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC PARATHORMONE","30100419","CDM","301","RC","83970","HCPCS","facility","both","","","","980","980","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY FOR CALPROTECTIN FECAL","30100420","CDM","301","RC","83993","HCPCS","facility","both","","","","242","242","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY FOR CALPROTECTIN FECAL","30100420","CDM","301","RC","83993","HCPCS","facility","both","","","","19.63","19.63","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC ASSAY FOR CALPROTECTIN FECAL","30100420","CDM","301","RC","83993","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY FOR CALPROTECTIN FECAL","30100420","CDM","301","RC","83993","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY FOR CALPROTECTIN FECAL","30100420","CDM","301","RC","83993","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTIPSYCHOTIC, NOS 1-3","30100421","CDM","301","RC","80342","HCPCS","facility","both","","","","176","176","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANTIPSYCHOTIC, NOS 1-3","30100421","CDM","301","RC","80342","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTIPSYCHOTIC, NOS 1-3","30100421","CDM","301","RC","80342","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHENYLALANINE BLOOD","30100422","CDM","301","RC","84030","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHENYLALANINE BLOOD","30100422","CDM","301","RC","84030","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PHENYLALANINE BLOOD","30100422","CDM","301","RC","84030","HCPCS","facility","both","","","","255","255","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROSTATIC ACID PHOSPHATASE","30100423","CDM","301","RC","84066","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PROSTATIC ACID PHOSPHATASE","30100423","CDM","301","RC","84066","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROSTATIC ACID PHOSPHATASE","30100423","CDM","301","RC","84066","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROSTATIC ACID PHOSPHATASE","30100423","CDM","301","RC","84066","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALKALINE PHOSPHATASE","30100424","CDM","301","RC","84075","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALKALINE PHOSPHATASE","30100424","CDM","301","RC","84075","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC ALKALINE PHOSPHATASE","30100424","CDM","301","RC","84075","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALKALINE PHOSPHATASE","30100424","CDM","301","RC","84075","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC ALKALINE PHOSPHATASE","30100424","CDM","301","RC","84075","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALKALINE PHOSPHATASE","30100424","CDM","301","RC","84075","HCPCS","facility","both","","","","132","132","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HT STBL ALKALINE PHOSPHATASE","30100425","CDM","301","RC","84078","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HT STBL ALKALINE PHOSPHATASE","30100425","CDM","301","RC","84078","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HT STBL ALKALINE PHOSPHATASE","30100425","CDM","301","RC","84078","HCPCS","facility","both","","","","88","88","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PHOSPHATE","30100426","CDM","301","RC","84100","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PHOSPHATE","30100426","CDM","301","RC","84100","HCPCS","facility","both","","","","4.74","4.74","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC PHOSPHATE","30100426","CDM","301","RC","84100","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC PHOSPHATE","30100426","CDM","301","RC","84100","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHOSPHATE","30100426","CDM","301","RC","84100","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PHOSPHATE","30100426","CDM","301","RC","84100","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC PHOSPHATE","30100426","CDM","301","RC","84100","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URINE PHOSPHATE","30100427","CDM","301","RC","84105","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC URINE PHOSPHATE","30100427","CDM","301","RC","84105","HCPCS","facility","both","","","","114","114","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URINE PHOSPHATE","30100427","CDM","301","RC","84105","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC URINE PHOSPHATE","30100427","CDM","301","RC","84105","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PORPHOBILINOGEN URINE; QUAL","30100428","CDM","301","RC","84106","HCPCS","facility","both","","","","11","11","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PORPHOBILINOGEN URINE; QUAL","30100428","CDM","301","RC","84106","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PORPHOBILINOGEN URINE; QUAL","30100428","CDM","301","RC","84106","HCPCS","facility","both","","","","25.12","25.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PORPHOBILINOGEN URINE; QUAL","30100428","CDM","301","RC","84106","HCPCS","facility","both","","","","32.16","32.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF SERUM POTASSIUM","30100429","CDM","301","RC","84132","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC ASSAY OF SERUM POTASSIUM","30100429","CDM","301","RC","84132","HCPCS","facility","both","","","","4.76","4.76","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC ASSAY OF SERUM POTASSIUM","30100429","CDM","301","RC","84132","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF SERUM POTASSIUM","30100429","CDM","301","RC","84132","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF SERUM POTASSIUM","30100429","CDM","301","RC","84132","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY OF SERUM POTASSIUM","30100429","CDM","301","RC","84132","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF SERUM POTASSIUM","30100429","CDM","301","RC","84132","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC URINE POTASSIUM","30100430","CDM","301","RC","84133","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC URINE POTASSIUM","30100430","CDM","301","RC","84133","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URINE POTASSIUM","30100430","CDM","301","RC","84133","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC URINE POTASSIUM","30100430","CDM","301","RC","84133","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC URINE POTASSIUM","30100430","CDM","301","RC","84133","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC PREALBUMIN","30100431","CDM","301","RC","84134","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PREALBUMIN","30100431","CDM","301","RC","84134","HCPCS","facility","both","","","","37","37","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC PREALBUMIN","30100431","CDM","301","RC","84134","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PREALBUMIN","30100431","CDM","301","RC","84134","HCPCS","facility","both","","","","241","241","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PREALBUMIN","30100431","CDM","301","RC","84134","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PREALBUMIN","30100431","CDM","301","RC","84134","HCPCS","facility","both","","","","14.59","14.59","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC PROLACTIN ASSAY","30100432","CDM","301","RC","84146","HCPCS","facility","both","","","","540","540","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROLACTIN ASSAY","30100432","CDM","301","RC","84146","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PROLACTIN ASSAY","30100432","CDM","301","RC","84146","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC PROLACTIN ASSAY","30100432","CDM","301","RC","84146","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROLACTIN ASSAY","30100432","CDM","301","RC","84146","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PSA; TOTAL","30100433","CDM","301","RC","84153","HCPCS","facility","both","","","","66","66","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PSA; TOTAL","30100433","CDM","301","RC","84153","HCPCS","facility","both","","","","18.39","18.39","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC PSA; TOTAL","30100433","CDM","301","RC","84153","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC PSA; TOTAL","30100433","CDM","301","RC","84153","HCPCS","facility","both","","","","344","344","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PSA; TOTAL","30100433","CDM","301","RC","84153","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PSA; TOTAL","30100433","CDM","301","RC","84153","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PSA; FREE","30100434","CDM","301","RC","84154","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PSA; FREE","30100434","CDM","301","RC","84154","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PSA; FREE","30100434","CDM","301","RC","84154","HCPCS","facility","both","","","","344","344","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PSA; FREE","30100434","CDM","301","RC","84154","HCPCS","facility","both","","","","18.39","18.39","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC PSA; FREE","30100434","CDM","301","RC","84154","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY OF PROTEIN SERUM","30100435","CDM","301","RC","84155","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC ASSAY OF PROTEIN SERUM","30100435","CDM","301","RC","84155","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF PROTEIN SERUM","30100435","CDM","301","RC","84155","HCPCS","facility","both","","","","219","219","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF PROTEIN SERUM","30100435","CDM","301","RC","84155","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC ASSAY OF PROTEIN SERUM","30100435","CDM","301","RC","84155","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF PROTEIN SERUM","30100435","CDM","301","RC","84155","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC URINE TOTAL PROTEIN","30100436","CDM","301","RC","84156","HCPCS","facility","both","","","","132","132","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URINE TOTAL PROTEIN","30100436","CDM","301","RC","84156","HCPCS","facility","both","","","","7","7","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC URINE TOTAL PROTEIN","30100436","CDM","301","RC","84156","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC URINE TOTAL PROTEIN","30100436","CDM","301","RC","84156","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC URINE TOTAL PROTEIN","30100436","CDM","301","RC","84156","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TOTAL PROTEIN OTHER SPECIMEN","30100437","CDM","301","RC","84157","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TOTAL PROTEIN OTHER SPECIMEN","30100437","CDM","301","RC","84157","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TOTAL PROTEIN OTHER SPECIMEN","30100437","CDM","301","RC","84157","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TOTAL PROTEIN OTHER SPECIMEN","30100437","CDM","301","RC","84157","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TOTAL PROTEIN OTHER SPECIMEN","30100437","CDM","301","RC","84157","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC PROTEIN; EP FRACT & QUAN","30100438","CDM","301","RC","84165","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PROTEIN; EP FRACT & QUAN","30100438","CDM","301","RC","84165","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROTEIN; EP FRACT & QUAN","30100438","CDM","301","RC","84165","HCPCS","facility","both","","","","390","390","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROTEIN; EP FRACT & QUAN","30100438","CDM","301","RC","84165","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROTEIN E-PHORESIS/URINE/CSF","30100439","CDM","301","RC","84166","HCPCS","facility","both","","","","93","93","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PROTEIN E-PHORESIS/URINE/CSF","30100439","CDM","301","RC","84166","HCPCS","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROTEIN E-PHORESIS/URINE/CSF","30100439","CDM","301","RC","84166","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROTEIN E-PHORESIS/URINE/CSF","30100439","CDM","301","RC","84166","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROTEIN WESTERN BLOT","30100440","CDM","301","RC","84181","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROTEIN WESTERN BLOT","30100440","CDM","301","RC","84181","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROTEIN WESTERN BLOT","30100440","CDM","301","RC","84181","HCPCS","facility","both","","","","7954","7954","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROTEIN WESTERN BLOT","30100440","CDM","301","RC","84181","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PROTEIN WB; IM ID FOR BANDS","30100441","CDM","301","RC","84182","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROTEIN WB; IM ID FOR BANDS","30100441","CDM","301","RC","84182","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROTEIN WB; IM ID FOR BANDS","30100441","CDM","301","RC","84182","HCPCS","facility","both","","","","1362","1362","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROTEIN WB; IM ID FOR BANDS","30100441","CDM","301","RC","84182","HCPCS","facility","both","","","","330","330","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RENIN","30100442","CDM","301","RC","84244","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RENIN","30100442","CDM","301","RC","84244","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RENIN","30100442","CDM","301","RC","84244","HCPCS","facility","both","","","","556","556","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RENIN","30100442","CDM","301","RC","84244","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF RIBOFLAVIN (VITAMIN B-2)","30100443","CDM","301","RC","84252","HCPCS","facility","both","","","","85.9","85.9","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY OF RIBOFLAVIN (VITAMIN B-2)","30100443","CDM","301","RC","84252","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF RIBOFLAVIN (VITAMIN B-2)","30100443","CDM","301","RC","84252","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF RIBOFLAVIN (VITAMIN B-2)","30100443","CDM","301","RC","84252","HCPCS","facility","both","","","","436","436","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SELENIUM","30100444","CDM","301","RC","84255","HCPCS","facility","both","","","","60.5","60.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SELENIUM","30100444","CDM","301","RC","84255","HCPCS","facility","both","","","","227","227","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SELENIUM","30100444","CDM","301","RC","84255","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SELENIUM","30100444","CDM","301","RC","84255","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF SERUM SODIUM","30100445","CDM","301","RC","84295","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF SERUM SODIUM","30100445","CDM","301","RC","84295","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC ASSAY OF SERUM SODIUM","30100445","CDM","301","RC","84295","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF SERUM SODIUM","30100445","CDM","301","RC","84295","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF SERUM SODIUM","30100445","CDM","301","RC","84295","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY OF SERUM SODIUM","30100445","CDM","301","RC","84295","HCPCS","facility","both","","","","4.81","4.81","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC SODIUM; URINE","30100446","CDM","301","RC","84300","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SODIUM; URINE","30100446","CDM","301","RC","84300","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SODIUM; URINE","30100446","CDM","301","RC","84300","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SODIUM; URINE","30100446","CDM","301","RC","84300","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SODIUM; URINE","30100446","CDM","301","RC","84300","HCPCS","facility","both","","","","7","7","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC SODIUM OTHER SOURCE","30100447","CDM","301","RC","84302","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SODIUM OTHER SOURCE","30100447","CDM","301","RC","84302","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SODIUM OTHER SOURCE","30100447","CDM","301","RC","84302","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SODIUM OTHER SOURCE","30100447","CDM","301","RC","84302","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SOMATOMEDIN","30100448","CDM","301","RC","84305","HCPCS","facility","both","","","","86.75","86.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SOMATOMEDIN","30100448","CDM","301","RC","84305","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC SOMATOMEDIN","30100448","CDM","301","RC","84305","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SOMATOMEDIN","30100448","CDM","301","RC","84305","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SOMATOMEDIN","30100448","CDM","301","RC","84305","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SOMATOMEDIN","30100448","CDM","301","RC","84305","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC SPECTROPHOTOMETRY ANALYTE NES","30100449","CDM","301","RC","84311","HCPCS","facility","both","","","","870","870","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SPECTROPHOTOMETRY ANALYTE NES","30100449","CDM","301","RC","84311","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SPECTROPHOTOMETRY ANALYTE NES","30100449","CDM","301","RC","84311","HCPCS","facility","both","","","","709","709","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SPECTROPHOTOMETRY ANALYTE NES","30100449","CDM","301","RC","84311","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SUGARS CHROMOTOGR TLC/PAPER","30100450","CDM","301","RC","84375","HCPCS","facility","both","","","","253.31","253.31","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SUGARS CHROMOTOGR TLC/PAPER","30100450","CDM","301","RC","84375","HCPCS","facility","both","","","","324.23","324.23","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SUGARS CHROMOTOGR TLC/PAPER","30100450","CDM","301","RC","84375","HCPCS","facility","both","","","","252","252","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SUGARS CHROMOTOGR TLC/PAPER","30100450","CDM","301","RC","84375","HCPCS","facility","both","","","","273","273","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URINE SULFATE","30100451","CDM","301","RC","84392","HCPCS","facility","both","","","","112.55","112.55","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC URINE SULFATE","30100451","CDM","301","RC","84392","HCPCS","facility","both","","","","87.93","87.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC URINE SULFATE","30100451","CDM","301","RC","84392","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URINE SULFATE","30100451","CDM","301","RC","84392","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TESTOSTERONE; FREE","30100452","CDM","301","RC","84402","HCPCS","facility","both","","","","529","529","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TESTOSTERONE; FREE","30100452","CDM","301","RC","84402","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TESTOSTERONE; FREE","30100452","CDM","301","RC","84402","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC THIOCYANATE","30100453","CDM","301","RC","84430","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC THIOCYANATE","30100453","CDM","301","RC","84430","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC THIOCYANATE","30100453","CDM","301","RC","84430","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THIOCYANATE","30100453","CDM","301","RC","84430","HCPCS","facility","both","","","","71.5","71.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC THROMBOXANE URINE","30100454","CDM","301","RC","84431","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC THROMBOXANE URINE","30100454","CDM","301","RC","84431","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THROMBOXANE URINE","30100454","CDM","301","RC","84431","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC THROMBOXANE URINE","30100454","CDM","301","RC","84431","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC THYROGLOBULIN","30100455","CDM","301","RC","84432","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC THYROGLOBULIN","30100455","CDM","301","RC","84432","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC THYROGLOBULIN","30100455","CDM","301","RC","84432","HCPCS","facility","both","","","","354","354","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THYROGLOBULIN","30100455","CDM","301","RC","84432","HCPCS","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC THYROGLOBULIN","30100455","CDM","301","RC","84432","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC THYROXINE; TOTAL","30100456","CDM","301","RC","84436","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC THYROXINE; TOTAL","30100456","CDM","301","RC","84436","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC THYROXINE; TOTAL","30100456","CDM","301","RC","84436","HCPCS","facility","both","","","","316","316","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THYROXINE; TOTAL","30100456","CDM","301","RC","84436","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC THYROXINE; TOTAL","30100456","CDM","301","RC","84436","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC THYROXINE; TOTAL","30100456","CDM","301","RC","84436","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC FREE THYROXINE","30100457","CDM","301","RC","84439","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FREE THYROXINE","30100457","CDM","301","RC","84439","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FREE THYROXINE","30100457","CDM","301","RC","84439","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FREE THYROXINE","30100457","CDM","301","RC","84439","HCPCS","facility","both","","","","390","390","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FREE THYROXINE","30100457","CDM","301","RC","84439","HCPCS","facility","both","","","","9.02","9.02","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC FREE THYROXINE","30100457","CDM","301","RC","84439","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC THYROXINE BINDING GLOBULIN","30100458","CDM","301","RC","84442","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC THYROXINE BINDING GLOBULIN","30100458","CDM","301","RC","84442","HCPCS","facility","both","","","","472","472","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THYROXINE BINDING GLOBULIN","30100458","CDM","301","RC","84442","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC THYROXINE BINDING GLOBULIN","30100458","CDM","301","RC","84442","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC THYROXINE BINDING GLOBULIN","30100459","CDM","301","RC","84442","HCPCS","facility","both","","","","472","472","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THYROID STIMULATING HORMONE","30100460","CDM","301","RC","84443","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC THYROID STIMULATING HORMONE","30100460","CDM","301","RC","84443","HCPCS","facility","both","","","","16.8","16.8","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC THYROID STIMULATING HORMONE","30100460","CDM","301","RC","84443","HCPCS","facility","both","","","","48","48","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC THYROID STIMULATING HORMONE","30100460","CDM","301","RC","84443","HCPCS","facility","both","","","","15.91","15.91","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC THYROID STIMULATING HORMONE","30100460","CDM","301","RC","84443","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC THYROID STIMULATING HORMONE","30100460","CDM","301","RC","84443","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC THYROID STIMULATING HORMONE","30100460","CDM","301","RC","84443","HCPCS","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AST OR SGOT","30100461","CDM","301","RC","84450","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AST OR SGOT","30100461","CDM","301","RC","84450","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AST OR SGOT","30100461","CDM","301","RC","84450","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AST OR SGOT","30100461","CDM","301","RC","84450","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AST OR SGOT","30100461","CDM","301","RC","84450","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AST OR SGOT","30100461","CDM","301","RC","84450","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC TRANSFERASE; ALANINE AMINO","30100462","CDM","301","RC","84460","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC TRANSFERASE; ALANINE AMINO","30100462","CDM","301","RC","84460","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TRANSFERASE; ALANINE AMINO","30100462","CDM","301","RC","84460","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC TRANSFERASE; ALANINE AMINO","30100462","CDM","301","RC","84460","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRANSFERASE; ALANINE AMINO","30100462","CDM","301","RC","84460","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TRANSFERASE; ALANINE AMINO","30100462","CDM","301","RC","84460","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TRANSFERRIN","30100463","CDM","301","RC","84466","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRANSFERRIN","30100463","CDM","301","RC","84466","HCPCS","facility","both","","","","12.76","12.76","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC TRANSFERRIN","30100463","CDM","301","RC","84466","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TRANSFERRIN","30100463","CDM","301","RC","84466","HCPCS","facility","both","","","","334","334","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TRANSFERRIN","30100463","CDM","301","RC","84466","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TRIGLYCERIDES","30100464","CDM","301","RC","84478","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TRIGLYCERIDES","30100464","CDM","301","RC","84478","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC TRIGLYCERIDES","30100464","CDM","301","RC","84478","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRIGLYCERIDES","30100464","CDM","301","RC","84478","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TRIGLYCERIDES","30100464","CDM","301","RC","84478","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC T3 OR T4 OR THBR","30100465","CDM","301","RC","84479","HCPCS","facility","both","","","","22.75","22.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC T3 OR T4 OR THBR","30100465","CDM","301","RC","84479","HCPCS","facility","both","","","","344","344","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC T3 OR T4 OR THBR","30100465","CDM","301","RC","84479","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC T3 OR T4 OR THBR","30100465","CDM","301","RC","84479","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC T3; TOTAL","30100466","CDM","301","RC","84480","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC T3; TOTAL","30100466","CDM","301","RC","84480","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC T3; TOTAL","30100466","CDM","301","RC","84480","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC T3; TOTAL","30100466","CDM","301","RC","84480","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC T3; TOTAL","30100466","CDM","301","RC","84480","HCPCS","facility","both","","","","390","390","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TROPONIN QUAN","30100467","CDM","301","RC","84484","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TROPONIN QUAN","30100467","CDM","301","RC","84484","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TROPONIN QUAN","30100467","CDM","301","RC","84484","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC TROPONIN QUAN","30100467","CDM","301","RC","84484","HCPCS","facility","both","","","","313","313","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TROPONIN QUAN","30100467","CDM","301","RC","84484","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UREA NITROGEN; QUAN","30100468","CDM","301","RC","84520","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC UREA NITROGEN; QUAN","30100468","CDM","301","RC","84520","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UREA NITROGEN; QUAN","30100468","CDM","301","RC","84520","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UREA NITROGEN; QUAN","30100468","CDM","301","RC","84520","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC UREA NITROGEN; QUAN","30100468","CDM","301","RC","84520","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UREA NITROGEN; QUAN","30100468","CDM","301","RC","84520","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UREA NITROGEN URINE","30100469","CDM","301","RC","84540","HCPCS","facility","both","","","","22","22","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UREA NITROGEN URINE","30100469","CDM","301","RC","84540","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UREA NITROGEN URINE","30100469","CDM","301","RC","84540","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UREA NITROGEN URINE","30100469","CDM","301","RC","84540","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC URIC ACID; BLOOD","30100470","CDM","301","RC","84550","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC URIC ACID; BLOOD","30100470","CDM","301","RC","84550","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC URIC ACID; BLOOD","30100470","CDM","301","RC","84550","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC URIC ACID; BLOOD","30100470","CDM","301","RC","84550","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC URIC ACID; BLOOD","30100470","CDM","301","RC","84550","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC URIC ACID; BLOOD","30100470","CDM","301","RC","84550","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URIC ACID; BLOOD","30100470","CDM","301","RC","84550","HCPCS","facility","both","","","","4.49","4.49","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC URIC ACID; NOT BLOOD","30100471","CDM","301","RC","84560","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URIC ACID; NOT BLOOD","30100471","CDM","301","RC","84560","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC URIC ACID; NOT BLOOD","30100471","CDM","301","RC","84560","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC URIC ACID; NOT BLOOD","30100471","CDM","301","RC","84560","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UROBILINOGEN URINE; QUAL","30100472","CDM","301","RC","84578","HCPCS","facility","both","","","","292","292","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UROBILINOGEN URINE; QUAL","30100472","CDM","301","RC","84578","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UROBILINOGEN URINE; QUAL","30100472","CDM","301","RC","84578","HCPCS","facility","both","","","","9","9","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UROBILINOGEN URINE; QUAL","30100472","CDM","301","RC","84578","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VMA URINE","30100473","CDM","301","RC","84585","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VMA URINE","30100473","CDM","301","RC","84585","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VMA URINE","30100473","CDM","301","RC","84585","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VMA URINE","30100473","CDM","301","RC","84585","HCPCS","facility","both","","","","532","532","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VITAMIN NOS","30100474","CDM","301","RC","84591","HCPCS","facility","both","","","","246","246","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VITAMIN NOS","30100474","CDM","301","RC","84591","HCPCS","facility","both","","","","81","81","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VITAMIN NOS","30100474","CDM","301","RC","84591","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VITAMIN NOS","30100474","CDM","301","RC","84591","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VITAMIN K","30100475","CDM","301","RC","84597","HCPCS","facility","both","","","","615","615","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VITAMIN K","30100475","CDM","301","RC","84597","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VITAMIN K","30100475","CDM","301","RC","84597","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VITAMIN K","30100475","CDM","301","RC","84597","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VOLATILES","30100476","CDM","301","RC","84600","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VOLATILES","30100476","CDM","301","RC","84600","HCPCS","facility","both","","","","38.5","38.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VOLATILES","30100476","CDM","301","RC","84600","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC VOLATILES","30100476","CDM","301","RC","84600","HCPCS","facility","both","","","","266","266","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VOLATILES","30100476","CDM","301","RC","84600","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC XYLOSE ABSORPTION BLOOD &/OR URINE","30100477","CDM","301","RC","84620","HCPCS","facility","both","","","","442","442","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC XYLOSE ABSORPTION BLOOD &/OR URINE","30100477","CDM","301","RC","84620","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC XYLOSE ABSORPTION BLOOD &/OR URINE","30100477","CDM","301","RC","84620","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC XYLOSE ABSORPTION BLOOD &/OR URINE","30100477","CDM","301","RC","84620","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ZINC","30100478","CDM","301","RC","84630","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ZINC","30100478","CDM","301","RC","84630","HCPCS","facility","both","","","","316","316","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ZINC","30100478","CDM","301","RC","84630","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ZINC","30100478","CDM","301","RC","84630","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC C-PEPTIDE","30100479","CDM","301","RC","84681","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC C-PEPTIDE","30100479","CDM","301","RC","84681","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC C-PEPTIDE","30100479","CDM","301","RC","84681","HCPCS","facility","both","","","","436","436","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC C-PEPTIDE","30100479","CDM","301","RC","84681","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HCG; QUAN","30100480","CDM","301","RC","84702","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC HCG; QUAN","30100480","CDM","301","RC","84702","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC HCG; QUAN","30100480","CDM","301","RC","84702","HCPCS","facility","both","","","","50.25","50.25","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HCG; QUAN","30100480","CDM","301","RC","84702","HCPCS","facility","both","","","","434","434","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HCG; QUAN","30100480","CDM","301","RC","84702","HCPCS","facility","both","","","","15.05","15.05","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC HCG; QUAN","30100480","CDM","301","RC","84702","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HCG; QUAN","30100480","CDM","301","RC","84702","HCPCS","facility","both","","","","64.31","64.31","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED CHEMISTRY (10)","30100481","CDM","301","RC","84999","HCPCS","facility","both","","","","36.5","36.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED CHEMISTRY (10)","30100481","CDM","301","RC","84999","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UNLISTED CHEMISTRY (10)","30100481","CDM","301","RC","84999","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED CHEMISTRY (10)","30100481","CDM","301","RC","84999","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED CHEMISTRY TEST","30100483","CDM","301","RC","84999","HCPCS","facility","both","","","","465","465","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED CHEMISTRY TEST","30100483","CDM","301","RC","84999","HCPCS","facility","both","","","","811.93","811.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED CHEMISTRY TEST","30100483","CDM","301","RC","84999","HCPCS","facility","both","","","","634.31","634.31","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IA QUANT; CA 15-3 (27.29)","30100484","CDM","302","RC","86300","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IA QUANT; CA 15-3 (27.29)","30100484","CDM","302","RC","86300","HCPCS","facility","both","","","","393","393","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IA QUANT; CA 15-3 (27.29)","30100484","CDM","302","RC","86300","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IA QUANT; CA 15-3 (27.29)","30100484","CDM","302","RC","86300","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INHIBIN A","30100485","CDM","302","RC","86336","HCPCS","facility","both","","","","64.31","64.31","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INHIBIN A","30100485","CDM","302","RC","86336","HCPCS","facility","both","","","","61","61","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC INHIBIN A","30100485","CDM","302","RC","86336","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INHIBIN A","30100485","CDM","302","RC","86336","HCPCS","facility","both","","","","50.25","50.25","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LYMES AMPLIFIED NA PROBE","30100486","CDM","306","RC","87476","HCPCS","facility","both","","","","994","994","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AMPHETAMINE SCREEN","30100487","CDM","301","RC","80301","HCPCS","facility","both","","","","324","324","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG ABUSE PROFILE 1","30100488","CDM","301","RC","","","facility","both","","","","220.5","220.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG ABUSE PROFILE 2","30100489","CDM","301","RC","","","facility","both","","","","220.5","220.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG ABUSE PROFILE 3, EMERG","30100490","CDM","301","RC","","","facility","both","","","","220.5","220.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG ABUSE PROFILE 4, EMERG","30100491","CDM","301","RC","","","facility","both","","","","220.5","220.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BUPRENORPHINE + METAB SCREEN","30100492","CDM","301","RC","","","facility","both","","","","220.5","220.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCREEN QUANT CAFFEINE","30100494","CDM","301","RC","80155","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN QUANT CAFFEINE","30100494","CDM","301","RC","80155","HCPCS","facility","both","","","","168","168","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCREEN QUANT CAFFEINE","30100494","CDM","301","RC","80155","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREEN QUANT CLOZAPINE","30100495","CDM","301","RC","80159","HCPCS","facility","both","","","","37.75","37.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG SCREEN QUANT CLOZAPINE","30100495","CDM","301","RC","80159","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN QUANT CLOZAPINE","30100495","CDM","301","RC","80159","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREEN QUANT CLOZAPINE","30100495","CDM","301","RC","80159","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCREEN QUANT EVEROLIMUS","30100496","CDM","301","RC","80169","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREEN QUANT EVEROLIMUS","30100496","CDM","301","RC","80169","HCPCS","facility","both","","","","162","162","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCREEN QUANT EVEROLIMUS","30100496","CDM","301","RC","80169","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG SCREEN QUANT EVEROLIMUS","30100496","CDM","301","RC","80169","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN QUANT GABAPENTIN","30100497","CDM","301","RC","80171","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN QUANT GABAPENTIN","30100497","CDM","301","RC","80171","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCREEN QUANT GABAPENTIN","30100497","CDM","301","RC","80171","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREEN QUAN LAMOTRIGINE","30100498","CDM","301","RC","80175","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN QUAN LAMOTRIGINE","30100498","CDM","301","RC","80175","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCREEN QUAN LAMOTRIGINE","30100498","CDM","301","RC","80175","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCRN QUAN LEVETIRACETAM","30100499","CDM","301","RC","80177","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCRN QUAN LEVETIRACETAM","30100499","CDM","301","RC","80177","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCRN QUAN LEVETIRACETAM","30100499","CDM","301","RC","80177","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCRN QUAN MYCOPHENOLATE","30100500","CDM","301","RC","80180","HCPCS","facility","both","","","","213","213","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCRN QUAN MYCOPHENOLATE","30100500","CDM","301","RC","80180","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCRN QUAN MYCOPHENOLATE","30100500","CDM","301","RC","80180","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCRN QUANT OXCARBAZEPIN","30100501","CDM","301","RC","80183","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCRN QUANT OXCARBAZEPIN","30100501","CDM","301","RC","80183","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCRN QUANT OXCARBAZEPIN","30100501","CDM","301","RC","80183","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROCAINAMIDE","30100502","CDM","301","RC","80190","HCPCS","facility","both","","","","720","720","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCREEN QUANT ZONISAMIDE","30100503","CDM","301","RC","80203","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN QUANT ZONISAMIDE","30100503","CDM","301","RC","80203","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREEN QUANT ZONISAMIDE","30100503","CDM","301","RC","80203","HCPCS","facility","both","","","","157","157","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ACTH STIM; ADRENAL INSUFF","30100504","CDM","301","RC","80400","HCPCS","facility","both","","","","485","485","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INSULIN T PANEL; ACTH INSUFF","30100505","CDM","301","RC","80434","HCPCS","facility","both","","","","1678","1678","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DMD DUP/DELET ANALYSIS","30100506","CDM","310","RC","81161","HCPCS","facility","both","","","","931.58","931.58","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DMD DUP/DELET ANALYSIS","30100506","CDM","310","RC","81161","HCPCS","facility","both","","","","1192.45","1192.45","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASPA GENE","30100507","CDM","310","RC","81200","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASPA GENE","30100507","CDM","310","RC","81200","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC APC GENE KNOWN FAM VARIANTS","30100508","CDM","310","RC","81202","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC APC GENE KNOWN FAM VARIANTS","30100508","CDM","310","RC","81202","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BCR/ABL1 GENE MAJOR BP","30100509","CDM","310","RC","81206","HCPCS","facility","both","","","","2931","2931","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BCR/ABL1 GENE MAJOR BP","30100509","CDM","310","RC","81206","HCPCS","facility","both","","","","508.71","508.71","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BCR/ABL1 GENE MAJOR BP","30100509","CDM","310","RC","81206","HCPCS","facility","both","","","","651.16","651.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BCR/ABL1 GENE MINOR BP","30100510","CDM","310","RC","81207","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BCR/ABL1 GENE MINOR BP","30100510","CDM","310","RC","81207","HCPCS","facility","both","","","","2577","2577","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BCR/ABL1 GENE MINOR BP","30100510","CDM","310","RC","81207","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BCR/ABL1 GENE OTHER BP","30100511","CDM","310","RC","81208","HCPCS","facility","both","","","","723.51","723.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BCR/ABL1 GENE OTHER BP","30100511","CDM","310","RC","81208","HCPCS","facility","both","","","","565.23","565.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BCR/ABL1 GENE OTHER BP","30100511","CDM","310","RC","81208","HCPCS","facility","both","","","","2862","2862","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLM GENE","30100512","CDM","310","RC","81209","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLM GENE","30100512","CDM","310","RC","81209","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLM GENE","30100512","CDM","310","RC","81209","HCPCS","facility","both","","","","140","140","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BRAF GENE","30100513","CDM","310","RC","81210","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BRAF GENE","30100513","CDM","310","RC","81210","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BRAF GENE","30100513","CDM","310","RC","81210","HCPCS","facility","both","","","","2339","2339","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYP2D6 GENE COM VARIANTS","30100519","CDM","310","RC","81226","HCPCS","facility","both","","","","190","190","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYP2D6 GENE COM VARIANTS","30100519","CDM","310","RC","81226","HCPCS","facility","both","","","","5888","5888","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYP2D6 GENE COM VARIANTS","30100519","CDM","310","RC","81226","HCPCS","facility","both","","","","240.74","240.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYP2D6 GENE COM VARIANTS","30100519","CDM","310","RC","81226","HCPCS","facility","both","","","","5888","5888","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYP2D6 GENE COM VARIANTS","30100519","CDM","310","RC","81226","HCPCS","facility","both","","","","308.16","308.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYP2C9 GENE COM VARIANTS","30100520","CDM","310","RC","81227","HCPCS","facility","both","","","","723.51","723.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYP2C9 GENE COM VARIANTS","30100520","CDM","310","RC","81227","HCPCS","facility","both","","","","565.23","565.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOGEN M ARRAY COPY NO&SNP","30100522","CDM","310","RC","81229","HCPCS","facility","both","","","","5842","5842","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOGEN M ARRAY COPY NO&SNP","30100522","CDM","310","RC","81229","HCPCS","facility","both","","","","735","735","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC EGFR GENE COM VARIANTS","30100523","CDM","310","RC","81235","HCPCS","facility","both","","","","4302","4302","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC EGFR GENE COM VARIANTS","30100523","CDM","310","RC","81235","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC EGFR GENE COM VARIANTS","30100523","CDM","310","RC","81235","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FMR1 GENE DETECTION","30100525","CDM","310","RC","81243","HCPCS","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FMR1 GENE DETECTION","30100525","CDM","310","RC","81243","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FMR1 GENE DETECTION","30100525","CDM","310","RC","81243","HCPCS","facility","both","","","","816","816","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FMR1 GENE DETECTION","30100525","CDM","310","RC","81243","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLT3 GENE","30100527","CDM","310","RC","81245","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLT3 GENE","30100527","CDM","310","RC","81245","HCPCS","facility","both","","","","2163","2163","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FLT3 GENE","30100527","CDM","310","RC","81245","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC G6PC GENE","30100528","CDM","310","RC","81250","HCPCS","facility","both","","","","795.51","795.51","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC G6PC GENE","30100528","CDM","310","RC","81250","HCPCS","facility","both","","","","525","525","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC G6PC GENE","30100528","CDM","310","RC","81250","HCPCS","facility","both","","","","1018.26","1018.26","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GJB2 GENE FULL SEQUENCE","30100530","CDM","310","RC","81252","HCPCS","facility","both","","","","753.64","753.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GJB2 GENE FULL SEQUENCE","30100530","CDM","310","RC","81252","HCPCS","facility","both","","","","964.68","964.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GJB2 GENE FULL SEQUENCE","30100530","CDM","310","RC","81252","HCPCS","facility","both","","","","700","700","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GJB6 GENE COM VARIANTS","30100531","CDM","310","RC","81254","HCPCS","facility","both","","","","429.16","429.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GJB6 GENE COM VARIANTS","30100531","CDM","310","RC","81254","HCPCS","facility","both","","","","549.33","549.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GJB6 GENE COM VARIANTS","30100531","CDM","310","RC","81254","HCPCS","facility","both","","","","325","325","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HFE GENE","30100532","CDM","310","RC","81256","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HFE GENE","30100532","CDM","310","RC","81256","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HFE GENE","30100532","CDM","310","RC","81256","HCPCS","facility","both","","","","1165","1165","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IKBKAP GENE","30100534","CDM","310","RC","81260","HCPCS","facility","both","","","","182.13","182.13","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IKBKAP GENE","30100534","CDM","310","RC","81260","HCPCS","facility","both","","","","233.13","233.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IGH GENE REARRANGE AMP METH","30100535","CDM","310","RC","81261","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IGH GENE REARRANGE AMP METH","30100535","CDM","310","RC","81261","HCPCS","facility","both","","","","3522","3522","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IGH GENE REARRANGE AMP METH","30100535","CDM","310","RC","81261","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IGH VARI REGIONAL MUTATION","30100536","CDM","310","RC","81263","HCPCS","facility","both","","","","399.27","399.27","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IGH VARI REGIONAL MUTATION","30100536","CDM","310","RC","81263","HCPCS","facility","both","","","","311.93","311.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IGH VARI REGIONAL MUTATION","30100536","CDM","310","RC","81263","HCPCS","facility","both","","","","1135","1135","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STR MARKERS SPECIMEN ANAL (275)","30100537","CDM","310","RC","81265","HCPCS","facility","both","","","","575.7","575.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STR MARKERS SPECIMEN ANAL (275)","30100537","CDM","310","RC","81265","HCPCS","facility","both","","","","736.9","736.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STR MARKERS SPEC ANAL ADDL","30100538","CDM","310","RC","81266","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STR MARKERS SPEC ANAL ADDL","30100538","CDM","310","RC","81266","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHIMERISM ANAL NO CELL SELEC","30100539","CDM","310","RC","81267","HCPCS","facility","both","","","","533.83","533.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHIMERISM ANAL NO CELL SELEC","30100539","CDM","310","RC","81267","HCPCS","facility","both","","","","3689","3689","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHIMERISM ANAL NO CELL SELEC","30100539","CDM","310","RC","81267","HCPCS","facility","both","","","","683.3","683.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHIMERISM ANAL W/CELL SELECT","30100540","CDM","310","RC","81268","HCPCS","facility","both","","","","961","961","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHIMERISM ANAL W/CELL SELECT","30100540","CDM","310","RC","81268","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHIMERISM ANAL W/CELL SELECT","30100540","CDM","310","RC","81268","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC JAK2 GENE","30100541","CDM","310","RC","81270","HCPCS","facility","both","","","","1740","1740","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC KRAS GENE","30100542","CDM","310","RC","81275","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KRAS GENE","30100542","CDM","310","RC","81275","HCPCS","facility","both","","","","2576","2576","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC KRAS GENE","30100542","CDM","310","RC","81275","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LONG QT SYND GENE FULL SEQ","30100543","CDM","309","RC","81280","HCPCS","facility","both","","","","1694.46","1694.46","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LONG QT SYND GENE FULL SEQ","30100543","CDM","309","RC","81280","HCPCS","facility","both","","","","2438.6","2438.6","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LONG QT SYN GENE DUP/DLT VAR","30100544","CDM","309","RC","81282","HCPCS","facility","both","","","","1093.26","1093.26","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LONG QT SYN GENE DUP/DLT VAR","30100544","CDM","309","RC","81282","HCPCS","facility","both","","","","1594.55","1594.55","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MGMT GENE METHYLATION ANAL","30100545","CDM","310","RC","81287","HCPCS","facility","both","","","","1138.86","1138.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MGMT GENE METHYLATION ANAL","30100545","CDM","310","RC","81287","HCPCS","facility","both","","","","889.71","889.71","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MGMT GENE METHYLATION ANAL","30100545","CDM","310","RC","81287","HCPCS","facility","both","","","","695","695","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MCOLN1 GENE","30100546","CDM","310","RC","81290","HCPCS","facility","both","","","","154.91","154.91","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MCOLN1 GENE","30100546","CDM","310","RC","81290","HCPCS","facility","both","","","","198.3","198.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MLH1 GENE DUP/DELETE VARIANT","30100547","CDM","310","RC","81294","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MLH1 GENE DUP/DELETE VARIANT","30100547","CDM","310","RC","81294","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MLH1 GENE DUP/DELETE VARIANT","30100547","CDM","310","RC","81294","HCPCS","facility","both","","","","2486","2486","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MICROSATELLITE INSTABILITY","30100548","CDM","310","RC","81301","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MICROSATELLITE INSTABILITY","30100548","CDM","310","RC","81301","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MICROSATELLITE INSTABILITY","30100548","CDM","310","RC","81301","HCPCS","facility","both","","","","5152","5152","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MECP2 GENE FULL SEQ","30100549","CDM","310","RC","81302","HCPCS","facility","both","","","","1795.37","1795.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MECP2 GENE FULL SEQ","30100549","CDM","310","RC","81302","HCPCS","facility","both","","","","1402.6","1402.6","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG CONFIRMATION","30100551","CDM","301","RC","80102","HCPCS","facility","both","","","","385.5","385.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUAL SERUM ACETONE/KETONES","30100552","CDM","301","RC","82009","HCPCS","facility","both","","","","15.5","15.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUAL SERUM ACETONE/KETONES","30100552","CDM","301","RC","82009","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MICROALBUMIN; URINE SEMIQUAN","30100553","CDM","301","RC","82044","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AMPHETAMINE/METHAMPH","30100554","CDM","301","RC","82145","HCPCS","facility","both","","","","193.5","193.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BILE ACIDS; TOTAL","30100555","CDM","301","RC","82239","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BILE ACIDS; TOTAL","30100555","CDM","301","RC","82239","HCPCS","facility","both","","","","197","197","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BILE ACIDS; TOTAL","30100555","CDM","301","RC","82239","HCPCS","facility","both","","","","88","88","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BILE ACIDS; TOTAL","30100555","CDM","301","RC","82239","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OCCULT BLD FECES 1-3 TESTS","30100556","CDM","301","RC","82272","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STONE; X-RAY DIFFRACTION","30100557","CDM","301","RC","82370","HCPCS","facility","both","","","","298","298","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHEMILUMINESCENT ASSAY","30100558","CDM","301","RC","82397","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHEMILUMINESCENT ASSAY","30100558","CDM","301","RC","82397","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHEMILUMINESCENT ASSAY","30100558","CDM","301","RC","82397","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHEMILUMINESCENT ASSAY","30100558","CDM","301","RC","82397","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHOLINESTERASE; RBC","30100559","CDM","301","RC","82482","HCPCS","facility","both","","","","286","286","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CPK: ISOENZYMES","30100560","CDM","301","RC","82552","HCPCS","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CPK: ISOENZYMES","30100560","CDM","301","RC","82552","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CPK: ISOENZYMES","30100560","CDM","301","RC","82552","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DESOXYCORTICOSTERONE 11","30100561","CDM","301","RC","82633","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DESOXYCORTICOSTERONE 11","30100561","CDM","301","RC","82633","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DESOXYCORTICOSTERONE 11","30100561","CDM","301","RC","82633","HCPCS","facility","both","","","","384","384","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ELECTROPHORESIS NES","30100562","CDM","301","RC","82664","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ELECTROPHORESIS NES","30100562","CDM","301","RC","82664","HCPCS","facility","both","","","","227","227","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ELECTROPHORESIS NES","30100562","CDM","301","RC","82664","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ELECTROPHORESIS NES","30100562","CDM","301","RC","82664","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ESTROGENS; TOTAL","30100563","CDM","301","RC","82672","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ESTROGENS; TOTAL","30100563","CDM","301","RC","82672","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ESTROGENS; TOTAL","30100563","CDM","301","RC","82672","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ESTROGENS; TOTAL","30100563","CDM","301","RC","82672","HCPCS","facility","both","","","","132","132","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FLURAZEPAM","30100564","CDM","301","RC","82742","HCPCS","facility","both","","","","329","329","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD GAS PH ONLY","30100565","CDM","301","RC","82800","HCPCS","facility","both","","","","6","6","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BLOOD GAS PH ONLY","30100565","CDM","301","RC","82800","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD GAS PH ONLY","30100565","CDM","301","RC","82800","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLOOD GAS PH ONLY","30100565","CDM","301","RC","82800","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEAVY METAL; SCREEN","30100566","CDM","301","RC","83015","HCPCS","facility","both","","","","1077","1077","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEMOSIDERIN; QUANT","30100567","CDM","301","RC","83071","HCPCS","facility","both","","","","167.5","167.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IRON BINDING CAPACITY","30100568","CDM","301","RC","83550","HCPCS","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FETAL LUNG MATURITY; QUAN","30100569","CDM","301","RC","83661","HCPCS","facility","both","","","","646","646","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FETAL LUNG MATURITY; QUAN","30100569","CDM","301","RC","83661","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FETAL LUNG MATURITY; QUAN","30100569","CDM","301","RC","83661","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FETAL LUNG MATURITY; QUAN","30100569","CDM","301","RC","83661","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LEUCINE AMINOPEPTIDASE","30100570","CDM","301","RC","83670","HCPCS","facility","both","","","","292","292","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEUCINE AMINOPEPTIDASE","30100570","CDM","301","RC","83670","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LEUCINE AMINOPEPTIDASE","30100570","CDM","301","RC","83670","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEUCINE AMINOPEPTIDASE","30100570","CDM","301","RC","83670","HCPCS","facility","both","","","","32.75","32.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LUTEINIZING RELEASING FACTOR","30100571","CDM","301","RC","83727","HCPCS","facility","both","","","","1106","1106","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUAL ORGANIC ACIDS EA SPECIM","30100572","CDM","301","RC","83919","HCPCS","facility","both","","","","196","196","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PCP QUAN ASSAY","30100573","CDM","301","RC","83992","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PCP QUAN ASSAY","30100573","CDM","301","RC","83992","HCPCS","facility","both","","","","348","348","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PCP QUAN ASSAY","30100573","CDM","301","RC","83992","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PCP QUAN ASSAY","30100573","CDM","301","RC","83992","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PREGNANEDIOL","30100574","CDM","301","RC","84135","HCPCS","facility","both","","","","273","273","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PYRUVATE KINASE","30100575","CDM","301","RC","84220","HCPCS","facility","both","","","","112","112","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THYROID STIMULATING IMMUNOGLOBULINS","30100576","CDM","301","RC","84445","HCPCS","facility","both","","","","142","142","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC THYROID STIMULATING IMMUNOGLOBULINS","30100576","CDM","301","RC","84445","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC THYROID STIMULATING IMMUNOGLOBULINS","30100576","CDM","301","RC","84445","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC THYROID STIMULATING IMMUNOGLOBULINS","30100576","CDM","301","RC","84445","HCPCS","facility","both","","","","292","292","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CANNABINOID EXLUS/TEST","30100577","CDM","301","RC","80301","HCPCS","facility","both","","","","220.5","220.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUGS SCR, SINGLE X 6","30100578","CDM","301","RC","","","facility","both","","","","220.5","220.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URINE DRUG SCREEN (8TEST)","30100579","CDM","301","RC","80301","HCPCS","facility","both","","","","87.68","87.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC URINE DRUG SCREEN (8TEST)","30100579","CDM","301","RC","80301","HCPCS","facility","both","","","","127.96","127.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC URINE DRUG SCREEN (8TEST)","30100579","CDM","301","RC","80301","HCPCS","facility","both","","","","220.5","220.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCREEN MULTI DRUG CLASS","30100580","CDM","301","RC","","","facility","both","","","","63","63","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYP2C19 GENE COM VARIANTS","30100581","CDM","310","RC","81225","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYP2C19 GENE COM VARIANTS","30100581","CDM","310","RC","81225","HCPCS","facility","both","","","","3804","3804","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYP2C19 GENE COM VARIANTS","30100581","CDM","310","RC","81225","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYP2C19 GENE COM VARIANTS","30100581","CDM","310","RC","81225","HCPCS","facility","both","","","","3804","3804","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC F2 GENE","30100582","CDM","310","RC","81240","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC F2 GENE","30100582","CDM","310","RC","81240","HCPCS","facility","both","","","","300","300","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC F2 GENE","30100582","CDM","310","RC","81240","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC F2 GENE","30100582","CDM","310","RC","81240","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC F5 GENE","30100583","CDM","310","RC","81241","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC F5 GENE","30100583","CDM","310","RC","81241","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC F5 GENE","30100583","CDM","310","RC","81241","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC F5 GENE","30100583","CDM","310","RC","81241","HCPCS","facility","both","","","","1093","1093","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MTHFR GENE","30100584","CDM","310","RC","81291","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MTHFR GENE","30100584","CDM","310","RC","81291","HCPCS","facility","both","","","","404","404","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MTHFR GENE","30100584","CDM","310","RC","81291","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MTHFR GENE","30100584","CDM","310","RC","81291","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALPHA-1-ANTITRYPSIN; PHENOTYPE (40)","30100585","CDM","301","RC","82104","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALPHA-1-ANTITRYPSIN; PHENOTYPE (40)","30100585","CDM","301","RC","82104","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALPHA-1-ANTITRYPSIN; PHENOTYPE (40)","30100585","CDM","301","RC","82104","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALPHA-1-ANTITRYPSIN; PHENOTYPE (40)","30100585","CDM","301","RC","82104","HCPCS","facility","both","","","","171","171","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AMINO ACIDS; 2-5 QUAN EA","30100586","CDM","301","RC","82136","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AMINO ACIDS; 2-5 QUAN EA","30100586","CDM","301","RC","82136","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AMINO ACIDS; 2-5 QUAN EA","30100586","CDM","301","RC","82136","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AMINO ACIDS; 2-5 QUAN EA","30100586","CDM","301","RC","82136","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COCAINE OR METABOLITE ASSAY","30100587","CDM","301","RC","82520","HCPCS","facility","both","","","","111.5","111.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STONE; QUALITATIVE ANALYSIS","30100588","CDM","301","RC","82355","HCPCS","facility","both","","","","232","232","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STONE; QUANTITATIVE ANALYSIS,  CHEMICAL","30100589","CDM","301","RC","82360","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STONE; QUANTITATIVE ANALYSIS,  CHEMICAL","30100589","CDM","301","RC","82360","HCPCS","facility","both","","","","42.5","42.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CATECHOLAMINES; TOTAL URINE","30100590","CDM","301","RC","82382","HCPCS","facility","both","","","","433","433","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY CARBOXYHB QUAL","30100591","CDM","301","RC","82376","HCPCS","facility","both","","","","71","71","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHOLINESTERASE; SERUM","30100592","CDM","301","RC","82480","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHOLINESTERASE; SERUM","30100592","CDM","301","RC","82480","HCPCS","facility","both","","","","255","255","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHOLINESTERASE; SERUM","30100592","CDM","301","RC","82480","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ENZYME ACTIVITY BC; RA","30100593","CDM","301","RC","82658","HCPCS","facility","both","","","","213","213","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DIBUCAINE NUMBER","30100594","CDM","301","RC","82638","HCPCS","facility","both","","","","203","203","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DIBUCAINE NUMBER","30100594","CDM","301","RC","82638","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DIBUCAINE NUMBER","30100594","CDM","301","RC","82638","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GLUCOSE; BLD BY MONITOR DEVICE","30100595","CDM","301","RC","82962","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GLUCOSE; BLD BY MONITOR DEVICE","30100595","CDM","301","RC","82962","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GLUCOSE; BLD BY MONITOR DEVICE","30100595","CDM","301","RC","82962","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GLUCOSE; BLD BY MONITOR DEVICE","30100595","CDM","301","RC","82962","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HGB; METHEMOGLOBIN QUAL","30100596","CDM","301","RC","83045","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GASTRIC ANALY W/PH EA SPEC","30100597","CDM","301","RC","82930","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FREE INSULIN","30100598","CDM","301","RC","83527","HCPCS","facility","both","","","","166","166","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC KETOSTEROIDS 17; FRACTIONATION","30100599","CDM","301","RC","83593","HCPCS","facility","both","","","","312","312","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC KETOSTEROIDS 17; FRACTIONATION","30100599","CDM","301","RC","83593","HCPCS","facility","both","","","","56.27","56.27","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KETOSTEROIDS 17; FRACTIONATION","30100599","CDM","301","RC","83593","HCPCS","facility","both","","","","43.96","43.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC KETOSTEROIDS 17; FRACTIONATION","30100599","CDM","301","RC","83593","HCPCS","facility","both","","","","213.5","213.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LIPOPRO BLD ELECTROPHORETIC","30100600","CDM","301","RC","83700","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LIPOPRO BLD ELECTROPHORETIC","30100600","CDM","301","RC","83700","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LIPOPRO BLD ELECTROPHORETIC","30100600","CDM","301","RC","83700","HCPCS","facility","both","","","","580","580","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC H PYLORI (C-13) BREATH TEST","30100601","CDM","301","RC","83013","HCPCS","facility","both","","","","795","795","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NON-URINE SPECIFIC GRAVITY","30100602","CDM","301","RC","84315","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SUGARS; MULTI QUAL EA SPECIMEN","30100603","CDM","301","RC","84377","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SUGARS; MULTI QUAL EA SPECIMEN","30100603","CDM","301","RC","84377","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SUGARS; MULTI QUAL EA SPECIMEN","30100603","CDM","301","RC","84377","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY DIPSTICK","30100604","CDM","301","RC","83518","HCPCS","facility","both","","","","101","101","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ISOCITRIC DEHYDROGENASE","30100605","CDM","301","RC","83570","HCPCS","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC KETOGENIC STEROIDS FRACTIONATION","30100606","CDM","301","RC","83582","HCPCS","facility","both","","","","168","168","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC KETOSTEROIDS 17; TOTAL","30100607","CDM","301","RC","83586","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KETOSTEROIDS 17; TOTAL","30100607","CDM","301","RC","83586","HCPCS","facility","both","","","","484","484","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC KETOSTEROIDS 17; TOTAL","30100607","CDM","301","RC","83586","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LACTOGEN MATERNAL SERUM HPL","30100608","CDM","301","RC","83632","HCPCS","facility","both","","","","535","535","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MEPROBAMATE","30100609","CDM","301","RC","83805","HCPCS","facility","both","","","","298","298","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANTIEPILEPTICS, NOS 1-3","30100610","CDM","301","RC","80339","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTIEPILEPTICS, NOS 1-3","30100610","CDM","301","RC","80339","HCPCS","facility","both","","","","176","176","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANTIEPILEPTICS, NOS 1-3","30100610","CDM","301","RC","80339","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTIEPILEPTICS, NOS 1-3","30100610","CDM","301","RC","80339","HCPCS","facility","both","","","","106","106","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MUCIN SYNORVIAL FLUID","30100611","CDM","301","RC","83872","HCPCS","facility","both","","","","210","210","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ONCOPROTEIN DCP","30100612","CDM","301","RC","83951","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ONCOPROTEIN DCP","30100612","CDM","301","RC","83951","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ONCOPROTEIN DCP","30100612","CDM","301","RC","83951","HCPCS","facility","both","","","","762","762","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TOTAL ACID PHOSPHATASE","30100613","CDM","301","RC","84060","HCPCS","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TOTAL ACID PHOSPHATASE","30100613","CDM","301","RC","84060","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TOTAL ACID PHOSPHATASE","30100613","CDM","301","RC","84060","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TOTAL ACID PHOSPHATASE","30100613","CDM","301","RC","84060","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PHOSPHATIDYLGLYCEROL","30100614","CDM","301","RC","84081","HCPCS","facility","both","","","","196","196","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC EVAL AMNIOTIC FLUID PROTEIN","30100615","CDM","301","RC","84112","HCPCS","facility","both","","","","762","762","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUAL URINE PORPHYRINS","30100616","CDM","301","RC","84119","HCPCS","facility","both","","","","284","284","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUAN FECAL PORPHYRINS","30100617","CDM","301","RC","84126","HCPCS","facility","both","","","","302","302","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PREGNANETRIOL","30100618","CDM","301","RC","84138","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PREGNANETRIOL","30100618","CDM","301","RC","84138","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PREGNANETRIOL","30100618","CDM","301","RC","84138","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PREGNANETRIOL","30100618","CDM","301","RC","84138","HCPCS","facility","both","","","","272","272","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROCALCITONIN (PCT)","30100619","CDM","301","RC","84145","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROCALCITONIN (PCT)","30100619","CDM","301","RC","84145","HCPCS","facility","both","","","","78","78","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PROCALCITONIN (PCT)","30100619","CDM","301","RC","84145","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROCALCITONIN (PCT)","30100619","CDM","301","RC","84145","HCPCS","facility","both","","","","317","317","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROSTAGLANDIN EACH","30100620","CDM","301","RC","84150","HCPCS","facility","both","","","","104.51","104.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROSTAGLANDIN EACH","30100620","CDM","301","RC","84150","HCPCS","facility","both","","","","81.64","81.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROSTAGLANDIN EACH","30100620","CDM","301","RC","84150","HCPCS","facility","both","","","","294","294","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROSTAGLANDIN EACH","30100620","CDM","301","RC","84150","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PSA - COMPLEXED","30100621","CDM","301","RC","84152","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ERA","30100622","CDM","301","RC","84233","HCPCS","facility","both","","","","762","762","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PRA","30100623","CDM","301","RC","84234","HCPCS","facility","both","","","","767","767","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SUGARS; SINGLE QUAL EA SPECIMEN","30100624","CDM","301","RC","84376","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SUGARS; SINGLE QUAL EA SPECIMEN","30100624","CDM","301","RC","84376","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SUGARS; SINGLE QUAL EA SPECIMEN","30100624","CDM","301","RC","84376","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SUGARS; SINGLE QUAL EA SPECIMEN","30100624","CDM","301","RC","84376","HCPCS","facility","both","","","","26.4","26.4","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SUGARS; SINGLE QUAN EA SPECIMEN","30100625","CDM","301","RC","84378","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TRANSCORTIN","30100626","CDM","301","RC","84449","HCPCS","facility","both","","","","213","213","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TRYPSIN; DUODENAL FLUID","30100627","CDM","301","RC","84485","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TRYPSIN; DUODENAL FLUID","30100627","CDM","301","RC","84485","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TRYPSIN; DUODENAL FLUID","30100627","CDM","301","RC","84485","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRYPSIN; FECES QUAL","30100628","CDM","301","RC","84488","HCPCS","facility","both","","","","157","157","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TRYPSIN; FECES QUAN 24-HR","30100629","CDM","301","RC","84490","HCPCS","facility","both","","","","186","186","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TROPONIN QUAL","30100630","CDM","301","RC","84512","HCPCS","facility","both","","","","88","88","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UREA NITROGEN CLEARANCE","30100631","CDM","301","RC","84545","HCPCS","facility","both","","","","186","186","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UROBILINOGEN FECES QUAN","30100632","CDM","301","RC","84577","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UROBILINOGEN URINE QUAN TIMED SPEC","30100633","CDM","301","RC","84580","HCPCS","facility","both","","","","84","84","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYCLIC ADP OR AMP","30100634","CDM","301","RC","82030","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYCLIC ADP OR AMP","30100634","CDM","301","RC","82030","HCPCS","facility","both","","","","305","305","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYCLIC ADP OR AMP","30100634","CDM","301","RC","82030","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYCLIC ADP OR AMP","30100634","CDM","301","RC","82030","HCPCS","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANDROSTANEDIOL GLUCURONIDE","30100635","CDM","301","RC","82154","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANDROSTANEDIOL GLUCURONIDE","30100635","CDM","301","RC","82154","HCPCS","facility","both","","","","98.39","98.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANDROSTANEDIOL GLUCURONIDE","30100635","CDM","301","RC","82154","HCPCS","facility","both","","","","125.95","125.95","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANDROSTANEDIOL GLUCURONIDE","30100635","CDM","301","RC","82154","HCPCS","facility","both","","","","342","342","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BILE ACIDS; CHOLYLGLYCINE","30100636","CDM","301","RC","82240","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CALCIUM; AFTER CALCIUM INFUSION","30100637","CDM","301","RC","82331","HCPCS","facility","both","","","","654","654","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CATECHOLAMINES; BLOOD","30100638","CDM","301","RC","82383","HCPCS","facility","both","","","","776","776","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHLORAMPHENICOL","30100639","CDM","301","RC","82415","HCPCS","facility","both","","","","272","272","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CPK; ISOFORMS","30100640","CDM","301","RC","82554","HCPCS","facility","both","","","","140","140","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CPK; ISOFORMS","30100640","CDM","301","RC","82554","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CPK; ISOFORMS","30100640","CDM","301","RC","82554","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CPK; ISOFORMS","30100640","CDM","301","RC","82554","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DIHYDROCODEINONE QUAN","30100641","CDM","301","RC","82646","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DIHYDROCODEINONE QUAN","30100641","CDM","301","RC","82646","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DIHYDROCODEINONE QUAN","30100641","CDM","301","RC","82646","HCPCS","facility","both","","","","191.5","191.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYSTINE & HC URINE QUAL","30100642","CDM","301","RC","82615","HCPCS","facility","both","","","","96","96","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DIHYDROMORPHINONE QUAN","30100643","CDM","301","RC","82649","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ETHCHLORVYNOL","30100644","CDM","301","RC","82690","HCPCS","facility","both","","","","273.5","273.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FAT DIFFERENTIAL FECES QUAN","30100645","CDM","301","RC","82715","HCPCS","facility","both","","","","105","105","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GALACTOSE","30100646","CDM","301","RC","82760","HCPCS","facility","both","","","","343","343","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GLUCOSE; TOLBUTAMIDE TOLERANCE","30100647","CDM","301","RC","82953","HCPCS","facility","both","","","","209","209","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC G6PD; SCREEN","30100648","CDM","301","RC","82960","HCPCS","facility","both","","","","73","73","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GLUTETHIMIDE","30100649","CDM","301","RC","82980","HCPCS","facility","both","","","","322","322","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HYDROXYPROLINE; FREE","30100650","CDM","301","RC","83500","HCPCS","facility","both","","","","380","380","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HYDROXYPROLINE; TOTAL","30100651","CDM","301","RC","83505","HCPCS","facility","both","","","","381","381","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CREATINE","30100652","CDM","301","RC","82540","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NPM1 GENE","30100653","CDM","310","RC","81310","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NPM1 GENE","30100653","CDM","310","RC","81310","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NPM1 GENE","30100653","CDM","310","RC","81310","HCPCS","facility","both","","","","3223","3223","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PML/RARALPHA COM BREAKPOINTS","30100654","CDM","310","RC","81315","HCPCS","facility","both","","","","3688","3688","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PML/RARALPHA COM BREAKPOINTS","30100654","CDM","310","RC","81315","HCPCS","facility","both","","","","230.28","230.28","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PML/RARALPHA COM BREAKPOINTS","30100654","CDM","310","RC","81315","HCPCS","facility","both","","","","294.77","294.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PTEN GENE FULL SEQUENCE","30100655","CDM","310","RC","81321","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PTEN GENE FULL SEQUENCE","30100655","CDM","310","RC","81321","HCPCS","facility","both","","","","2271.38","2271.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PTEN GENE FULL SEQUENCE","30100655","CDM","310","RC","81321","HCPCS","facility","both","","","","7833","7833","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PTEN GENE FULL SEQUENCE","30100655","CDM","310","RC","81321","HCPCS","facility","both","","","","2907.43","2907.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PTEN GENE KNOWN FAM VARIANT","30100656","CDM","310","RC","81322","HCPCS","facility","both","","","","764","764","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PTEN GENE DUP/DELET VARIANT","30100657","CDM","310","RC","81323","HCPCS","facility","both","","","","1143","1143","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PTEN GENE DUP/DELET VARIANT","30100657","CDM","310","RC","81323","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PTEN GENE DUP/DELET VARIANT","30100657","CDM","310","RC","81323","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PMP22 GENE DUP/DELET","30100658","CDM","310","RC","81324","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PMP22 GENE DUP/DELET","30100658","CDM","310","RC","81324","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PMP22 GENE FULL SEQUENCE","30100659","CDM","310","RC","81325","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PMP22 GENE FULL SEQUENCE","30100659","CDM","310","RC","81325","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PMP22 GENE KNOWN FAM VARIANT","30100660","CDM","310","RC","81326","HCPCS","facility","both","","","","879.25","879.25","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PMP22 GENE KNOWN FAM VARIANT","30100660","CDM","310","RC","81326","HCPCS","facility","both","","","","740","740","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PMP22 GENE KNOWN FAM VARIANT","30100660","CDM","310","RC","81326","HCPCS","facility","both","","","","1125.46","1125.46","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SMPD1 GENE COMMON VARIANTS","30100661","CDM","310","RC","81330","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SMPD1 GENE COMMON VARIANTS","30100661","CDM","310","RC","81330","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SMPD1 GENE COMMON VARIANTS","30100661","CDM","310","RC","81330","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SNRPN/UBE3A GENE","30100662","CDM","310","RC","81331","HCPCS","facility","both","","","","224","224","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SNRPN/UBE3A GENE","30100662","CDM","310","RC","81331","HCPCS","facility","both","","","","286.72","286.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SERPINA1 GENE","30100663","CDM","310","RC","81332","HCPCS","facility","both","","","","112.55","112.55","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SERPINA1 GENE","30100663","CDM","310","RC","81332","HCPCS","facility","both","","","","777","777","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SERPINA1 GENE","30100663","CDM","310","RC","81332","HCPCS","facility","both","","","","87.93","87.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TRG GENE REARRANGEMENT ANAL","30100664","CDM","310","RC","81342","HCPCS","facility","both","","","","418.68","418.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TRG GENE REARRANGEMENT ANAL","30100664","CDM","310","RC","81342","HCPCS","facility","both","","","","535.93","535.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRG GENE REARRANGEMENT ANAL","30100664","CDM","310","RC","81342","HCPCS","facility","both","","","","3585","3585","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VKORC1 GENE","30100665","CDM","310","RC","81355","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VKORC1 GENE","30100665","CDM","310","RC","81355","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VKORC1 GENE","30100665","CDM","310","RC","81355","HCPCS","facility","both","","","","292","292","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HLA I TYPING COMPLETE LR (150)","30100666","CDM","310","RC","81372","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA I TYPING COMPLETE LR (150)","30100666","CDM","310","RC","81372","HCPCS","facility","both","","","","3929","3929","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA I TYPING COMPLETE LR (150)","30100666","CDM","310","RC","81372","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA I TYPING 1 ANTIGEN LR (150)","30100667","CDM","310","RC","81374","HCPCS","facility","both","","","","1295","1295","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA I TYPING 1 ANTIGEN LR (150)","30100667","CDM","310","RC","81374","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA I TYPING 1 ANTIGEN LR (150)","30100667","CDM","310","RC","81374","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA II TYPING AG EQUIV LR (170)","30100668","CDM","310","RC","81375","HCPCS","facility","both","","","","455.54","455.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA II TYPING AG EQUIV LR (170)","30100668","CDM","310","RC","81375","HCPCS","facility","both","","","","355.88","355.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA II TYPING AG EQUIV LR (170)","30100668","CDM","310","RC","81375","HCPCS","facility","both","","","","3927","3927","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA II TYPING 1 LOCUS LR (40)","30100669","CDM","310","RC","81376","HCPCS","facility","both","","","","3503","3503","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA II TYPING 1 LOCUS LR (40)","30100669","CDM","310","RC","81376","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA II TYPING 1 LOCUS LR (40)","30100669","CDM","310","RC","81376","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA II TYPING 1 LOCUS LR (40)","30100669","CDM","310","RC","81376","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HLA I TYPING COMPLETE HR (290)","30100670","CDM","310","RC","81379","HCPCS","facility","both","","","","5964","5964","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA I TYPING COMPLETE HR (290)","30100670","CDM","310","RC","81379","HCPCS","facility","both","","","","607.1","607.1","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA I TYPING COMPLETE HR (290)","30100670","CDM","310","RC","81379","HCPCS","facility","both","","","","777.1","777.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA I TYPING 1 ALLELE HR","30100671","CDM","310","RC","81381","HCPCS","facility","both","","","","1684","1684","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA I TYPING 1 ALLELE HR","30100671","CDM","310","RC","81381","HCPCS","facility","both","","","","177.94","177.94","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA I TYPING 1 ALLELE HR","30100671","CDM","310","RC","81381","HCPCS","facility","both","","","","227.77","227.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA I TYPING 1 ALLELE HR","30100671","CDM","310","RC","81381","HCPCS","facility","both","","","","151","151","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  HLA II TYPING 1 LOCUS HR (40)","30100672","CDM","310","RC","81382","HCPCS","facility","both","","","","2198","2198","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC  HLA II TYPING 1 LOCUS HR (40)","30100672","CDM","310","RC","81382","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  HLA II TYPING 1 LOCUS HR (40)","30100672","CDM","310","RC","81382","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  HLA II TYPING 1 LOCUS HR (40)","30100672","CDM","310","RC","81382","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA II TYPING 1 ALLELE HR","30100673","CDM","310","RC","81383","HCPCS","facility","both","","","","1943","1943","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 1","30100674","CDM","310","RC","81400","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 1","30100674","CDM","310","RC","81400","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 1","30100674","CDM","310","RC","81400","HCPCS","facility","both","","","","961","961","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 2","30100675","CDM","310","RC","81401","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 2","30100675","CDM","310","RC","81401","HCPCS","facility","both","","","","191","191","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 2","30100675","CDM","310","RC","81401","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 2","30100675","CDM","310","RC","81401","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 3","30100676","CDM","310","RC","81402","HCPCS","facility","both","","","","1793","1793","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 3","30100676","CDM","310","RC","81402","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 3","30100676","CDM","310","RC","81402","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 4","30100677","CDM","310","RC","81403","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 4","30100677","CDM","310","RC","81403","HCPCS","facility","both","","","","257","257","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 4","30100677","CDM","310","RC","81403","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 4","30100677","CDM","310","RC","81403","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 5","30100678","CDM","310","RC","81404","HCPCS","facility","both","","","","382","382","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 5","30100678","CDM","310","RC","81404","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 5","30100678","CDM","310","RC","81404","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 5","30100678","CDM","310","RC","81404","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 6","30100679","CDM","310","RC","81405","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 6","30100679","CDM","310","RC","81405","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 6","30100679","CDM","310","RC","81405","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 7","30100680","CDM","310","RC","81406","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 7","30100680","CDM","310","RC","81406","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 7","30100680","CDM","310","RC","81406","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 8","30100681","CDM","310","RC","81407","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 8","30100681","CDM","310","RC","81407","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 8","30100681","CDM","310","RC","81407","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 9","30100682","CDM","310","RC","81408","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 9","30100682","CDM","310","RC","81408","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 9","30100682","CDM","310","RC","81408","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOLECULAR PATHOLOGY","30100683","CDM","310","RC","81479","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOLECULAR PATHOLOGY","30100683","CDM","310","RC","81479","HCPCS","facility","both","","","","1321","1321","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED MOLECULAR PATHOLOGY","30100683","CDM","310","RC","81479","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOLECULAR PATHOLOGY","30100683","CDM","310","RC","81479","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DISOPYRAMIDE","30100684","CDM","301","RC","80299","HCPCS","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DISOPYRAMIDE","30100684","CDM","301","RC","80299","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DISOPYRAMIDE","30100684","CDM","301","RC","80299","HCPCS","facility","both","","","","37","37","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DISOPYRAMIDE","30100684","CDM","301","RC","80299","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LORAZEPAM","30100685","CDM","301","RC","80299","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LORAZEPAM","30100685","CDM","301","RC","80299","HCPCS","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LORAZEPAM","30100685","CDM","301","RC","80299","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOMIPRAMINE","30100686","CDM","301","RC","80299","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOMIPRAMINE","30100686","CDM","301","RC","80299","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOMIPRAMINE","30100686","CDM","301","RC","80299","HCPCS","facility","both","","","","180","180","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FLUOXETIN","30100687","CDM","301","RC","80332","HCPCS","facility","both","","","","36.75","36.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FLUOXETIN","30100687","CDM","301","RC","80332","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLUOXETIN","30100687","CDM","301","RC","80332","HCPCS","facility","both","","","","442","442","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FLUOXETIN","30100687","CDM","301","RC","80332","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AMIODARONE","30100688","CDM","301","RC","80299","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AMIODARONE","30100688","CDM","301","RC","80299","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AMIODARONE","30100688","CDM","301","RC","80299","HCPCS","facility","both","","","","155","155","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCREEN SINGLE X 9","30100689","CDM","301","RC","80301","HCPCS","facility","both","","","","143.7","143.7","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN SINGLE X 9","30100689","CDM","301","RC","80301","HCPCS","facility","both","","","","98.64","98.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREEN SINGLE","30100690","CDM","301","RC","80301","HCPCS","facility","both","","","","220.5","220.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCREEN SINGLE","30100690","CDM","301","RC","80301","HCPCS","facility","both","","","","10.96","10.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREEN SINGLE","30100690","CDM","301","RC","80301","HCPCS","facility","both","","","","16","16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN SINGLE X 12","30100691","CDM","301","RC","80301","HCPCS","facility","both","","","","508","508","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VALPROIC ACID FREE","30100692","CDM","301","RC","80165","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VALPROIC ACID FREE","30100692","CDM","301","RC","80165","HCPCS","facility","both","","","","367","367","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VALPROIC ACID FREE","30100692","CDM","301","RC","80165","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VALPROIC ACID FREE","30100692","CDM","301","RC","80165","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALCOHOL","30100693","CDM","301","RC","80320","HCPCS","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALCOHOL","30100693","CDM","301","RC","80320","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC ALCOHOL","30100693","CDM","301","RC","80320","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALCOHOL","30100693","CDM","301","RC","80320","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALCOHOL","30100693","CDM","301","RC","80320","HCPCS","facility","both","","","","406","406","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANTIDEPRESSANT 1 OR 2","30100694","CDM","301","RC","80335","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANTIDEPRESSANT 1 OR 2","30100694","CDM","301","RC","80335","HCPCS","facility","both","","","","36","36","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTIDEPRESSANT 1 OR 2","30100694","CDM","301","RC","80335","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTIDEPRESSANT 1 OR 2","30100694","CDM","301","RC","80335","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROPOXYPHENE","30100695","CDM","301","RC","80367","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROPOXYPHENE","30100695","CDM","301","RC","80367","HCPCS","facility","both","","","","258","258","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROPOXYPHENE","30100695","CDM","301","RC","80367","HCPCS","facility","both","","","","34","34","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PROPOXYPHENE","30100695","CDM","301","RC","80367","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BUPRENORPHINE","30100696","CDM","301","RC","80348","HCPCS","facility","both","","","","258","258","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BUPRENORPHINE","30100696","CDM","301","RC","80348","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BUPRENORPHINE","30100696","CDM","301","RC","80348","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BUPRENORPHINE","30100696","CDM","301","RC","80348","HCPCS","facility","both","","","","68.45","68.45","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  ALKALOIDS NOS","30100697","CDM","301","RC","80323","HCPCS","facility","both","","","","77.46","77.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  ALKALOIDS NOS","30100697","CDM","301","RC","80323","HCPCS","facility","both","","","","282","282","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC  ALKALOIDS NOS","30100697","CDM","301","RC","80323","HCPCS","facility","both","","","","99.15","99.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC METHADONE","30100698","CDM","301","RC","80358","HCPCS","facility","both","","","","728","728","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC METHADONE","30100698","CDM","301","RC","80358","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC METHADONE","30100698","CDM","301","RC","80358","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANABOLIC STEROIDS, 1 OR 2","30100699","CDM","301","RC","80327","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANABOLIC STEROIDS, 1 OR 2","30100699","CDM","301","RC","80327","HCPCS","facility","both","","","","152","152","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANABOLIC STEROIDS, 1 OR 2","30100699","CDM","301","RC","80327","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANALGESICS,NON-OPIOD 1 OR 2","30100700","CDM","301","RC","80329","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANALGESICS,NON-OPIOD 1 OR 2","30100700","CDM","301","RC","80329","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANALGESICS,NON-OPIOD 1 OR 2","30100700","CDM","301","RC","80329","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG CLASS A SCREEN IEA;5 DRUG","30100701","CDM","301","RC","80301","HCPCS","facility","both","","","","79.97","79.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG CLASS A SCREEN IEA;5 DRUG","30100701","CDM","301","RC","80301","HCPCS","facility","both","","","","54.8","54.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG CLASS A SCREEN IEA;5 DRUG","30100701","CDM","301","RC","80301","HCPCS","facility","both","","","","220.5","220.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC  CANNABINOIDS,NATURAL","30100702","CDM","301","RC","80349","HCPCS","facility","both","","","","74.5","74.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  CANNABINOIDS,NATURAL","30100702","CDM","301","RC","80349","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  CANNABINOIDS,NATURAL","30100702","CDM","301","RC","80349","HCPCS","facility","both","","","","398","398","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC  CANNABINOIDS,NATURAL","30100702","CDM","301","RC","80349","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PREGABALIN","30100703","CDM","301","RC","80366","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PREGABALIN","30100703","CDM","301","RC","80366","HCPCS","facility","both","","","","213","213","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PREGABALIN","30100703","CDM","301","RC","80366","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PREGABALIN","30100703","CDM","301","RC","80366","HCPCS","facility","both","","","","131","131","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG CLASS A SCREEN IEA; 7 DRUG","30100704","CDM","301","RC","80301","HCPCS","facility","both","","","","76.72","76.72","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG CLASS A SCREEN IEA; 7 DRUG","30100704","CDM","301","RC","80301","HCPCS","facility","both","","","","111.96","111.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN AMPHETAMINES 1 OR 2","30100706","CDM","301","RC","80324","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN AMPHETAMINES 1 OR 2","30100706","CDM","301","RC","80324","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREEN AMPHETAMINES 1 OR 2","30100706","CDM","301","RC","80324","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPLEMENT C3A","30100707","CDM","301","RC","83520","HCPCS","facility","both","","","","143","143","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (25)","30100709","CDM","301","RC","80299","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANTITATIVE ASSAY DRUG (25)","30100709","CDM","301","RC","80299","HCPCS","facility","both","","","","40.25","40.25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (25)","30100709","CDM","301","RC","80299","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ASSAY DRUG (25)","30100709","CDM","301","RC","80299","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (30)","30100710","CDM","301","RC","80299","HCPCS","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (30)","30100710","CDM","301","RC","80299","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ASSAY DRUG (30)","30100710","CDM","301","RC","80299","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (30)","30100710","CDM","301","RC","80299","HCPCS","facility","both","","","","44.75","44.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (30)","30100710","CDM","301","RC","80299","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANTITATIVE ASSAY DRUG (35)","30100711","CDM","301","RC","80299","HCPCS","facility","both","","","","174","174","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (35)","30100711","CDM","301","RC","80299","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ASSAY DRUG (35)","30100711","CDM","301","RC","80299","HCPCS","facility","both","","","","174","174","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (35)","30100711","CDM","301","RC","80299","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANTITATIVE ASSAY DRUG (35)","30100711","CDM","301","RC","80299","HCPCS","facility","both","","","","71.35","71.35","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (55)","30100712","CDM","301","RC","80299","HCPCS","facility","both","","","","147.37","147.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANTITATIVE ASSAY DRUG (55)","30100712","CDM","301","RC","80299","HCPCS","facility","both","","","","103","103","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (55)","30100712","CDM","301","RC","80299","HCPCS","facility","both","","","","115.14","115.14","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ASSAY DRUG (65)","30100713","CDM","301","RC","80299","HCPCS","facility","both","","","","174.17","174.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANTITATIVE ASSAY DRUG (65)","30100713","CDM","301","RC","80299","HCPCS","facility","both","","","","107","107","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (65)","30100713","CDM","301","RC","80299","HCPCS","facility","both","","","","136.07","136.07","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ASSAY DRUG (75)","30100714","CDM","301","RC","80299","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANTITATIVE ASSAY DRUG (75)","30100714","CDM","301","RC","80299","HCPCS","facility","both","","","","374","374","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (75)","30100714","CDM","301","RC","80299","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ASSAY DRUG (75)","30100714","CDM","301","RC","80299","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (80)","30100715","CDM","301","RC","80299","HCPCS","facility","both","","","","214.37","214.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANTITATIVE ASSAY DRUG (80)","30100715","CDM","301","RC","80299","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (80)","30100715","CDM","301","RC","80299","HCPCS","facility","both","","","","167.48","167.48","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ASSAY DRUG (145)","30100716","CDM","301","RC","80299","HCPCS","facility","both","","","","388.56","388.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANTITATIVE ASSAY DRUG (145)","30100716","CDM","301","RC","80299","HCPCS","facility","both","","","","284","284","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (145)","30100716","CDM","301","RC","80299","HCPCS","facility","both","","","","303.55","303.55","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ASSAY DRUG (165)","30100717","CDM","301","RC","80299","HCPCS","facility","both","","","","345.42","345.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ASSAY DRUG (165)","30100717","CDM","301","RC","80299","HCPCS","facility","both","","","","257","257","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (165)","30100717","CDM","301","RC","80299","HCPCS","facility","both","","","","442.14","442.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG CLASS A SCRN BY IA, 9","30100718","CDM","301","RC","80301","HCPCS","facility","both","","","","143.95","143.95","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG CLASS A SCRN BY IA, 9","30100718","CDM","301","RC","80301","HCPCS","facility","both","","","","98.64","98.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREENING COCAINE","30100719","CDM","301","RC","80353","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREENING COCAINE","30100719","CDM","301","RC","80353","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG SCREENING COCAINE","30100719","CDM","301","RC","80353","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OPIOID &OPIATE ANALOG 5/MORE","30100720","CDM","301","RC","80364","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC OPIOID &OPIATE ANALOG 5/MORE","30100720","CDM","301","RC","80364","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OPIOID &OPIATE ANALOG 5/MORE","30100720","CDM","301","RC","80364","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ASSAY DRUG (85)","30100721","CDM","301","RC","80299","HCPCS","facility","both","","","","227.77","227.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANTITATIVE ASSAY DRUG (85)","30100721","CDM","301","RC","80299","HCPCS","facility","both","","","","156.25","156.25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (85)","30100721","CDM","301","RC","80299","HCPCS","facility","both","","","","177.94","177.94","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ASSAY DRUG (85)","30100721","CDM","301","RC","80299","HCPCS","facility","both","","","","423","423","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC  UNLISTED CHEM PROC (200)","30100722","CDM","301","RC","84999","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  UNLISTED CHEM PROC (200)","30100722","CDM","301","RC","84999","HCPCS","facility","both","","","","535.93","535.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  UNLISTED CHEM PROC (200)","30100722","CDM","301","RC","84999","HCPCS","facility","both","","","","418.68","418.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED CHEM PROC (25)","30100723","CDM","301","RC","84999","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED CHEM PROC (25)","30100723","CDM","301","RC","84999","HCPCS","facility","both","","","","67","67","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED CHEM PROC (25)","30100723","CDM","301","RC","84999","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY C-D TGREANSFER MEASURE (155)","30100724","CDM","301","RC","82373","HCPCS","facility","both","","","","324.48","324.48","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY C-D TGREANSFER MEASURE (155)","30100724","CDM","301","RC","82373","HCPCS","facility","both","","","","415.34","415.34","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY C-D TGREANSFER MEASURE (155)","30100724","CDM","301","RC","82373","HCPCS","facility","both","","","","225","225","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTI-DEPRESS,SEROTO 1-2 (45)","30100725","CDM","301","RC","80332","HCPCS","facility","both","","","","94.2","94.2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-DEPRESS,SEROTO 1-2 (45)","30100725","CDM","301","RC","80332","HCPCS","facility","both","","","","120.59","120.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-DEPRESS,SEROTO 1-2 (45)","30100725","CDM","301","RC","80332","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTI-DEPRESS,SEROTO 1-2 (50)","30100726","CDM","301","RC","80332","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-DEPRESS,SEROTO 1-2 (50)","30100726","CDM","301","RC","80332","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTI-DEPRESS,SEROTO 1-2 (50)","30100726","CDM","301","RC","80332","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-DEPRESS,SEROTO 1-2 (70)","30100727","CDM","301","RC","80332","HCPCS","facility","both","","","","129","129","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTI-DEPRESS,SEROTO 1-2 (70)","30100727","CDM","301","RC","80332","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-DEPRESS,SEROTO 1-2 (70)","30100727","CDM","301","RC","80332","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-DEPRESS,SEROTO 1-2 (70)","30100727","CDM","301","RC","80332","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (40)","30100728","CDM","301","RC","80342","HCPCS","facility","both","","","","79","79","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (40)","30100728","CDM","301","RC","80342","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (40)","30100728","CDM","301","RC","80342","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (45)","30100729","CDM","301","RC","80342","HCPCS","facility","both","","","","93","93","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (45)","30100729","CDM","301","RC","80342","HCPCS","facility","both","","","","120.59","120.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (45)","30100729","CDM","301","RC","80342","HCPCS","facility","both","","","","94.2","94.2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (50)","30100730","CDM","301","RC","80342","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (50)","30100730","CDM","301","RC","80342","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (50)","30100730","CDM","301","RC","80342","HCPCS","facility","both","","","","98","98","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (70)","30100731","CDM","301","RC","80342","HCPCS","facility","both","","","","133","133","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (70)","30100731","CDM","301","RC","80342","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (70)","30100731","CDM","301","RC","80342","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (105)","30100732","CDM","301","RC","80342","HCPCS","facility","both","","","","219.81","219.81","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (105)","30100732","CDM","301","RC","80342","HCPCS","facility","both","","","","281.36","281.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (105)","30100732","CDM","301","RC","80342","HCPCS","facility","both","","","","186","186","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (110)","30100733","CDM","301","RC","80342","HCPCS","facility","both","","","","230.28","230.28","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (110)","30100733","CDM","301","RC","80342","HCPCS","facility","both","","","","294.77","294.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (110)","30100733","CDM","301","RC","80342","HCPCS","facility","both","","","","194","194","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (115)","30100734","CDM","301","RC","80342","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (115)","30100734","CDM","301","RC","80342","HCPCS","facility","both","","","","240.74","240.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-PSYCHOTIC ,NOS 1-3 (115)","30100734","CDM","301","RC","80342","HCPCS","facility","both","","","","308.16","308.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-DEPRESS, NOS (60)","30100735","CDM","301","RC","80338","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-DEPRESS, NOS (60)","30100735","CDM","301","RC","80338","HCPCS","facility","both","","","","249","249","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTI-DEPRESS, NOS (60)","30100735","CDM","301","RC","80338","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-DEPRESS, NOS (60)","30100735","CDM","301","RC","80338","HCPCS","facility","both","","","","115","115","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG/SUBS, DEFIN,NOS, 1-3 (95)","30100736","CDM","301","RC","80375","HCPCS","facility","both","","","","198.87","198.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG/SUBS, DEFIN,NOS, 1-3 (95)","30100736","CDM","301","RC","80375","HCPCS","facility","both","","","","254.57","254.57","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG/SUBS, DEFIN,NOS, 1-3 (95)","30100736","CDM","301","RC","80375","HCPCS","facility","both","","","","172","172","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  CHLORINATED HYDROCARBONS, SCRN","30100737","CDM","301","RC","82441","HCPCS","facility","both","","","","45.55","45.55","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  CHLORINATED HYDROCARBONS, SCRN","30100737","CDM","301","RC","82441","HCPCS","facility","both","","","","35.59","35.59","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG/SUBST DEFINITIVE QUAL/QUANT","30100738","CDM","301","RC","80375","HCPCS","facility","both","","","","632","632","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG/SUBST DEFINITIVE QUAL/QUANT","30100738","CDM","301","RC","80375","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG/SUBST DEFINITIVE QUAL/QUANT","30100738","CDM","301","RC","80375","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCRN,NOS PRESUMPTIVE","30100739","CDM","301","RC","80304","HCPCS","facility","both","","","","471.5","471.5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCRN,NOS PRESUMPTIVE","30100739","CDM","301","RC","80304","HCPCS","facility","both","","","","59.93","59.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCRN,NOS PRESUMPTIVE","30100739","CDM","301","RC","80304","HCPCS","facility","both","","","","41.1","41.1","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCRN OXYCODONE","30100740","CDM","301","RC","80365","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCRN OXYCODONE","30100740","CDM","301","RC","80365","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG SCRN OXYCODONE","30100740","CDM","301","RC","80365","HCPCS","facility","both","","","","632","632","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCRN OXYCODONE","30100740","CDM","301","RC","80365","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PAPPA SERUM","30100741","CDM","301","RC","84163","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PAPPA SERUM","30100741","CDM","301","RC","84163","HCPCS","facility","both","","","","56.27","56.27","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PAPPA SERUM","30100741","CDM","301","RC","84163","HCPCS","facility","both","","","","43.96","43.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HCG FREE BETA CHAIN","30100742","CDM","301","RC","84704","HCPCS","facility","both","","","","43.96","43.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HCG FREE BETA CHAIN","30100742","CDM","301","RC","84704","HCPCS","facility","both","","","","56.27","56.27","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HCG FREE BETA CHAIN","30100742","CDM","301","RC","84704","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNSP CHEM PROC (280)","30100743","CDM","301","RC","84999","HCPCS","facility","both","","","","586.16","586.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNSP CHEM PROC (280)","30100743","CDM","301","RC","84999","HCPCS","facility","both","","","","750.3","750.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANT ASSAY DRUG (250)","30100744","CDM","301","RC","80299","HCPCS","facility","both","","","","669.91","669.91","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANT ASSAY DRUG (250)","30100744","CDM","301","RC","80299","HCPCS","facility","both","","","","523.36","523.36","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANTITATIVE ASSAY DRUG (40)","30100745","CDM","301","RC","80299","HCPCS","facility","both","","","","82.8","82.8","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANTITATIVE ASSAY DRUG (40)","30100745","CDM","301","RC","80299","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUANTITATIVE ASSAY DRUG (40)","30100745","CDM","301","RC","80299","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (10)","30100746","CDM","301","RC","83520","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (10)","30100746","CDM","301","RC","83520","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (10)","30100746","CDM","301","RC","83520","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (10)","30100746","CDM","301","RC","83520","HCPCS","facility","both","","","","22","22","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CARB DEFICIENT TRANSFERRIN (30)","30100747","CDM","301","RC","82373","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CARB DEFICIENT TRANSFERRIN (30)","30100747","CDM","301","RC","82373","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CARB DEFICIENT TRANSFERRIN (30)","30100747","CDM","301","RC","82373","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  DRUG SCREEN, INSTRUMENT SINGLE DRUG","30100748","CDM","301","RC","80307","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  DRUG SCREEN, INSTRUMENT SINGLE DRUG","30100748","CDM","301","RC","80307","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  DRUG SCREEN, INSTRUMENT SINGLE DRUG","30100748","CDM","301","RC","80307","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  DRUG SCREEN, INSTRUMENT SINGLE DRUG","30100748","CDM","301","RC","80307","HCPCS","facility","both","","","","296","296","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  DRUG SCREEN, INSTRUMENT  8 DRUG","30100749","CDM","301","RC","80307","HCPCS","facility","both","","","","296","296","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  DRUG SCREEN, INSTRUMENT  8 DRUG","30100749","CDM","301","RC","80307","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC  DRUG SCREEN, INSTRUMENT  8 DRUG","30100749","CDM","301","RC","80307","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  DRUG SCREEN, INSTRUMENT  8 DRUG","30100749","CDM","301","RC","80307","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  DRUG SCREEN, INSTRUMENT  8 DRUG","30100749","CDM","301","RC","80307","HCPCS","facility","both","","","","171.5","171.5","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN, INSTRUMENT 9 DRUG","30100750","CDM","301","RC","80307","HCPCS","facility","both","","","","511","511","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DRUG SCREEN, INSTRUMENT 9 DRUG","30100750","CDM","301","RC","80307","HCPCS","facility","both","","","","150.73","150.73","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREEN, INSTRUMENT 9 DRUG","30100750","CDM","301","RC","80307","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG SCREEN, INSTRUMENT 9 DRUG","30100750","CDM","301","RC","80307","HCPCS","facility","both","","","","192.94","192.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN, INSTRUMENT 12 DRUG","30100751","CDM","301","RC","80307","HCPCS","facility","both","","","","257.25","257.25","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN, INSTRUMENT 12 DRUG","30100751","CDM","301","RC","80307","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC DRUG SCREEN, INSTRUMENT 12 DRUG","30100751","CDM","301","RC","80307","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG SCREEN, INSTRUMENT 12 DRUG","30100751","CDM","301","RC","80307","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREEN, INSTRUMENT 12 DRUG","30100751","CDM","301","RC","80307","HCPCS","facility","both","","","","682","682","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREEN, INSTRUMENT 5 DRUG","30100752","CDM","301","RC","80307","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREEN, INSTRUMENT 5 DRUG","30100752","CDM","301","RC","80307","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN, INSTRUMENT 5 DRUG","30100752","CDM","301","RC","80307","HCPCS","facility","both","","","","296","296","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREEN, INSTRUMENT 5 DRUG","30100752","CDM","301","RC","80307","HCPCS","facility","both","","","","68","68","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG SCREEN  MASS SPEC INSTR","30100753","CDM","301","RC","80307","HCPCS","facility","both","","","","632","632","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREEN  MASS SPEC INSTR","30100753","CDM","301","RC","80307","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREEN  MASS SPEC INSTR","30100753","CDM","301","RC","80307","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN  MASS SPEC INSTR","30100753","CDM","301","RC","80307","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (270)","30100754","CDM","301","RC","83520","HCPCS","facility","both","","","","802","802","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (270)","30100754","CDM","301","RC","83520","HCPCS","facility","both","","","","565.23","565.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY QUANT NOS NONAB (270)","30100754","CDM","301","RC","83520","HCPCS","facility","both","","","","723.51","723.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALCOHOLS BIOMARKERS 1 OR 2","30100755","CDM","301","RC","80321","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALCOHOLS BIOMARKERS 1 OR 2","30100755","CDM","301","RC","80321","HCPCS","facility","both","","","","316","316","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALCOHOLS BIOMARKERS 1 OR 2","30100755","CDM","301","RC","80321","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALCOHOLS BIOMARKERS 1 OR 2","30100755","CDM","301","RC","80321","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALCOHOLS BIOMARKERS 1 OR 2","30100755","CDM","301","RC","80321","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (135)","30100756","CDM","301","RC","83520","HCPCS","facility","both","","","","401","401","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (135)","30100756","CDM","301","RC","83520","HCPCS","facility","both","","","","282.61","282.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY QUANT NOS NONAB (135)","30100756","CDM","301","RC","83520","HCPCS","facility","both","","","","235","235","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (135)","30100756","CDM","301","RC","83520","HCPCS","facility","both","","","","361.76","361.76","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (50)","30100757","CDM","301","RC","83520","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (50)","30100757","CDM","301","RC","83520","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (50)","30100757","CDM","301","RC","83520","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (50)","30100757","CDM","301","RC","83520","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUMOASSAY QUANT NOS NONAB (50)","30100757","CDM","301","RC","83520","HCPCS","facility","both","","","","104.49","104.49","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUANT ASSAY DRUG (265)","30100758","CDM","301","RC","80299","HCPCS","facility","both","","","","554.76","554.76","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUANT ASSAY DRUG (265)","30100758","CDM","301","RC","80299","HCPCS","facility","both","","","","1281","1281","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC QUANT ASSAY DRUG (265)","30100758","CDM","301","RC","80299","HCPCS","facility","both","","","","1281","1281","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUANT ASSAY DRUG (265)","30100758","CDM","301","RC","80299","HCPCS","facility","both","","","","710.1","710.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY LIPOPROTEIN PLA2 (35)","30100759","CDM","301","RC","83698","HCPCS","facility","both","","","","65.45","65.45","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY LIPOPROTEIN PLA2 (35)","30100759","CDM","301","RC","83698","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY LIPOPROTEIN PLA2 (35)","30100759","CDM","301","RC","83698","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY LIPOPROTEIN PLA2 (35)","30100759","CDM","301","RC","83698","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY LIPOPROTEIN PLA2 (35)","30100759","CDM","301","RC","83698","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (345)","30100760","CDM","301","RC","83520","HCPCS","facility","both","","","","722.23","722.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (345)","30100760","CDM","301","RC","83520","HCPCS","facility","both","","","","924.48","924.48","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG/SUBSTANCE NOS 7/MORE (40)","30100761","CDM","301","RC","80377","HCPCS","facility","both","","","","226","226","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG/SUBSTANCE NOS 7/MORE (40)","30100761","CDM","301","RC","80377","HCPCS","facility","both","","","","71.91","71.91","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG/SUBSTANCE NOS 7/MORE (40)","30100761","CDM","301","RC","80377","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG/SUBSTANCE NOS 7/MORE (40)","30100761","CDM","301","RC","80377","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG/SUBSTANCE NOS 7/MORE (30)","30100762","CDM","301","RC","80377","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG/SUBSTANCE NOS 7/MORE (30)","30100762","CDM","301","RC","80377","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC DRUG/SUBSTANCE NOS 7/MORE (30)","30100762","CDM","301","RC","80377","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG/SUBSTANCE NOS 7/MORE (30)","30100762","CDM","301","RC","80377","HCPCS","facility","both","","","","51.51","51.51","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG/SUBSTANCE NOS 7/MORE (30)","30100762","CDM","301","RC","80377","HCPCS","facility","both","","","","224","224","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG/SUBSTANCE NOS 7/MORE (135)","30100763","CDM","301","RC","80377","HCPCS","facility","both","","","","224","224","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG/SUBSTANCE NOS 7/MORE (135)","30100763","CDM","301","RC","80377","HCPCS","facility","both","","","","361.76","361.76","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG/SUBSTANCE NOS 7/MORE (135)","30100763","CDM","301","RC","80377","HCPCS","facility","both","","","","234","234","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG/SUBSTANCE NOS 7/MORE (135)","30100763","CDM","301","RC","80377","HCPCS","facility","both","","","","282.61","282.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEROIN METABOLITE (25)","30100764","CDM","301","RC","80356","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEROIN METABOLITE (25)","30100764","CDM","301","RC","80356","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEROIN METABOLITE (25)","30100764","CDM","301","RC","80356","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEROIN METABOLITE (25)","30100764","CDM","301","RC","80356","HCPCS","facility","both","","","","294","294","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KETAMINE AND NORKETAMINE (25)","30100765","CDM","301","RC","80357","HCPCS","facility","both","","","","79","79","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC KETAMINE AND NORKETAMINE (25)","30100765","CDM","301","RC","80357","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC KETAMINE AND NORKETAMINE (25)","30100765","CDM","301","RC","80357","HCPCS","facility","both","","","","294","294","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KETAMINE AND NORKETAMINE (25)","30100765","CDM","301","RC","80357","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OPIOIDS AND OPIATE ANALOGS 1/2 (30)","30100766","CDM","301","RC","80362","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OPIOIDS AND OPIATE ANALOGS 1/2 (30)","30100766","CDM","301","RC","80362","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC OPIOIDS AND OPIATE ANALOGS 1/2 (30)","30100766","CDM","301","RC","80362","HCPCS","facility","both","","","","294","294","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPIOIDS AND OPIATE ANALOGS 1/2 (30)","30100766","CDM","301","RC","80362","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRAMADOL (30)","30100767","CDM","301","RC","80373","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TRAMADOL (30)","30100767","CDM","301","RC","80373","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRAMADOL (30)","30100767","CDM","301","RC","80373","HCPCS","facility","both","","","","294","294","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRAMADOL (30)","30100767","CDM","301","RC","80373","HCPCS","facility","both","","","","77","77","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CALC GENE COM VARIANTS (210)","30100768","CDM","310","RC","81219","HCPCS","facility","both","","","","562.73","562.73","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CALC GENE COM VARIANTS (210)","30100768","CDM","310","RC","81219","HCPCS","facility","both","","","","439.62","439.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CALC GENE COM VARIANTS (210)","30100768","CDM","310","RC","81219","HCPCS","facility","both","","","","398","398","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CALC GENE COM VARIANTS (210)","30100768","CDM","310","RC","81219","HCPCS","facility","both","","","","807","807","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GLUCOSIDASE, BETA","30100769","CDM","301","RC","82963","HCPCS","facility","both","","","","81.64","81.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GLUCOSIDASE, BETA","30100769","CDM","301","RC","82963","HCPCS","facility","both","","","","104.51","104.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GLUCOSIDASE, BETA","30100769","CDM","301","RC","82963","HCPCS","facility","both","","","","63.5","63.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GLUCOSIDASE, BETA","30100769","CDM","301","RC","82963","HCPCS","facility","both","","","","95","95","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (205)","30100770","CDM","301","RC","83520","HCPCS","facility","both","","","","429.16","429.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUMOASSAY QUANT NOS NONAB (205)","30100770","CDM","301","RC","83520","HCPCS","facility","both","","","","609","609","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUMOASSAY QUANT NOS NONAB (205)","30100770","CDM","301","RC","83520","HCPCS","facility","both","","","","549.33","549.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DIHYDROTESTOSTERONE (DHT)","30100771","CDM","301","RC","82642","HCPCS","facility","both","","","","152","152","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIHYDROTESTOSTERONE (DHT)","30100771","CDM","301","RC","82642","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DIHYDROTESTOSTERONE (DHT)","30100771","CDM","301","RC","82642","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DIHYDROTESTOSTERONE (DHT)","30100771","CDM","301","RC","82642","HCPCS","facility","both","","","","56.5","56.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (354)","30100772","CDM","301","RC","83520","HCPCS","facility","both","","","","1052","1052","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (354)","30100772","CDM","301","RC","83520","HCPCS","facility","both","","","","656","656","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (354)","30100772","CDM","301","RC","83520","HCPCS","facility","both","","","","741.08","741.08","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY QUANT NOS NONAB (354)","30100772","CDM","301","RC","83520","HCPCS","facility","both","","","","1052","1052","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUNOASSAY QUANT NOS NONAB (354)","30100772","CDM","301","RC","83520","HCPCS","facility","both","","","","948.6","948.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC METHYLENEDIOXYAMPHETAMINES (29)","30100773","CDM","301","RC","80359","HCPCS","facility","both","","","","77.71","77.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC METHYLENEDIOXYAMPHETAMINES (29)","30100773","CDM","301","RC","80359","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC METHYLENEDIOXYAMPHETAMINES (29)","30100773","CDM","301","RC","80359","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC METHYLENEDIOXYAMPHETAMINES (29)","30100773","CDM","301","RC","80359","HCPCS","facility","both","","","","60.71","60.71","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  CANNABINOIDS,NATURAL (19)","30100774","CDM","301","RC","80349","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  CANNABINOIDS,NATURAL (19)","30100774","CDM","301","RC","80349","HCPCS","facility","both","","","","39.77","39.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  CANNABINOIDS,NATURAL (19)","30100774","CDM","301","RC","80349","HCPCS","facility","both","","","","50.91","50.91","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BENZODIAZEPINES, 1-12 (19)","30100775","CDM","301","RC","80346","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BENZODIAZEPINES, 1-12 (19)","30100775","CDM","301","RC","80346","HCPCS","facility","both","","","","39.77","39.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BENZODIAZEPINES, 1-12 (19)","30100775","CDM","301","RC","80346","HCPCS","facility","both","","","","50.91","50.91","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BARBITURATES (9)","30100776","CDM","301","RC","80345","HCPCS","facility","both","","","","24.11","24.11","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BARBITURATES (9)","30100776","CDM","301","RC","80345","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BARBITURATES (9)","30100776","CDM","301","RC","80345","HCPCS","facility","both","","","","18.84","18.84","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREENING COCAINE (6)","30100777","CDM","301","RC","80353","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREENING COCAINE (6)","30100777","CDM","301","RC","80353","HCPCS","facility","both","","","","12.56","12.56","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREENING COCAINE (6)","30100777","CDM","301","RC","80353","HCPCS","facility","both","","","","16.08","16.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OPIATES 1 OR MORE (7)","30100778","CDM","301","RC","80361","HCPCS","facility","both","","","","14.65","14.65","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OPIATES 1 OR MORE (7)","30100778","CDM","301","RC","80361","HCPCS","facility","both","","","","18.75","18.75","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OPIATES 1 OR MORE (7)","30100778","CDM","301","RC","80361","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCRN OXYCODONE (7)","30100779","CDM","301","RC","80365","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCRN OXYCODONE (7)","30100779","CDM","301","RC","80365","HCPCS","facility","both","","","","14.65","14.65","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCRN OXYCODONE (7)","30100779","CDM","301","RC","80365","HCPCS","facility","both","","","","18.75","18.75","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC METHADONE (22)","30100780","CDM","301","RC","80358","HCPCS","facility","both","","","","58.96","58.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC METHADONE (22)","30100780","CDM","301","RC","80358","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC METHADONE (22)","30100780","CDM","301","RC","80358","HCPCS","facility","both","","","","46.06","46.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC METHADONE (22)","30100780","CDM","301","RC","80358","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREENING COCAINE (39)","30100781","CDM","301","RC","80353","HCPCS","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG SCREENING COCAINE (39)","30100781","CDM","301","RC","80353","HCPCS","facility","both","","","","104.51","104.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREENING COCAINE (39)","30100781","CDM","301","RC","80353","HCPCS","facility","both","","","","81.64","81.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREENING OXYCODONE (14)","30100782","CDM","301","RC","80365","HCPCS","facility","both","","","","29.31","29.31","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREENING OXYCODONE (14)","30100782","CDM","301","RC","80365","HCPCS","facility","both","","","","37.52","37.52","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREENING OXYCODONE (14)","30100782","CDM","301","RC","80365","HCPCS","facility","both","","","","21.5","21.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG SCREENING BUPRENORPHINE (39)","30100783","CDM","301","RC","80348","HCPCS","facility","both","","","","81.64","81.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG SCREENING BUPRENORPHINE (39)","30100783","CDM","301","RC","80348","HCPCS","facility","both","","","","104.51","104.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREENING BUPRENORPHINE (39)","30100783","CDM","301","RC","80348","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG TEST PRSMV CHEM ANLYZR (19)","30100784","CDM","301","RC","80307","HCPCS","facility","both","","","","39.77","39.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG TEST PRSMV CHEM ANLYZR (19)","30100784","CDM","301","RC","80307","HCPCS","facility","both","","","","50.91","50.91","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG ASSAY ADALIMUMAB (265)","30100785","CDM","301","RC","80145","HCPCS","facility","both","","","","554.76","554.76","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG ASSAY ADALIMUMAB (265)","30100785","CDM","301","RC","80145","HCPCS","facility","both","","","","290","290","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG ASSAY ADALIMUMAB (265)","30100785","CDM","301","RC","80145","HCPCS","facility","both","","","","194","194","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG ASSAY ADALIMUMAB (265)","30100785","CDM","301","RC","80145","HCPCS","facility","both","","","","710.1","710.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG ASSAY POSACONAZOLE (30)","30100786","CDM","301","RC","80187","HCPCS","facility","both","","","","194","194","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG ASSAY POSACONAZOLE (30)","30100786","CDM","301","RC","80187","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG ASSAY POSACONAZOLE (30)","30100786","CDM","301","RC","80187","HCPCS","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG ASSAY POSACONAZOLE (30)","30100786","CDM","301","RC","80187","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG ASSAY INFLIXIMAB (165)","30100787","CDM","301","RC","80230","HCPCS","facility","both","","","","442.14","442.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG ASSAY INFLIXIMAB (165)","30100787","CDM","301","RC","80230","HCPCS","facility","both","","","","210","210","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG ASSAY INFLIXIMAB (165)","30100787","CDM","301","RC","80230","HCPCS","facility","both","","","","345.42","345.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG ASSAY INFLIXIMAB (165)","30100787","CDM","301","RC","80230","HCPCS","facility","both","","","","194","194","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG ASSAY LACOSAMIDE (80)","30100788","CDM","301","RC","80235","HCPCS","facility","both","","","","194","194","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG ASSAY LACOSAMIDE (80)","30100788","CDM","301","RC","80235","HCPCS","facility","both","","","","167.48","167.48","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG ASSAY LACOSAMIDE (80)","30100788","CDM","301","RC","80235","HCPCS","facility","both","","","","167","167","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG ASSAY LACOSAMIDE (80)","30100788","CDM","301","RC","80235","HCPCS","facility","both","","","","214.37","214.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG ASSAY VORICONAZOLE (45)","30100789","CDM","301","RC","80285","HCPCS","facility","both","","","","120.59","120.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG ASSAY VORICONAZOLE (45)","30100789","CDM","301","RC","80285","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG ASSAY VORICONAZOLE (45)","30100789","CDM","301","RC","80285","HCPCS","facility","both","","","","194","194","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NFCT DS CHRNC HCV 6 ASSAYS (55)","30100790","CDM","310","RC","81596","HCPCS","facility","both","","","","262","262","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NFCT DS CHRNC HCV 6 ASSAYS (55)","30100790","CDM","310","RC","81596","HCPCS","facility","both","","","","147.37","147.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NFCT DS CHRNC HCV 6 ASSAYS (55)","30100790","CDM","310","RC","81596","HCPCS","facility","both","","","","115.14","115.14","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NFCT DS CHRNC HCV 6 ASSAYS (55)","30100790","CDM","310","RC","81596","HCPCS","facility","both","","","","308.75","308.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALCOHOLS BIOMARKERS 1 OR 2 (63)","30100791","CDM","301","RC","80321","HCPCS","facility","both","","","","131.89","131.89","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALCOHOLS BIOMARKERS 1 OR 2 (63)","30100791","CDM","301","RC","80321","HCPCS","facility","both","","","","168.81","168.81","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALCOHOLS BIOMARKERS 1 OR 2 (63)","30100791","CDM","301","RC","80321","HCPCS","facility","both","","","","316","316","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED CHEM PROC (1)","30100792","CDM","301","RC","84999","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED CHEM PROC (1)","30100792","CDM","301","RC","84999","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED CHEM PROC (1)","30100792","CDM","301","RC","84999","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREENING FENTANYL (38)","30100793","CDM","301","RC","80354","HCPCS","facility","both","","","","101.82","101.82","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREENING FENTANYL (38)","30100793","CDM","301","RC","80354","HCPCS","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DRUG SCREENING FENTANYL (38)","30100793","CDM","301","RC","80354","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG SCREENING FENTANYL (38)","30100793","CDM","301","RC","80354","HCPCS","facility","both","","","","79.55","79.55","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACETOMINOPHEN","30100795","CDM","301","RC","80143","HCPCS","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ACETOMINOPHEN","30100795","CDM","301","RC","80143","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACETOMINOPHEN","30100795","CDM","301","RC","80143","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETOMINOPHEN","30100795","CDM","301","RC","80143","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AMIODARONE","30100796","CDM","301","RC","80151","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AMIODARONE","30100796","CDM","301","RC","80151","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AMIODARONE","30100796","CDM","301","RC","80151","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AMIODARONE","30100796","CDM","301","RC","80151","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARBAMAZEPINE;10,11-EPOXIDE","30100797","CDM","301","RC","80161","HCPCS","facility","both","","","","390","390","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARBAMAZEPINE;10,11-EPOXIDE","30100797","CDM","301","RC","80161","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CARBAMAZEPINE;10,11-EPOXIDE","30100797","CDM","301","RC","80161","HCPCS","facility","both","","","","81.5","81.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CARBAMAZEPINE;10,11-EPOXIDE","30100797","CDM","301","RC","80161","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FELBAMATE","30100798","CDM","301","RC","80167","HCPCS","facility","both","","","","38","38","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FELBAMATE","30100798","CDM","301","RC","80167","HCPCS","facility","both","","","","95","95","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FELBAMATE","30100798","CDM","301","RC","80167","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FELBAMATE","30100798","CDM","301","RC","80167","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SALICYLATE","30100799","CDM","301","RC","80179","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SALICYLATE","30100799","CDM","301","RC","80179","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SALICYLATE","30100799","CDM","301","RC","80179","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SALICYLATE","30100799","CDM","301","RC","80179","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLECAINIDE","30100800","CDM","301","RC","80181","HCPCS","facility","both","","","","82.5","82.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FLECAINIDE","30100800","CDM","301","RC","80181","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLECAINIDE","30100800","CDM","301","RC","80181","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ITRACONAZOLE","30100801","CDM","301","RC","80189","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ITRACONAZOLE","30100801","CDM","301","RC","80189","HCPCS","facility","both","","","","88","88","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ITRACONAZOLE","30100801","CDM","301","RC","80189","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ITRACONAZOLE","30100801","CDM","301","RC","80189","HCPCS","facility","both","","","","210","210","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LEFLUNOMIDE","30100802","CDM","301","RC","80193","HCPCS","facility","both","","","","160","160","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LEFLUNOMIDE","30100802","CDM","301","RC","80193","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEFLUNOMIDE","30100802","CDM","301","RC","80193","HCPCS","facility","both","","","","356","356","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LEFLUNOMIDE","30100802","CDM","301","RC","80193","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC METHOTREXATE","30100803","CDM","301","RC","80204","HCPCS","facility","both","","","","77","77","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC METHOTREXATE","30100803","CDM","301","RC","80204","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC METHOTREXATE","30100803","CDM","301","RC","80204","HCPCS","facility","both","","","","119","119","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC METHOTREXATE","30100803","CDM","301","RC","80204","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RUFINAMIDE","30100804","CDM","301","RC","80210","HCPCS","facility","both","","","","176","176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RUFINAMIDE","30100804","CDM","301","RC","80210","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RUFINAMIDE","30100804","CDM","301","RC","80210","HCPCS","facility","both","","","","134","134","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RUFINAMIDE","30100804","CDM","301","RC","80210","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY SPEC XCP UR&BREATH IA","30100805","CDM","301","RC","82077","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY SPEC XCP UR&BREATH IA","30100805","CDM","301","RC","82077","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY SPEC XCP UR&BREATH IA","30100805","CDM","301","RC","82077","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY SPEC XCP UR&BREATH IA","30100805","CDM","301","RC","82077","HCPCS","facility","both","","","","406","406","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY DIR MEAS FR ESTRADIOL","30100806","CDM","301","RC","82681","HCPCS","facility","both","","","","205","205","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY DIR MEAS FR ESTRADIOL","30100806","CDM","301","RC","82681","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY DIR MEAS FR ESTRADIOL","30100806","CDM","301","RC","82681","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY DIR MEAS FR ESTRADIOL","30100806","CDM","301","RC","82681","HCPCS","facility","both","","","","550","550","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG ASSAY HYDROXYCHLOROQUINE","30100811","CDM","301","RC","80220","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG ASSAY HYDROXYCHLOROQUINE","30100811","CDM","301","RC","80220","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG ASSAY HYDROXYCHLOROQUINE","30100811","CDM","301","RC","80220","HCPCS","facility","both","","","","356","356","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EL-1 FECAL QUANTITATIVE","30100812","CDM","301","RC","82653","HCPCS","facility","both","","","","242","242","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EL-1 FECAL QUANTITATIVE","30100812","CDM","301","RC","82653","HCPCS","facility","both","","","","509.13","509.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC EL-1 FECAL QUANTITATIVE","30100812","CDM","301","RC","82653","HCPCS","facility","both","","","","397.75","397.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IG LIGHT CHAINS FREE EACH","30100813","CDM","301","RC","83521","HCPCS","facility","both","","","","96","96","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IG LIGHT CHAINS FREE EACH","30100813","CDM","301","RC","83521","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IG LIGHT CHAINS FREE EACH","30100813","CDM","301","RC","83521","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF INTERLEUKIN-6 (IL-6)","30100814","CDM","301","RC","83529","HCPCS","facility","both","","","","81","81","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASSAY OF INTERLEUKIN-6 (IL-6)","30100814","CDM","301","RC","83529","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF INTERLEUKIN-6 (IL-6)","30100814","CDM","301","RC","83529","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VOLTAGE-GATED CALCIUM CHANNEL AB, EA","30100815","CDM","301","RC","86596","HCPCS","facility","both","","","","234","234","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRUG ASSAY ADALIMUMAB","30100817","CDM","301","RC","80145","HCPCS","facility","both","","","","385.87","385.87","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG ASSAY ADALIMUMAB","30100817","CDM","301","RC","80145","HCPCS","facility","both","","","","301.45","301.45","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG ASSAY ADALIMUMAB","30100817","CDM","301","RC","80145","HCPCS","facility","both","","","","116","116","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SYNTHETIC GLUCOCORTICOID SCREEN, SERUM(91)","30100820","CDM","301","RC","80299","HCPCS","facility","both","","","","313","313","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SYNTHETIC GLUCOCORTICOID SCREEN, SERUM(91)","30100820","CDM","301","RC","80299","HCPCS","facility","both","","","","243.85","243.85","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SYNTHETIC GLUCOCORTICOID SCREEN, SERUM(91)","30100820","CDM","301","RC","80299","HCPCS","facility","both","","","","190.51","190.51","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-MULLERIAN HORMONE (AMH)","30100823","CDM","301","RC","82166","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-MULLERIAN HORMONE (AMH)","30100823","CDM","301","RC","82166","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-MULLERIAN HORMONE (AMH)","30100823","CDM","301","RC","82166","HCPCS","facility","both","","","","157","157","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENZYME EVAL; ALPHA GALA, EACH SPECIMEN","30100831","CDM","301","RC","82657","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ENZYME EVAL; ALPHA GALA, EACH SPECIMEN","30100831","CDM","301","RC","82657","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ENZYME EVAL; ALPHA GALA, EACH SPECIMEN","30100831","CDM","301","RC","82657","HCPCS","facility","both","","","","253","253","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC- DRUG SCREEN, INSTRUMENT 13  DRUG","30100832","CDM","301","RC","80307","HCPCS","facility","both","","","","217.71","217.71","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC- DRUG SCREEN, INSTRUMENT 13  DRUG","30100832","CDM","301","RC","80307","HCPCS","facility","both","","","","278.68","278.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INTERLEUKIN-18 (282)","30100833","CDM","301","RC","83520","HCPCS","facility","both","","","","590.35","590.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INTERLEUKIN-18 (282)","30100833","CDM","301","RC","83520","HCPCS","facility","both","","","","755.66","755.66","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG/SUBS, DEFIN,NOS, 1-3 (44)","30100835","CDM","301","RC","80375","HCPCS","facility","both","","","","92.11","92.11","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DRUG/SUBS, DEFIN,NOS, 1-3 (44)","30100835","CDM","301","RC","80375","HCPCS","facility","both","","","","117.9","117.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY QUANT NOS NONAB (109)","30100836","CDM","301","RC","83520","HCPCS","facility","both","","","","292.08","292.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY QUANT NOS NONAB (109)","30100836","CDM","301","RC","83520","HCPCS","facility","both","","","","228.19","228.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TAU, TOTAL (109)","30100837","CDM","301","RC","84394","HCPCS","facility","both","","","","228.19","228.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TAU, TOTAL (109)","30100837","CDM","301","RC","84394","HCPCS","facility","both","","","","292.08","292.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NEUROFILAMENT LT CHN (40)","30100838","CDM","301","RC","83884","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NEUROFILAMENT LT CHN (40)","30100838","CDM","301","RC","83884","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY QUANT NOS NONAB (177)","30100840","CDM","301","RC","83520","HCPCS","facility","both","","","","370.71","370.71","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY QUANT NOS NONAB (177)","30100840","CDM","301","RC","83520","HCPCS","facility","both","","","","474.3","474.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY QUANT NOS NONAB (127)","30100841","CDM","301","RC","83520","HCPCS","facility","both","","","","340.32","340.32","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNOASSAY QUANT NOS NONAB (127)","30100841","CDM","301","RC","83520","HCPCS","facility","both","","","","265.99","265.99","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY QUANT NOS NONAB (30)","30100842","CDM","301","RC","83520","HCPCS","facility","both","","","","62.83","62.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOASSAY QUANT NOS NONAB (30)","30100842","CDM","301","RC","83520","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TAU PHOSPHORYLATED, EACH (154)","30100865","CDM","301","RC","84393","HCPCS","facility","both","","","","412.57","412.57","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TAU PHOSPHORYLATED, EACH (154)","30100865","CDM","301","RC","84393","HCPCS","facility","both","","","","321.86","321.86","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BETA-AMYLOID; 1-42 (ABETA) (154)","30100866","CDM","301","RC","82234","HCPCS","facility","both","","","","412.57","412.57","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BETA-AMYLOID; 1-42 (ABETA) (154)","30100866","CDM","301","RC","82234","HCPCS","facility","both","","","","321.86","321.86","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TAU, TOTAL (154)","30100867","CDM","301","RC","84394","HCPCS","facility","both","","","","321.86","321.86","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TAU, TOTAL (154)","30100867","CDM","301","RC","84394","HCPCS","facility","both","","","","412.57","412.57","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INHIBIN-B       QUEST","30160029","CDM","301","RC","83520","HCPCS","facility","both","","","","174","174","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INHIBIN-B       QUEST","30160029","CDM","301","RC","83520","HCPCS","facility","both","","","","117.9","117.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INHIBIN-B       QUEST","30160029","CDM","301","RC","83520","HCPCS","facility","both","","","","92.11","92.11","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SOLUBLE LIVER ANTIGEN   QUEST","30160037","CDM","301","RC","83520","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SOLUBLE LIVER ANTIGEN   QUEST","30160037","CDM","301","RC","83520","HCPCS","facility","both","","","","27.22","27.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SOLUBLE LIVER ANTIGEN   QUEST","30160037","CDM","301","RC","83520","HCPCS","facility","both","","","","34.84","34.84","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CBG(CORTICOSTER BIND GLOB) NIC","30160071","CDM","301","RC","84449","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CBG(CORTICOSTER BIND GLOB) NIC","30160071","CDM","301","RC","84449","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TYROSINE,FILTER CARD","30160073","CDM","301","RC","84510","HCPCS","facility","both","","","","33.49","33.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TYROSINE,FILTER CARD","30160073","CDM","301","RC","84510","HCPCS","facility","both","","","","42.87","42.87","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LAB IMMUNOLOGY","30200000","CDM","302","RC","","","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LAB IMMUNOLOGY","30200000","CDM","302","RC","","","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACUTE HEPATITIS PANEL","30200001","CDM","301","RC","80074","HCPCS","facility","both","","","","934","934","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ACUTE HEPATITIS PANEL","30200001","CDM","301","RC","80074","HCPCS","facility","both","","","","241.17","241.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACUTE HEPATITIS PANEL","30200001","CDM","301","RC","80074","HCPCS","facility","both","","","","188.41","188.41","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACUTE HEPATITIS PANEL","30200001","CDM","301","RC","80074","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DOXEPIN","30200002","CDM","302","RC","80166","HCPCS","facility","both","","","","123.5","123.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ETHOSUXIMIDE","30200003","CDM","301","RC","80168","HCPCS","facility","both","","","","224","224","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ETHOSUXIMIDE","30200003","CDM","301","RC","80168","HCPCS","facility","both","","","","38","38","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ETHOSUXIMIDE","30200003","CDM","301","RC","80168","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ETHOSUXIMIDE","30200003","CDM","301","RC","80168","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALDOLASE","30200004","CDM","301","RC","82085","HCPCS","facility","both","","","","23.8","23.8","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALDOLASE","30200004","CDM","301","RC","82085","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALDOLASE","30200004","CDM","301","RC","82085","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALDOLASE","30200004","CDM","301","RC","82085","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALPHA-1-ANTITRYPSIN; TOTAL","30200005","CDM","301","RC","82103","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALPHA-1-ANTITRYPSIN; TOTAL","30200005","CDM","301","RC","82103","HCPCS","facility","both","","","","38","38","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALPHA-1-ANTITRYPSIN; TOTAL","30200005","CDM","301","RC","82103","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC ALPHA-1-ANTITRYPSIN; TOTAL","30200005","CDM","301","RC","82103","HCPCS","facility","both","","","","314","314","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALPHA-1-ANTITRYPSIN; TOTAL","30200005","CDM","301","RC","82103","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALUMINUM ASSAY","30200006","CDM","301","RC","82108","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALUMINUM ASSAY","30200006","CDM","301","RC","82108","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALUMINUM ASSAY","30200006","CDM","301","RC","82108","HCPCS","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALUMINUM ASSAY","30200006","CDM","301","RC","82108","HCPCS","facility","both","","","","224","224","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AMINO ACIDS; SGL QUAN EA","30200007","CDM","301","RC","82131","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AMINO ACIDS; SGL QUAN EA","30200007","CDM","301","RC","82131","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AMINO ACIDS; SGL QUAN EA","30200007","CDM","301","RC","82131","HCPCS","facility","both","","","","192","192","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AMINO ACIDS; SGL QUAN EA","30200007","CDM","301","RC","82131","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DELTA ALA","30200008","CDM","301","RC","82135","HCPCS","facility","both","","","","38","38","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DELTA ALA","30200008","CDM","301","RC","82135","HCPCS","facility","both","","","","54.43","54.43","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DELTA ALA","30200008","CDM","301","RC","82135","HCPCS","facility","both","","","","69.66","69.66","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DELTA ALA","30200008","CDM","301","RC","82135","HCPCS","facility","both","","","","382","382","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANDROSTENEDIONE","30200009","CDM","301","RC","82157","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANDROSTENEDIONE","30200009","CDM","301","RC","82157","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANDROSTENEDIONE","30200009","CDM","301","RC","82157","HCPCS","facility","both","","","","797","797","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANDROSTENEDIONE","30200009","CDM","301","RC","82157","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANGIOTENSIN II","30200010","CDM","301","RC","82163","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANGIOTENSIN II","30200010","CDM","301","RC","82163","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANGIOTENSIN II","30200010","CDM","301","RC","82163","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANGIOTENSIN II","30200010","CDM","301","RC","82163","HCPCS","facility","both","","","","242","242","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANGIOTENSIN I - CONVERTING ENZYME","30200011","CDM","301","RC","82164","HCPCS","facility","both","","","","41","41","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANGIOTENSIN I - CONVERTING ENZYME","30200011","CDM","301","RC","82164","HCPCS","facility","both","","","","444","444","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANGIOTENSIN I - CONVERTING ENZYME","30200011","CDM","301","RC","82164","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANGIOTENSIN I - CONVERTING ENZYME","30200011","CDM","301","RC","82164","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC APOLIPOPROTEIN EACH","30200012","CDM","301","RC","82172","HCPCS","facility","both","","","","116","116","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC APOLIPOPROTEIN EACH","30200012","CDM","301","RC","82172","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC APOLIPOPROTEIN EACH","30200012","CDM","301","RC","82172","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC APOLIPOPROTEIN EACH","30200012","CDM","301","RC","82172","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC APOLIPOPROTEIN EACH","30200012","CDM","301","RC","82172","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ARSENIC","30200013","CDM","301","RC","82175","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ARSENIC","30200013","CDM","301","RC","82175","HCPCS","facility","both","","","","38","38","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ARSENIC","30200013","CDM","301","RC","82175","HCPCS","facility","both","","","","560","560","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ARSENIC","30200013","CDM","301","RC","82175","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BIOTINIDASE EA SPECIMEN","30200014","CDM","301","RC","82261","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BIOTINIDASE EA SPECIMEN","30200014","CDM","301","RC","82261","HCPCS","facility","both","","","","115","115","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BIOTINIDASE EA SPECIMEN","30200014","CDM","301","RC","82261","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BIOTINIDASE EA SPECIMEN","30200014","CDM","301","RC","82261","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CARB DEFICIENT TRANSRERRIN","30200015","CDM","301","RC","82373","HCPCS","facility","both","","","","309.71","309.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CARB DEFICIENT TRANSRERRIN","30200015","CDM","301","RC","82373","HCPCS","facility","both","","","","68.25","68.25","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CAROTENE","30200016","CDM","301","RC","82380","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CAROTENE","30200016","CDM","301","RC","82380","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CAROTENE","30200016","CDM","301","RC","82380","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CAROTENE","30200016","CDM","301","RC","82380","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CATECHOLAMINES FRACTIONATED","30200017","CDM","301","RC","82384","HCPCS","facility","both","","","","241.17","241.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CATECHOLAMINES FRACTIONATED","30200017","CDM","301","RC","82384","HCPCS","facility","both","","","","188.41","188.41","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CATECHOLAMINES FRACTIONATED","30200017","CDM","301","RC","82384","HCPCS","facility","both","","","","47.75","47.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CATECHOLAMINES FRACTIONATED","30200017","CDM","301","RC","82384","HCPCS","facility","both","","","","1000","1000","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CERULOPLASMIN","30200018","CDM","301","RC","82390","HCPCS","facility","both","","","","25.6","25.6","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CERULOPLASMIN","30200018","CDM","301","RC","82390","HCPCS","facility","both","","","","382","382","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CERULOPLASMIN","30200018","CDM","301","RC","82390","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CERULOPLASMIN","30200018","CDM","301","RC","82390","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CITRATE","30200019","CDM","301","RC","82507","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CITRATE","30200019","CDM","301","RC","82507","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CITRATE","30200019","CDM","301","RC","82507","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CITRATE","30200019","CDM","301","RC","82507","HCPCS","facility","both","","","","328","328","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYANIDE","30200020","CDM","301","RC","82600","HCPCS","facility","both","","","","77.71","77.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYANIDE","30200020","CDM","301","RC","82600","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYANIDE","30200020","CDM","301","RC","82600","HCPCS","facility","both","","","","60.71","60.71","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYANIDE","30200020","CDM","301","RC","82600","HCPCS","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VIT  B-12; UNSATURATED BC","30200021","CDM","301","RC","82608","HCPCS","facility","both","","","","48.15","48.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VIT  B-12; UNSATURATED BC","30200021","CDM","301","RC","82608","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VIT  B-12; UNSATURATED BC","30200021","CDM","301","RC","82608","HCPCS","facility","both","","","","61.64","61.64","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VIT  B-12; UNSATURATED BC","30200021","CDM","301","RC","82608","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DHEA","30200022","CDM","301","RC","82626","HCPCS","facility","both","","","","54","54","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DHEA","30200022","CDM","301","RC","82626","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DHEA","30200022","CDM","301","RC","82626","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DHEA","30200022","CDM","301","RC","82626","HCPCS","facility","both","","","","300","300","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DHEA-S","30200023","CDM","301","RC","82627","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC DHEA-S","30200023","CDM","301","RC","82627","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DHEA-S","30200023","CDM","301","RC","82627","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DHEA-S","30200023","CDM","301","RC","82627","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DHEA-S","30200023","CDM","301","RC","82627","HCPCS","facility","both","","","","48","48","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DEOXYCORTISOL 11","30200024","CDM","301","RC","82634","HCPCS","facility","both","","","","65.5","65.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DEOXYCORTISOL 11","30200024","CDM","301","RC","82634","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DEOXYCORTISOL 11","30200024","CDM","301","RC","82634","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DEOXYCORTISOL 11","30200024","CDM","301","RC","82634","HCPCS","facility","both","","","","345","345","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DIHYDROTESTOSTERONE","30200025","CDM","302","RC","82651","HCPCS","facility","both","","","","113","113","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ERYTHROPOIETIN","30200026","CDM","301","RC","82668","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ERYTHROPOIETIN","30200026","CDM","301","RC","82668","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ERYTHROPOIETIN","30200026","CDM","301","RC","82668","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ERYTHROPOIETIN","30200026","CDM","301","RC","82668","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ESTROGENS; FRACTIONATED","30200027","CDM","301","RC","82671","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ESTROGENS; FRACTIONATED","30200027","CDM","301","RC","82671","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ESTROGENS; FRACTIONATED","30200027","CDM","301","RC","82671","HCPCS","facility","both","","","","580","580","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ESTROGENS; FRACTIONATED","30200027","CDM","301","RC","82671","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ESTRONE","30200028","CDM","301","RC","82679","HCPCS","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ESTRONE","30200028","CDM","301","RC","82679","HCPCS","facility","both","","","","298","298","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ESTRONE","30200028","CDM","301","RC","82679","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ESTRONE","30200028","CDM","301","RC","82679","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ETHYLENE GLYCOL","30200029","CDM","301","RC","82693","HCPCS","facility","both","","","","44.5","44.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ETHYLENE GLYCOL","30200029","CDM","301","RC","82693","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ETHYLENE GLYCOL","30200029","CDM","301","RC","82693","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ETHYLENE GLYCOL","30200029","CDM","301","RC","82693","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FAT/LIPIDS FECES; QUAL","30200030","CDM","301","RC","82705","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FAT/LIPIDS FECES; QUAL","30200030","CDM","301","RC","82705","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FAT/LIPIDS FECES; QUAL","30200030","CDM","301","RC","82705","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FAT/LIPIDS FECES; QUAL","30200030","CDM","301","RC","82705","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FATTY ACIDS NONESTERIFIED","30200031","CDM","301","RC","82725","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FATTY ACIDS NONESTERIFIED","30200031","CDM","301","RC","82725","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FATTY ACIDS NONESTERIFIED","30200031","CDM","301","RC","82725","HCPCS","facility","both","","","","124","124","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FATTY ACIDS NONESTERIFIED","30200031","CDM","301","RC","82725","HCPCS","facility","both","","","","36","36","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GALACTOKINASE RBC","30200032","CDM","301","RC","82759","HCPCS","facility","both","","","","91.1","91.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GALACTOKINASE RBC","30200032","CDM","301","RC","82759","HCPCS","facility","both","","","","254","254","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GALACTOKINASE RBC","30200032","CDM","301","RC","82759","HCPCS","facility","both","","","","21","21","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GALACTOKINASE RBC","30200032","CDM","301","RC","82759","HCPCS","facility","both","","","","71.17","71.17","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GALACTOSEMIA; QUAN","30200033","CDM","301","RC","82775","HCPCS","facility","both","","","","224","224","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GALACTOSEMIA; QUAN","30200033","CDM","301","RC","82775","HCPCS","facility","both","","","","286.72","286.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GALACTOSEMIA; QUAN","30200033","CDM","301","RC","82775","HCPCS","facility","both","","","","175","175","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GALACTOSEMIA; QUAN","30200033","CDM","301","RC","82775","HCPCS","facility","both","","","","248","248","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GASTRIN","30200034","CDM","301","RC","82941","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GASTRIN","30200034","CDM","301","RC","82941","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GASTRIN","30200034","CDM","301","RC","82941","HCPCS","facility","both","","","","37","37","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GASTRIN","30200034","CDM","301","RC","82941","HCPCS","facility","both","","","","382","382","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GLUCAGON","30200035","CDM","301","RC","82943","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GLUCAGON","30200035","CDM","301","RC","82943","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GLUCAGON","30200035","CDM","301","RC","82943","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GLUCAGON","30200035","CDM","301","RC","82943","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC G6PD; QUAN","30200036","CDM","301","RC","82955","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC G6PD; QUAN","30200036","CDM","301","RC","82955","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC G6PD; QUAN","30200036","CDM","301","RC","82955","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC G6PD; QUAN","30200036","CDM","301","RC","82955","HCPCS","facility","both","","","","314","314","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GLYCATED PROTEIN","30200037","CDM","301","RC","82985","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GLYCATED PROTEIN","30200037","CDM","301","RC","82985","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GLYCATED PROTEIN","30200037","CDM","301","RC","82985","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GLYCATED PROTEIN","30200037","CDM","301","RC","82985","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HISTAMINE","30200038","CDM","301","RC","83088","HCPCS","facility","both","","","","1090","1090","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HISTAMINE","30200038","CDM","301","RC","83088","HCPCS","facility","both","","","","64.31","64.31","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HISTAMINE","30200038","CDM","301","RC","83088","HCPCS","facility","both","","","","48.25","48.25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HISTAMINE","30200038","CDM","301","RC","83088","HCPCS","facility","both","","","","50.25","50.25","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HOMOVANILLIC ACID","30200039","CDM","301","RC","83150","HCPCS","facility","both","","","","696","696","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HOMOVANILLIC ACID","30200039","CDM","301","RC","83150","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HOMOVANILLIC ACID","30200039","CDM","301","RC","83150","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HOMOVANILLIC ACID","30200039","CDM","301","RC","83150","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC 17-OHCS","30200040","CDM","301","RC","83491","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC 17-OHCS","30200040","CDM","301","RC","83491","HCPCS","facility","both","","","","33.5","33.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC 17-OHCS","30200040","CDM","301","RC","83491","HCPCS","facility","both","","","","273","273","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC 17-OHCS","30200040","CDM","301","RC","83491","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HYDROXYPROGESTERONE 17-D","30200041","CDM","301","RC","83498","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HYDROXYPROGESTERONE 17-D","30200041","CDM","301","RC","83498","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HYDROXYPROGESTERONE 17-D","30200041","CDM","301","RC","83498","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HYDROXYPROGESTERONE 17-D","30200041","CDM","301","RC","83498","HCPCS","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LDH; ISOENZYMES","30200042","CDM","301","RC","83625","HCPCS","facility","both","","","","999","999","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LDH; ISOENZYMES","30200042","CDM","301","RC","83625","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LDH; ISOENZYMES","30200042","CDM","301","RC","83625","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LDH; ISOENZYMES","30200042","CDM","301","RC","83625","HCPCS","facility","both","","","","39.75","39.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MANGANESE","30200043","CDM","301","RC","83785","HCPCS","facility","both","","","","79.5","79.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MANGANESE","30200043","CDM","301","RC","83785","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MANGANESE","30200043","CDM","301","RC","83785","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MANGANESE","30200043","CDM","301","RC","83785","HCPCS","facility","both","","","","227","227","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MERCURY QUAN","30200044","CDM","301","RC","83825","HCPCS","facility","both","","","","532","532","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MERCURY QUAN","30200044","CDM","301","RC","83825","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MERCURY QUAN","30200044","CDM","301","RC","83825","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MERCURY QUAN","30200044","CDM","301","RC","83825","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC METHADONE","30200045","CDM","302","RC","83840","HCPCS","facility","both","","","","543","543","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MYELIN BASIC PROTEIN CSF","30200046","CDM","301","RC","83873","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MYELIN BASIC PROTEIN CSF","30200046","CDM","301","RC","83873","HCPCS","facility","both","","","","715","715","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MYELIN BASIC PROTEIN CSF","30200046","CDM","301","RC","83873","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MYELIN BASIC PROTEIN CSF","30200046","CDM","301","RC","83873","HCPCS","facility","both","","","","46.5","46.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC NEPHELOMETRY EA ANALYTE NES","30200047","CDM","301","RC","83883","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC NEPHELOMETRY EA ANALYTE NES","30200047","CDM","301","RC","83883","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NEPHELOMETRY EA ANALYTE NES","30200047","CDM","301","RC","83883","HCPCS","facility","both","","","","96","96","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NEPHELOMETRY EA ANALYTE NES","30200047","CDM","301","RC","83883","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NICOTINE","30200048","CDM","302","RC","83887","HCPCS","facility","both","","","","189","189","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OSTEOCALCIN","30200049","CDM","301","RC","83937","HCPCS","facility","both","","","","63","63","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC OSTEOCALCIN","30200049","CDM","301","RC","83937","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OSTEOCALCIN","30200049","CDM","301","RC","83937","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OSTEOCALCIN","30200049","CDM","301","RC","83937","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OSTEOCALCIN","30200049","CDM","301","RC","83937","HCPCS","facility","both","","","","48","48","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC OXALATE","30200050","CDM","301","RC","83945","HCPCS","facility","both","","","","432","432","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OXALATE","30200050","CDM","301","RC","83945","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OXALATE","30200050","CDM","301","RC","83945","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OXALATE","30200050","CDM","301","RC","83945","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALKALINE PHOSPHATASE ISOENZYM","30200051","CDM","301","RC","84080","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALKALINE PHOSPHATASE ISOENZYM","30200051","CDM","301","RC","84080","HCPCS","facility","both","","","","404","404","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALKALINE PHOSPHATASE ISOENZYM","30200051","CDM","301","RC","84080","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALKALINE PHOSPHATASE ISOENZYM","30200051","CDM","301","RC","84080","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PORPHOBILINOGEN URINE; QUAN","30200052","CDM","301","RC","84110","HCPCS","facility","both","","","","31","31","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PORPHOBILINOGEN URINE; QUAN","30200052","CDM","301","RC","84110","HCPCS","facility","both","","","","324","324","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PORPHOBILINOGEN URINE; QUAN","30200052","CDM","301","RC","84110","HCPCS","facility","both","","","","27.22","27.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PORPHOBILINOGEN URINE; QUAN","30200052","CDM","301","RC","84110","HCPCS","facility","both","","","","34.84","34.84","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUAN URINE PORPHYRINS","30200053","CDM","301","RC","84120","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUAN URINE PORPHYRINS","30200053","CDM","301","RC","84120","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUAN URINE PORPHYRINS","30200053","CDM","301","RC","84120","HCPCS","facility","both","","","","334","334","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUAN URINE PORPHYRINS","30200053","CDM","301","RC","84120","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PREGNENOLONE","30200054","CDM","301","RC","84140","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PREGNENOLONE","30200054","CDM","301","RC","84140","HCPCS","facility","both","","","","42.75","42.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PREGNENOLONE","30200054","CDM","301","RC","84140","HCPCS","facility","both","","","","417","417","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PREGNENOLONE","30200054","CDM","301","RC","84140","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC 17-HYDROXYPREGNENOLONE","30200055","CDM","301","RC","84143","HCPCS","facility","both","","","","62","62","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC 17-HYDROXYPREGNENOLONE","30200055","CDM","301","RC","84143","HCPCS","facility","both","","","","270","270","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC 17-HYDROXYPREGNENOLONE","30200055","CDM","301","RC","84143","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC 17-HYDROXYPREGNENOLONE","30200055","CDM","301","RC","84143","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROTOPORPHYRIN RBC; QUAN","30200056","CDM","301","RC","84202","HCPCS","facility","both","","","","496","496","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROTOPORPHYRIN RBC; QUAN","30200056","CDM","301","RC","84202","HCPCS","facility","both","","","","144.7","144.7","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROTOPORPHYRIN RBC; QUAN","30200056","CDM","301","RC","84202","HCPCS","facility","both","","","","84","84","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PROTOPORPHYRIN RBC; QUAN","30200056","CDM","301","RC","84202","HCPCS","facility","both","","","","113.04","113.04","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROINSULIN","30200057","CDM","301","RC","84206","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PROINSULIN","30200057","CDM","301","RC","84206","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROINSULIN","30200057","CDM","301","RC","84206","HCPCS","facility","both","","","","319","319","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROINSULIN","30200057","CDM","301","RC","84206","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VITAMIN B6","30200058","CDM","301","RC","84207","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VITAMIN B6","30200058","CDM","301","RC","84207","HCPCS","facility","both","","","","524","524","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VITAMIN B6","30200058","CDM","301","RC","84207","HCPCS","facility","both","","","","58.25","58.25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VITAMIN B6","30200058","CDM","301","RC","84207","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PYRUVATE","30200059","CDM","301","RC","84210","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PYRUVATE","30200059","CDM","301","RC","84210","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PYRUVATE","30200059","CDM","301","RC","84210","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PYRUVATE","30200059","CDM","301","RC","84210","HCPCS","facility","both","","","","334","334","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY NONENDOCRINE RECEPTOR","30200060","CDM","301","RC","84238","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY NONENDOCRINE RECEPTOR","30200060","CDM","301","RC","84238","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY NONENDOCRINE RECEPTOR","30200060","CDM","301","RC","84238","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY NONENDOCRINE RECEPTOR","30200060","CDM","301","RC","84238","HCPCS","facility","both","","","","75","75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SEROTONIN","30200061","CDM","301","RC","84260","HCPCS","facility","both","","","","87","87","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SEROTONIN","30200061","CDM","301","RC","84260","HCPCS","facility","both","","","","741","741","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SEROTONIN","30200061","CDM","301","RC","84260","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SEROTONIN","30200061","CDM","301","RC","84260","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SEX HORMONE BINDING GLOBULIN","30200062","CDM","301","RC","84270","HCPCS","facility","both","","","","38","38","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SEX HORMONE BINDING GLOBULIN","30200062","CDM","301","RC","84270","HCPCS","facility","both","","","","132","132","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SEX HORMONE BINDING GLOBULIN","30200062","CDM","301","RC","84270","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SEX HORMONE BINDING GLOBULIN","30200062","CDM","301","RC","84270","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY OF THIAMINE (VITAMIN B-1)","30200063","CDM","301","RC","84425","HCPCS","facility","both","","","","102.58","102.58","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY OF THIAMINE (VITAMIN B-1)","30200063","CDM","301","RC","84425","HCPCS","facility","both","","","","404","404","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY OF THIAMINE (VITAMIN B-1)","30200063","CDM","301","RC","84425","HCPCS","facility","both","","","","42.75","42.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY OF THIAMINE (VITAMIN B-1)","30200063","CDM","301","RC","84425","HCPCS","facility","both","","","","131.31","131.31","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TOCOPHEROL ALPHA (VIT E)","30200064","CDM","301","RC","84446","HCPCS","facility","both","","","","432","432","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TOCOPHEROL ALPHA (VIT E)","30200064","CDM","301","RC","84446","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TOCOPHEROL ALPHA (VIT E)","30200064","CDM","301","RC","84446","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TOCOPHEROL ALPHA (VIT E)","30200064","CDM","301","RC","84446","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC T3; FREE","30200065","CDM","301","RC","84481","HCPCS","facility","both","","","","31","31","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC T3; FREE","30200065","CDM","301","RC","84481","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC T3; FREE","30200065","CDM","301","RC","84481","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC T3; FREE","30200065","CDM","301","RC","84481","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC T3; FREE","30200065","CDM","301","RC","84481","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VIP - VASOACTIVE INTESTINAL PEPTIDE","30200066","CDM","301","RC","84586","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VIP - VASOACTIVE INTESTINAL PEPTIDE","30200066","CDM","301","RC","84586","HCPCS","facility","both","","","","67.5","67.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VIP - VASOACTIVE INTESTINAL PEPTIDE","30200066","CDM","301","RC","84586","HCPCS","facility","both","","","","359","359","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VIP - VASOACTIVE INTESTINAL PEPTIDE","30200066","CDM","301","RC","84586","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VASOPRESSIN","30200067","CDM","301","RC","84588","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VASOPRESSIN","30200067","CDM","301","RC","84588","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VASOPRESSIN","30200067","CDM","301","RC","84588","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VASOPRESSIN","30200067","CDM","301","RC","84588","HCPCS","facility","both","","","","63","63","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VITAMIN A","30200068","CDM","301","RC","84590","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VITAMIN A","30200068","CDM","301","RC","84590","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VITAMIN A","30200068","CDM","301","RC","84590","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VITAMIN A","30200068","CDM","301","RC","84590","HCPCS","facility","both","","","","270","270","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MURAMIDASE","30200069","CDM","305","RC","85549","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MURAMIDASE","30200069","CDM","305","RC","85549","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MURAMIDASE","30200069","CDM","305","RC","85549","HCPCS","facility","both","","","","172","172","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MURAMIDASE","30200069","CDM","305","RC","85549","HCPCS","facility","both","","","","41.25","41.25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AGGLUTININS FEBRILE","30200070","CDM","302","RC","86000","HCPCS","facility","both","","","","115","115","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AGGLUTININS FEBRILE","30200070","CDM","302","RC","86000","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AGGLUTININS FEBRILE","30200070","CDM","302","RC","86000","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AGGLUTININS FEBRILE","30200070","CDM","302","RC","86000","HCPCS","facility","both","","","","227","227","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALLERG SP  IGG QUAN OR SEMIQUAN","30200071","CDM","302","RC","86001","HCPCS","facility","both","","","","62","62","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALLERGEN SPECIFIC IGE","30200072","CDM","302","RC","86005","HCPCS","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALLERGEN SPECIFIC IGE","30200072","CDM","302","RC","86005","HCPCS","facility","both","","","","34","34","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB ID; PLATELET AB","30200073","CDM","302","RC","86022","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB ID; PLATELET AB","30200073","CDM","302","RC","86022","HCPCS","facility","both","","","","240","240","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB ID; PLATELET AB","30200073","CDM","302","RC","86022","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB ID; PLATELET AB","30200073","CDM","302","RC","86022","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTINUCLEAR AB (ANA);","30200074","CDM","302","RC","86038","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTINUCLEAR AB (ANA);","30200074","CDM","302","RC","86038","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTINUCLEAR AB (ANA);","30200074","CDM","302","RC","86038","HCPCS","facility","both","","","","132","132","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANTINUCLEAR AB (ANA);","30200074","CDM","302","RC","86038","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTINUCLEAR AB (ANA);","30200074","CDM","302","RC","86038","HCPCS","facility","both","","","","22","22","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC ANTINUCLEAR AB (ANA);","30200074","CDM","302","RC","86038","HCPCS","facility","both","","","","12.09","12.09","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC ANTINUCLEAR AB (ANA); TITER","30200075","CDM","302","RC","86039","HCPCS","facility","both","","","","32","32","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTINUCLEAR AB (ANA); TITER","30200075","CDM","302","RC","86039","HCPCS","facility","both","","","","58.62","58.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTINUCLEAR AB (ANA); TITER","30200075","CDM","302","RC","86039","HCPCS","facility","both","","","","75.03","75.03","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTINUCLEAR AB (ANA); TITER","30200075","CDM","302","RC","86039","HCPCS","facility","both","","","","134","134","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC C-REACTIVE PROTEIN","30200076","CDM","302","RC","86140","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC C-REACTIVE PROTEIN","30200076","CDM","302","RC","86140","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC C-REACTIVE PROTEIN","30200076","CDM","302","RC","86140","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC C-REACTIVE PROTEIN","30200076","CDM","302","RC","86140","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC C-REACTIVE PROTEIN","30200076","CDM","302","RC","86140","HCPCS","facility","both","","","","5.18","5.18","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC C-REACTIVE PROTEIN","30200076","CDM","302","RC","86140","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC C-REACTIVE PROTEIN","30200076","CDM","302","RC","86140","HCPCS","facility","both","","","","292","292","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC C-REACTIVE PROTEIN HS","30200077","CDM","302","RC","86141","HCPCS","facility","both","","","","42.87","42.87","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC C-REACTIVE PROTEIN HS","30200077","CDM","302","RC","86141","HCPCS","facility","both","","","","33.49","33.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC C-REACTIVE PROTEIN HS","30200077","CDM","302","RC","86141","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC C-REACTIVE PROTEIN HS","30200077","CDM","302","RC","86141","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC C-REACTIVE PROTEIN HS","30200077","CDM","302","RC","86141","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BETA 2 GLYCOPROTEIN I AB EA","30200078","CDM","302","RC","86146","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BETA 2 GLYCOPROTEIN I AB EA","30200078","CDM","302","RC","86146","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BETA 2 GLYCOPROTEIN I AB EA","30200078","CDM","302","RC","86146","HCPCS","facility","both","","","","298","298","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BETA 2 GLYCOPROTEIN I AB EA","30200078","CDM","302","RC","86146","HCPCS","facility","both","","","","164","164","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CARDIOLIPIN AB EA IG CLASS","30200079","CDM","302","RC","86147","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CARDIOLIPIN AB EA IG CLASS","30200079","CDM","302","RC","86147","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CARDIOLIPIN AB EA IG CLASS","30200079","CDM","302","RC","86147","HCPCS","facility","both","","","","852","852","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CARDIOLIPIN AB EA IG CLASS","30200079","CDM","302","RC","86147","HCPCS","facility","both","","","","31","31","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPLEMENT; AG EA","30200080","CDM","302","RC","86160","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COMPLEMENT; AG EA","30200080","CDM","302","RC","86160","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPLEMENT; AG EA","30200080","CDM","302","RC","86160","HCPCS","facility","both","","","","53.25","53.25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPLEMENT; AG EA","30200080","CDM","302","RC","86160","HCPCS","facility","both","","","","583","583","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPLEMENT; FCN ACTIVITY EA","30200081","CDM","302","RC","86161","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COMPLEMENT; FCN ACTIVITY EA","30200081","CDM","302","RC","86161","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPLEMENT; FCN ACTIVITY EA","30200081","CDM","302","RC","86161","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPLEMENT; FCN ACTIVITY EA","30200081","CDM","302","RC","86161","HCPCS","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPLEMENT; TOT HEMOLYTIC (CH50)","30200082","CDM","302","RC","86162","HCPCS","facility","both","","","","390","390","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPLEMENT; TOT HEMOLYTIC (CH50)","30200082","CDM","302","RC","86162","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPLEMENT; TOT HEMOLYTIC (CH50)","30200082","CDM","302","RC","86162","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPLEMENT; TOT HEMOLYTIC (CH50)","30200082","CDM","302","RC","86162","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CCP ANTIBODY","30200083","CDM","302","RC","86200","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CCP ANTIBODY","30200083","CDM","302","RC","86200","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CCP ANTIBODY","30200083","CDM","302","RC","86200","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC CCP ANTIBODY","30200083","CDM","302","RC","86200","HCPCS","facility","both","","","","32.5","32.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CCP ANTIBODY","30200083","CDM","302","RC","86200","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DNA AB","30200084","CDM","302","RC","86215","HCPCS","facility","both","","","","37","37","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DNA AB","30200084","CDM","302","RC","86215","HCPCS","facility","both","","","","56.27","56.27","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DNA AB","30200084","CDM","302","RC","86215","HCPCS","facility","both","","","","43.96","43.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DNA AB","30200084","CDM","302","RC","86215","HCPCS","facility","both","","","","271","271","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DNA AB; NATIVE OR DS","30200085","CDM","302","RC","86225","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DNA AB; NATIVE OR DS","30200085","CDM","302","RC","86225","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DNA AB; NATIVE OR DS","30200085","CDM","302","RC","86225","HCPCS","facility","both","","","","276","276","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DNA AB; NATIVE OR DS","30200085","CDM","302","RC","86225","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ENA ANY METHOD","30200086","CDM","302","RC","86235","HCPCS","facility","both","","","","75.03","75.03","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ENA ANY METHOD","30200086","CDM","302","RC","86235","HCPCS","facility","both","","","","58.62","58.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ENA ANY METHOD","30200086","CDM","302","RC","86235","HCPCS","facility","both","","","","124","124","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ENA ANY METHOD","30200086","CDM","302","RC","86235","HCPCS","facility","both","","","","82.5","82.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FLUORESCENT AB; SCRN EA AB","30200087","CDM","302","RC","86255","HCPCS","facility","both","","","","460","460","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FLUORESCENT AB; SCRN EA AB","30200087","CDM","302","RC","86255","HCPCS","facility","both","","","","322","322","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FLUORESCENT AB; SCRN EA AB","30200087","CDM","302","RC","86255","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLUORESCENT AB; SCRN EA AB","30200087","CDM","302","RC","86255","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLUORESCENT AB; SCRN EA AB","30200087","CDM","302","RC","86255","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC FLUORESCENT AB; TITER EA AB","30200088","CDM","302","RC","86256","HCPCS","facility","both","","","","78","78","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FLUORESCENT AB; TITER EA AB","30200088","CDM","302","RC","86256","HCPCS","facility","both","","","","75.03","75.03","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLUORESCENT AB; TITER EA AB","30200088","CDM","302","RC","86256","HCPCS","facility","both","","","","58.62","58.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLUORESCENT AB; TITER EA AB","30200088","CDM","302","RC","86256","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IA QUANT; CA 19-9","30200089","CDM","302","RC","86301","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IA QUANT; CA 19-9","30200089","CDM","302","RC","86301","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IA QUANT; CA 19-9","30200089","CDM","302","RC","86301","HCPCS","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IA QUANT; CA 19-9","30200089","CDM","302","RC","86301","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IA QUANT; CA 125","30200090","CDM","302","RC","86304","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IA QUANT; CA 125","30200090","CDM","302","RC","86304","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IA QUANT; CA 125","30200090","CDM","302","RC","86304","HCPCS","facility","both","","","","486","486","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IA QUANT; CA 125","30200090","CDM","302","RC","86304","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUAL HETEROPHILE AB","30200091","CDM","302","RC","86308","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUAL HETEROPHILE AB","30200091","CDM","302","RC","86308","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUAL HETEROPHILE AB","30200091","CDM","302","RC","86308","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUAL HETEROPHILE AB","30200091","CDM","302","RC","86308","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUAL HETEROPHILE AB","30200091","CDM","302","RC","86308","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC IA; OTHER TUMOR AG QUAN EA","30200092","CDM","302","RC","86316","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IA; OTHER TUMOR AG QUAN EA","30200092","CDM","302","RC","86316","HCPCS","facility","both","","","","246","246","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IA; OTHER TUMOR AG QUAN EA","30200092","CDM","302","RC","86316","HCPCS","facility","both","","","","88","88","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IA; OTHER TUMOR AG QUAN EA","30200092","CDM","302","RC","86316","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IA INFECTIOUS AGENT AB QUAN","30200093","CDM","302","RC","86317","HCPCS","facility","both","","","","178","178","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IA INFECTIOUS AGENT AB QUAN","30200093","CDM","302","RC","86317","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IA INFECTIOUS AGENT AB QUAN","30200093","CDM","302","RC","86317","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 01/01/2025 HC IEP; CROSSED","30200094","CDM","302","RC","86327","HCPCS","facility","both","","","","96.9","96.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 01/01/2025 HC IEP; CROSSED","30200094","CDM","302","RC","86327","HCPCS","facility","both","","","","268","268","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"DEAC 01/01/2025 HC IEP; CROSSED","30200094","CDM","302","RC","86327","HCPCS","facility","both","","","","132.26","132.26","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNE COMPLEX ASSAY;","30200095","CDM","302","RC","86332","HCPCS","facility","both","","","","290","290","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUNE COMPLEX ASSAY;","30200095","CDM","302","RC","86332","HCPCS","facility","both","","","","75.36","75.36","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNE COMPLEX ASSAY;","30200095","CDM","302","RC","86332","HCPCS","facility","both","","","","96.46","96.46","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNE COMPLEX ASSAY;","30200095","CDM","302","RC","86332","HCPCS","facility","both","","","","95","95","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SERUM IMMUNOFIXATION ELECTROPHORES","30200096","CDM","302","RC","86334","HCPCS","facility","both","","","","266","266","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SERUM IMMUNOFIXATION ELECTROPHORES","30200096","CDM","302","RC","86334","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SERUM IMMUNOFIXATION ELECTROPHORES","30200096","CDM","302","RC","86334","HCPCS","facility","both","","","","105","105","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SERUM IMMUNOFIXATION ELECTROPHORES","30200096","CDM","302","RC","86334","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNFIX E-PHORSIS/URINE/CSF","30200097","CDM","302","RC","86335","HCPCS","facility","both","","","","149","149","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IMMUNFIX E-PHORSIS/URINE/CSF","30200097","CDM","302","RC","86335","HCPCS","facility","both","","","","117.9","117.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IMMUNFIX E-PHORSIS/URINE/CSF","30200097","CDM","302","RC","86335","HCPCS","facility","both","","","","92.11","92.11","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNFIX E-PHORSIS/URINE/CSF","30200097","CDM","302","RC","86335","HCPCS","facility","both","","","","180","180","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INSULIN AB","30200098","CDM","302","RC","86337","HCPCS","facility","both","","","","175","175","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC INSULIN AB","30200098","CDM","302","RC","86337","HCPCS","facility","both","","","","99.15","99.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INSULIN AB","30200098","CDM","302","RC","86337","HCPCS","facility","both","","","","77.46","77.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INSULIN AB","30200098","CDM","302","RC","86337","HCPCS","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INTRINSIC FACTOR  AB","30200099","CDM","302","RC","86340","HCPCS","facility","both","","","","308","308","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INTRINSIC FACTOR  AB","30200099","CDM","302","RC","86340","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INTRINSIC FACTOR  AB","30200099","CDM","302","RC","86340","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INTRINSIC FACTOR  AB","30200099","CDM","302","RC","86340","HCPCS","facility","both","","","","48.5","48.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ISLET CELL AB","30200100","CDM","302","RC","86341","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ISLET CELL AB","30200100","CDM","302","RC","86341","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ISLET CELL AB","30200100","CDM","302","RC","86341","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ISLET CELL AB","30200100","CDM","302","RC","86341","HCPCS","facility","both","","","","234","234","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ISLET CELL AB","30200100","CDM","302","RC","86341","HCPCS","facility","both","","","","22.39","22.39","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC CELL FUNCTION ASSAY W/STIM","30200101","CDM","302","RC","86352","HCPCS","facility","both","","","","206.33","206.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CELL FUNCTION ASSAY W/STIM","30200101","CDM","302","RC","86352","HCPCS","facility","both","","","","161.19","161.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CELL FUNCTION ASSAY W/STIM","30200101","CDM","302","RC","86352","HCPCS","facility","both","","","","226","226","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CELL FUNCTION ASSAY W/STIM","30200101","CDM","302","RC","86352","HCPCS","facility","both","","","","1606","1606","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MONONUCLEAR CELL ANTIGEN","30200102","CDM","302","RC","86356","HCPCS","facility","both","","","","75","75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MONONUCLEAR CELL ANTIGEN","30200102","CDM","302","RC","86356","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MONONUCLEAR CELL ANTIGEN","30200102","CDM","302","RC","86356","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MONONUCLEAR CELL ANTIGEN","30200102","CDM","302","RC","86356","HCPCS","facility","both","","","","140","140","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC T CELLS; TOTAL COUNT","30200103","CDM","302","RC","86359","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC T CELLS; TOTAL COUNT","30200103","CDM","302","RC","86359","HCPCS","facility","both","","","","338","338","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC T CELLS; TOTAL COUNT","30200103","CDM","302","RC","86359","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC T CELLS; TOTAL COUNT","30200103","CDM","302","RC","86359","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC T CELLS; TOTAL COUNT","30200103","CDM","302","RC","86359","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC T CELLS; TOTAL COUNT","30200103","CDM","302","RC","86359","HCPCS","facility","both","","","","133","133","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC T CELLS; ABSOL CD4 AND CD8","30200104","CDM","302","RC","86360","HCPCS","facility","both","","","","357","357","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC T CELLS; ABSOL CD4 AND CD8","30200104","CDM","302","RC","86360","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC T CELLS; ABSOL CD4 AND CD8","30200104","CDM","302","RC","86360","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC T CELLS; ABSOL CD4 AND CD8","30200104","CDM","302","RC","86360","HCPCS","facility","both","","","","141.09","141.09","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC T CELLS; ABSOL CD4 AND CD8","30200104","CDM","302","RC","86360","HCPCS","facility","both","","","","165","165","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC T CELLS; ABSOL CD4 AND CD8","30200104","CDM","302","RC","86360","HCPCS","facility","both","","","","86","86","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC T CELLS; ABSOL CD4 COUNT","30200105","CDM","302","RC","86361","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC T CELLS; ABSOL CD4 COUNT","30200105","CDM","302","RC","86361","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC T CELLS; ABSOL CD4 COUNT","30200105","CDM","302","RC","86361","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC T CELLS; ABSOL CD4 COUNT","30200105","CDM","302","RC","86361","HCPCS","facility","both","","","","317","317","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MICROSOMAL AB EACH","30200106","CDM","302","RC","86376","HCPCS","facility","both","","","","78","78","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MICROSOMAL AB EACH","30200106","CDM","302","RC","86376","HCPCS","facility","both","","","","46.06","46.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MICROSOMAL AB EACH","30200106","CDM","302","RC","86376","HCPCS","facility","both","","","","58.96","58.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MICROSOMAL AB EACH","30200106","CDM","302","RC","86376","HCPCS","facility","both","","","","34.25","34.25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MICROSOMAL AB EACH","30200106","CDM","302","RC","86376","HCPCS","facility","both","","","","23","23","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC VIRAL NEUTRALIZATION","30200107","CDM","302","RC","86382","HCPCS","facility","both","","","","292","292","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VIRAL NEUTRALIZATION","30200107","CDM","302","RC","86382","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VIRAL NEUTRALIZATION","30200107","CDM","302","RC","86382","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VIRAL NEUTRALIZATION","30200107","CDM","302","RC","86382","HCPCS","facility","both","","","","870","870","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PA; TITER EA AB","30200108","CDM","302","RC","86406","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PA; TITER EA AB","30200108","CDM","302","RC","86406","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PA; TITER EA AB","30200108","CDM","302","RC","86406","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUAL RHEUM FACTOR","30200109","CDM","302","RC","86430","HCPCS","facility","both","","","","6.14","6.14","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC QUAL RHEUM FACTOR","30200109","CDM","302","RC","86430","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC QUAL RHEUM FACTOR","30200109","CDM","302","RC","86430","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUAL RHEUM FACTOR","30200109","CDM","302","RC","86430","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUAL RHEUM FACTOR","30200109","CDM","302","RC","86430","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC QUAL RHEUM FACTOR","30200109","CDM","302","RC","86430","HCPCS","facility","both","","","","132","132","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TB TEST CELL IMMUN MEASURE","30200110","CDM","302","RC","86480","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC TB TEST CELL IMMUN MEASURE","30200110","CDM","302","RC","86480","HCPCS","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TB TEST CELL IMMUN MEASURE","30200110","CDM","302","RC","86480","HCPCS","facility","both","","","","180","180","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TB TEST CELL IMMUN MEASURE","30200110","CDM","302","RC","86480","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TB TEST CELL IMMUN MEASURE","30200110","CDM","302","RC","86480","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SYPHILIS TEST NON-TREP QUAL","30200111","CDM","302","RC","86592","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SYPHILIS TEST NON-TREP QUAL","30200111","CDM","302","RC","86592","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SYPHILIS TEST NON-TREP QUAL","30200111","CDM","302","RC","86592","HCPCS","facility","both","","","","14.5","14.5","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC SYPHILIS TEST NON-TREP QUAL","30200111","CDM","302","RC","86592","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SYPHILIS TEST NON-TREP QUAL","30200111","CDM","302","RC","86592","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SYPHILIS TEST NON-TREP QUANT","30200112","CDM","302","RC","86593","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SYPHILIS TEST NON-TREP QUANT","30200112","CDM","302","RC","86593","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SYPHILIS TEST NON-TREP QUANT","30200112","CDM","302","RC","86593","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SYPHILIS TEST NON-TREP QUANT","30200112","CDM","302","RC","86593","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; ADENOVIRUS","30200113","CDM","302","RC","86603","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; ADENOVIRUS","30200113","CDM","302","RC","86603","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; ADENOVIRUS","30200113","CDM","302","RC","86603","HCPCS","facility","both","","","","293","293","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; ADENOVIRUS","30200113","CDM","302","RC","86603","HCPCS","facility","both","","","","41","41","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; ASPERGILLUS","30200114","CDM","302","RC","86606","HCPCS","facility","both","","","","18","18","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; ASPERGILLUS","30200114","CDM","302","RC","86606","HCPCS","facility","both","","","","84","84","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; ASPERGILLUS","30200114","CDM","302","RC","86606","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; ASPERGILLUS","30200114","CDM","302","RC","86606","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; BACTERIUM NES","30200115","CDM","302","RC","86609","HCPCS","facility","both","","","","240","240","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; BACTERIUM NES","30200115","CDM","302","RC","86609","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; BACTERIUM NES","30200115","CDM","302","RC","86609","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; BACTERIUM NES","30200115","CDM","302","RC","86609","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; BARTONELLA","30200116","CDM","302","RC","86611","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; BARTONELLA","30200116","CDM","302","RC","86611","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; BARTONELLA","30200116","CDM","302","RC","86611","HCPCS","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; BARTONELLA","30200116","CDM","302","RC","86611","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; BLASTOMYCES","30200117","CDM","302","RC","86612","HCPCS","facility","both","","","","149","149","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; BLASTOMYCES","30200117","CDM","302","RC","86612","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; BLASTOMYCES","30200117","CDM","302","RC","86612","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; BLASTOMYCES","30200117","CDM","302","RC","86612","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; BORDETELLA","30200118","CDM","302","RC","86615","HCPCS","facility","both","","","","71.25","71.25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; BORDETELLA","30200118","CDM","302","RC","86615","HCPCS","facility","both","","","","172","172","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; BORDETELLA","30200118","CDM","302","RC","86615","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; BORDETELLA","30200118","CDM","302","RC","86615","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; LYME'S (WB) CONFIRM","30200119","CDM","302","RC","86617","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; LYME'S (WB) CONFIRM","30200119","CDM","302","RC","86617","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; LYME'S (WB) CONFIRM","30200119","CDM","302","RC","86617","HCPCS","facility","both","","","","140","140","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; LYME'S (WB) CONFIRM","30200119","CDM","302","RC","86617","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; LYME'S DISEASE","30200120","CDM","302","RC","86618","HCPCS","facility","both","","","","203","203","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; LYME'S DISEASE","30200120","CDM","302","RC","86618","HCPCS","facility","both","","","","140","140","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; LYME'S DISEASE","30200120","CDM","302","RC","86618","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; LYME'S DISEASE","30200120","CDM","302","RC","86618","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; BRUCELLA","30200121","CDM","302","RC","86622","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; BRUCELLA","30200121","CDM","302","RC","86622","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; BRUCELLA","30200121","CDM","302","RC","86622","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; BRUCELLA","30200121","CDM","302","RC","86622","HCPCS","facility","both","","","","240","240","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; CANDIDA","30200122","CDM","302","RC","86628","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; CANDIDA","30200122","CDM","302","RC","86628","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; CANDIDA","30200122","CDM","302","RC","86628","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; CANDIDA","30200122","CDM","302","RC","86628","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; CHLAMYDIA","30200123","CDM","302","RC","86631","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; CHLAMYDIA","30200123","CDM","302","RC","86631","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; CHLAMYDIA","30200123","CDM","302","RC","86631","HCPCS","facility","both","","","","436","436","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; CHLAMYDIA","30200123","CDM","302","RC","86631","HCPCS","facility","both","","","","29","29","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; CHLAMYDIA IGM","30200124","CDM","302","RC","86632","HCPCS","facility","both","","","","29","29","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; CHLAMYDIA IGM","30200124","CDM","302","RC","86632","HCPCS","facility","both","","","","436","436","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; CHLAMYDIA IGM","30200124","CDM","302","RC","86632","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; CHLAMYDIA IGM","30200124","CDM","302","RC","86632","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; COCCIDIOIDES","30200125","CDM","302","RC","86635","HCPCS","facility","both","","","","71.5","71.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; COCCIDIOIDES","30200125","CDM","302","RC","86635","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; COCCIDIOIDES","30200125","CDM","302","RC","86635","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; COCCIDIOIDES","30200125","CDM","302","RC","86635","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; COXIELLA BRUNETII","30200126","CDM","302","RC","86638","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; COXIELLA BRUNETII","30200126","CDM","302","RC","86638","HCPCS","facility","both","","","","174","174","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; COXIELLA BRUNETII","30200126","CDM","302","RC","86638","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; COXIELLA BRUNETII","30200126","CDM","302","RC","86638","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; CMV","30200127","CDM","302","RC","86644","HCPCS","facility","both","","","","41","41","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; CMV","30200127","CDM","302","RC","86644","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; CMV","30200127","CDM","302","RC","86644","HCPCS","facility","both","","","","410","410","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; CMV","30200127","CDM","302","RC","86644","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; CMV  IGM","30200128","CDM","302","RC","86645","HCPCS","facility","both","","","","64","64","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; CMV  IGM","30200128","CDM","302","RC","86645","HCPCS","facility","both","","","","382","382","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; CMV  IGM","30200128","CDM","302","RC","86645","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; CMV  IGM","30200128","CDM","302","RC","86645","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; DIPHTHERIA","30200129","CDM","302","RC","86648","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; DIPHTHERIA","30200129","CDM","302","RC","86648","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; DIPHTHERIA","30200129","CDM","302","RC","86648","HCPCS","facility","both","","","","181","181","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; DIPHTHERIA","30200129","CDM","302","RC","86648","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; ENCEPHALITIS CALIF","30200130","CDM","302","RC","86651","HCPCS","facility","both","","","","98.39","98.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; ENCEPHALITIS CALIF","30200130","CDM","302","RC","86651","HCPCS","facility","both","","","","54","54","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; ENCEPHALITIS CALIF","30200130","CDM","302","RC","86651","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; ENCEPHALITIS CALIF","30200130","CDM","302","RC","86651","HCPCS","facility","both","","","","125.95","125.95","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; ENCEPHALITIS E EQUINE","30200131","CDM","302","RC","86652","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; ENCEPHALITIS E EQUINE","30200131","CDM","302","RC","86652","HCPCS","facility","both","","","","54","54","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; ENCEPHALITIS E EQUINE","30200131","CDM","302","RC","86652","HCPCS","facility","both","","","","98.39","98.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; ENCEPHALITIS E EQUINE","30200131","CDM","302","RC","86652","HCPCS","facility","both","","","","125.95","125.95","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; ENCEPHALITIS ST. LOUIS","30200132","CDM","302","RC","86653","HCPCS","facility","both","","","","125.95","125.95","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; ENCEPHALITIS ST. LOUIS","30200132","CDM","302","RC","86653","HCPCS","facility","both","","","","98.39","98.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; ENCEPHALITIS ST. LOUIS","30200132","CDM","302","RC","86653","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; ENCEPHALITIS ST. LOUIS","30200132","CDM","302","RC","86653","HCPCS","facility","both","","","","54","54","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; ENCEPHALITIS W EQUINE","30200133","CDM","302","RC","86654","HCPCS","facility","both","","","","98.39","98.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; ENCEPHALITIS W EQUINE","30200133","CDM","302","RC","86654","HCPCS","facility","both","","","","125.95","125.95","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; ENCEPHALITIS W EQUINE","30200133","CDM","302","RC","86654","HCPCS","facility","both","","","","54","54","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; ENCEPHALITIS W EQUINE","30200133","CDM","302","RC","86654","HCPCS","facility","both","","","","174","174","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; ENTEROVIRUS","30200134","CDM","302","RC","86658","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; ENTEROVIRUS","30200134","CDM","302","RC","86658","HCPCS","facility","both","","","","58.5","58.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; ENTEROVIRUS","30200134","CDM","302","RC","86658","HCPCS","facility","both","","","","1705","1705","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; ENTEROVIRUS","30200134","CDM","302","RC","86658","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; EPSTEIN BARR VCA","30200135","CDM","302","RC","86665","HCPCS","facility","both","","","","125.95","125.95","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; EPSTEIN BARR VCA","30200135","CDM","302","RC","86665","HCPCS","facility","both","","","","66","66","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AB; EPSTEIN BARR VCA","30200135","CDM","302","RC","86665","HCPCS","facility","both","","","","98.39","98.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; EPSTEIN BARR VCA","30200135","CDM","302","RC","86665","HCPCS","facility","both","","","","196","196","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; EPSTEIN BARR VCA","30200135","CDM","302","RC","86665","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; ERLICHIA","30200136","CDM","302","RC","86666","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; ERLICHIA","30200136","CDM","302","RC","86666","HCPCS","facility","both","","","","1054","1054","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; ERLICHIA","30200136","CDM","302","RC","86666","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; ERLICHIA","30200136","CDM","302","RC","86666","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; FUNGUS NES (70)","30200137","CDM","302","RC","86671","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; FUNGUS NES (70)","30200137","CDM","302","RC","86671","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; FUNGUS NES (70)","30200137","CDM","302","RC","86671","HCPCS","facility","both","","","","155","155","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; FUNGUS NES (70)","30200137","CDM","302","RC","86671","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HELICOBACTER PYLORI","30200138","CDM","302","RC","86677","HCPCS","facility","both","","","","88","88","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HELICOBACTER PYLORI","30200138","CDM","302","RC","86677","HCPCS","facility","both","","","","211","211","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HELICOBACTER PYLORI","30200138","CDM","302","RC","86677","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HELICOBACTER PYLORI","30200138","CDM","302","RC","86677","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HELMINTH NES","30200139","CDM","302","RC","86682","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HELMINTH NES","30200139","CDM","302","RC","86682","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HELMINTH NES","30200139","CDM","302","RC","86682","HCPCS","facility","both","","","","178","178","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HELMINTH NES","30200139","CDM","302","RC","86682","HCPCS","facility","both","","","","68","68","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HTLV-I","30200140","CDM","302","RC","86687","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HTLV-I","30200140","CDM","302","RC","86687","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HTLV-I","30200140","CDM","302","RC","86687","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HTLV-II","30200141","CDM","302","RC","86688","HCPCS","facility","both","","","","23","23","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HTLV-II","30200141","CDM","302","RC","86688","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HTLV-II","30200141","CDM","302","RC","86688","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HTLV-II","30200141","CDM","302","RC","86688","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HTLV OR HIV WB","30200142","CDM","302","RC","86689","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HTLV OR HIV WB","30200142","CDM","302","RC","86689","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AB; HTLV OR HIV WB","30200142","CDM","302","RC","86689","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HTLV OR HIV WB","30200142","CDM","302","RC","86689","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HTLV OR HIV WB","30200142","CDM","302","RC","86689","HCPCS","facility","both","","","","750","750","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HEPATITIS D","30200143","CDM","302","RC","86692","HCPCS","facility","both","","","","162","162","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HEPATITIS D","30200143","CDM","302","RC","86692","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HEPATITIS D","30200143","CDM","302","RC","86692","HCPCS","facility","both","","","","98","98","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HEPATITIS D","30200143","CDM","302","RC","86692","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HSV 1","30200144","CDM","302","RC","86695","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HSV 1","30200144","CDM","302","RC","86695","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HSV 1","30200144","CDM","302","RC","86695","HCPCS","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HSV 1","30200144","CDM","302","RC","86695","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HSV TYPE 2","30200145","CDM","302","RC","86696","HCPCS","facility","both","","","","106","106","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HSV TYPE 2","30200145","CDM","302","RC","86696","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HSV TYPE 2","30200145","CDM","302","RC","86696","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HSV TYPE 2","30200145","CDM","302","RC","86696","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HIV-1","30200146","CDM","302","RC","86701","HCPCS","facility","both","","","","230","230","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HIV-1","30200146","CDM","302","RC","86701","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HIV-1","30200146","CDM","302","RC","86701","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HIV-1","30200146","CDM","302","RC","86701","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HIV-1","30200146","CDM","302","RC","86701","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AB; HBCAB - TOTAL","30200147","CDM","302","RC","86704","HCPCS","facility","both","","","","177","177","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HBCAB - TOTAL","30200147","CDM","302","RC","86704","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HBCAB - TOTAL","30200147","CDM","302","RC","86704","HCPCS","facility","both","","","","18","18","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AB; HBCAB - TOTAL","30200147","CDM","302","RC","86704","HCPCS","facility","both","","","","21","21","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HBCAB - TOTAL","30200147","CDM","302","RC","86704","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HBCAB - TOTAL","30200147","CDM","302","RC","86704","HCPCS","facility","both","","","","12.05","12.05","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC AB: HBCAB -  IGM AB","30200148","CDM","302","RC","86705","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AB: HBCAB -  IGM AB","30200148","CDM","302","RC","86705","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB: HBCAB -  IGM AB","30200148","CDM","302","RC","86705","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AB: HBCAB -  IGM AB","30200148","CDM","302","RC","86705","HCPCS","facility","both","","","","230","230","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB: HBCAB -  IGM AB","30200148","CDM","302","RC","86705","HCPCS","facility","both","","","","66","66","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB: HBCAB -  IGM AB","30200148","CDM","302","RC","86705","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB: HBSAB","30200149","CDM","302","RC","86706","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB: HBSAB","30200149","CDM","302","RC","86706","HCPCS","facility","both","","","","10.74","10.74","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC AB: HBSAB","30200149","CDM","302","RC","86706","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AB: HBSAB","30200149","CDM","302","RC","86706","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB: HBSAB","30200149","CDM","302","RC","86706","HCPCS","facility","both","","","","11","11","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AB: HBSAB","30200149","CDM","302","RC","86706","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB: HBSAB","30200149","CDM","302","RC","86706","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HBEAB","30200150","CDM","302","RC","86707","HCPCS","facility","both","","","","266","266","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HBEAB","30200150","CDM","302","RC","86707","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HBEAB","30200150","CDM","302","RC","86707","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HBEAB","30200150","CDM","302","RC","86707","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HAAB - TOTAL","30200151","CDM","302","RC","86708","HCPCS","facility","both","","","","36.5","36.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HAAB - TOTAL","30200151","CDM","302","RC","86708","HCPCS","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HAAB - TOTAL","30200151","CDM","302","RC","86708","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HAAB - TOTAL","30200151","CDM","302","RC","86708","HCPCS","facility","both","","","","12.39","12.39","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC AB; HAAB - TOTAL","30200151","CDM","302","RC","86708","HCPCS","facility","both","","","","18","18","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AB; HAAB - TOTAL","30200151","CDM","302","RC","86708","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB: HAAB - IGM","30200152","CDM","302","RC","86709","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AB: HAAB - IGM","30200152","CDM","302","RC","86709","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB: HAAB - IGM","30200152","CDM","302","RC","86709","HCPCS","facility","both","","","","327","327","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB: HAAB - IGM","30200152","CDM","302","RC","86709","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB: HAAB - IGM","30200152","CDM","302","RC","86709","HCPCS","facility","both","","","","62","62","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB: HAAB - IGM","30200152","CDM","302","RC","86709","HCPCS","facility","both","","","","30.25","30.25","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AB; INFLUENZA VIRUS","30200153","CDM","302","RC","86710","HCPCS","facility","both","","","","76","76","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; INFLUENZA VIRUS","30200153","CDM","302","RC","86710","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; INFLUENZA VIRUS","30200153","CDM","302","RC","86710","HCPCS","facility","both","","","","19.5","19.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; INFLUENZA VIRUS","30200153","CDM","302","RC","86710","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; LEGIONELLA","30200154","CDM","302","RC","86713","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; LEGIONELLA","30200154","CDM","302","RC","86713","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; LEGIONELLA","30200154","CDM","302","RC","86713","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; LEGIONELLA","30200154","CDM","302","RC","86713","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC AB; LEGIONELLA","30200154","CDM","302","RC","86713","HCPCS","facility","both","","","","222","222","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; LEISHMANIA","30200155","CDM","302","RC","86717","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; LEISHMANIA","30200155","CDM","302","RC","86717","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; LEISHMANIA","30200155","CDM","302","RC","86717","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; LEPTOSPIRA","30200156","CDM","302","RC","86720","HCPCS","facility","both","","","","633","633","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; LEPTOSPIRA","30200156","CDM","302","RC","86720","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; LEPTOSPIRA","30200156","CDM","302","RC","86720","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; LEPTOSPIRA","30200156","CDM","302","RC","86720","HCPCS","facility","both","","","","37","37","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; LCM","30200157","CDM","302","RC","86727","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; LCM","30200157","CDM","302","RC","86727","HCPCS","facility","both","","","","242","242","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; LCM","30200157","CDM","302","RC","86727","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; LCM","30200157","CDM","302","RC","86727","HCPCS","facility","both","","","","128","128","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; MUMPS","30200158","CDM","302","RC","86735","HCPCS","facility","both","","","","22","22","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; MUMPS","30200158","CDM","302","RC","86735","HCPCS","facility","both","","","","11","11","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AB; MUMPS","30200158","CDM","302","RC","86735","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; MUMPS","30200158","CDM","302","RC","86735","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AB; MUMPS","30200158","CDM","302","RC","86735","HCPCS","facility","both","","","","293","293","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; MUMPS","30200158","CDM","302","RC","86735","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; MYCOPLASMA","30200159","CDM","302","RC","86738","HCPCS","facility","both","","","","402","402","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; MYCOPLASMA","30200159","CDM","302","RC","86738","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; MYCOPLASMA","30200159","CDM","302","RC","86738","HCPCS","facility","both","","","","31","31","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; MYCOPLASMA","30200159","CDM","302","RC","86738","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; NEISSERIA MENINGITIDIS","30200160","CDM","302","RC","86741","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; NEISSERIA MENINGITIDIS","30200160","CDM","302","RC","86741","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; NEISSERIA MENINGITIDIS","30200160","CDM","302","RC","86741","HCPCS","facility","both","","","","157","157","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; NEISSERIA MENINGITIDIS","30200160","CDM","302","RC","86741","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; PARVOVIRUS","30200161","CDM","302","RC","86747","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; PARVOVIRUS","30200161","CDM","302","RC","86747","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; PARVOVIRUS","30200161","CDM","302","RC","86747","HCPCS","facility","both","","","","66","66","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; PARVOVIRUS","30200161","CDM","302","RC","86747","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BABESIA MICROTI ANTIBODY","30200162","CDM","302","RC","86753","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BABESIA MICROTI ANTIBODY","30200162","CDM","302","RC","86753","HCPCS","facility","both","","","","422","422","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BABESIA MICROTI ANTIBODY","30200162","CDM","302","RC","86753","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRYPANOSOMA CRUZI IGG","30200163","CDM","302","RC","86753","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TRYPANOSOMA CRUZI IGG","30200163","CDM","302","RC","86753","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRYPANOSOMA CRUZI IGG","30200163","CDM","302","RC","86753","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TRYPANOSOMA CRUZI IGG","30200163","CDM","302","RC","86753","HCPCS","facility","both","","","","88","88","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AB; PROTOZOA NES","30200164","CDM","302","RC","86753","HCPCS","facility","both","","","","68","68","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; RSV","30200165","CDM","302","RC","86756","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; RSV","30200165","CDM","302","RC","86756","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; RSV","30200165","CDM","302","RC","86756","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; RSV","30200165","CDM","302","RC","86756","HCPCS","facility","both","","","","67","67","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; RICKETTSIA","30200166","CDM","302","RC","86757","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; RICKETTSIA","30200166","CDM","302","RC","86757","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; RICKETTSIA","30200166","CDM","302","RC","86757","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; RICKETTSIA","30200166","CDM","302","RC","86757","HCPCS","facility","both","","","","230","230","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; RUBELLA","30200167","CDM","302","RC","86762","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; RUBELLA","30200167","CDM","302","RC","86762","HCPCS","facility","both","","","","28.75","28.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; RUBELLA","30200167","CDM","302","RC","86762","HCPCS","facility","both","","","","11","11","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AB; RUBELLA","30200167","CDM","302","RC","86762","HCPCS","facility","both","","","","349","349","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; RUBELLA","30200167","CDM","302","RC","86762","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AB; RUBELLA","30200167","CDM","302","RC","86762","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; RUBEOLA","30200168","CDM","302","RC","86765","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; RUBEOLA","30200168","CDM","302","RC","86765","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; RUBEOLA","30200168","CDM","302","RC","86765","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AB; RUBEOLA","30200168","CDM","302","RC","86765","HCPCS","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; RUBEOLA","30200168","CDM","302","RC","86765","HCPCS","facility","both","","","","11","11","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AB; RUBEOLA","30200168","CDM","302","RC","86765","HCPCS","facility","both","","","","312","312","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; SALMONELLA","30200169","CDM","302","RC","86768","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; SALMONELLA","30200169","CDM","302","RC","86768","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; SALMONELLA","30200169","CDM","302","RC","86768","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; SALMONELLA","30200169","CDM","302","RC","86768","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; TETANUS","30200170","CDM","302","RC","86774","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; TETANUS","30200170","CDM","302","RC","86774","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; TETANUS","30200170","CDM","302","RC","86774","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; TETANUS","30200170","CDM","302","RC","86774","HCPCS","facility","both","","","","175","175","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; TOXOPLASMA","30200171","CDM","302","RC","86777","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; TOXOPLASMA","30200171","CDM","302","RC","86777","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; TOXOPLASMA","30200171","CDM","302","RC","86777","HCPCS","facility","both","","","","148","148","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; TOXOPLASMA","30200171","CDM","302","RC","86777","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; TOXOPLASMA IGM","30200172","CDM","302","RC","86778","HCPCS","facility","both","","","","148","148","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; TOXOPLASMA IGM","30200172","CDM","302","RC","86778","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; TOXOPLASMA IGM","30200172","CDM","302","RC","86778","HCPCS","facility","both","","","","59","59","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; TOXOPLASMA IGM","30200172","CDM","302","RC","86778","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TREPONEMA PALLIDUM","30200173","CDM","302","RC","86780","HCPCS","facility","both","","","","255","255","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TREPONEMA PALLIDUM","30200173","CDM","302","RC","86780","HCPCS","facility","both","","","","35.59","35.59","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TREPONEMA PALLIDUM","30200173","CDM","302","RC","86780","HCPCS","facility","both","","","","45.55","45.55","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TREPONEMA PALLIDUM","30200173","CDM","302","RC","86780","HCPCS","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TREPONEMA PALLIDUM","30200173","CDM","302","RC","86780","HCPCS","facility","both","","","","13.24","13.24","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC TREPONEMA PALLIDUM","30200173","CDM","302","RC","86780","HCPCS","facility","both","","","","14.5","14.5","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AB; TRICHINELLA","30200174","CDM","302","RC","86784","HCPCS","facility","both","","","","266","266","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; TRICHINELLA","30200174","CDM","302","RC","86784","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; TRICHINELLA","30200174","CDM","302","RC","86784","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; TRICHINELLA","30200174","CDM","302","RC","86784","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; VARICELLA-ZOSTER","30200175","CDM","302","RC","86787","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; VARICELLA-ZOSTER","30200175","CDM","302","RC","86787","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; VARICELLA-ZOSTER","30200175","CDM","302","RC","86787","HCPCS","facility","both","","","","313","313","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; VARICELLA-ZOSTER","30200175","CDM","302","RC","86787","HCPCS","facility","both","","","","11","11","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AB; VARICELLA-ZOSTER","30200175","CDM","302","RC","86787","HCPCS","facility","both","","","","48.5","48.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC WEST NILE VIRUS AB IGM","30200176","CDM","302","RC","86788","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC WEST NILE VIRUS AB IGM","30200176","CDM","302","RC","86788","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC WEST NILE VIRUS AB IGM","30200176","CDM","302","RC","86788","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC WEST NILE VIRUS AB IGM","30200176","CDM","302","RC","86788","HCPCS","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC WEST NILE VIRUS ANTIBODY","30200177","CDM","302","RC","86789","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC WEST NILE VIRUS ANTIBODY","30200177","CDM","302","RC","86789","HCPCS","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC WEST NILE VIRUS ANTIBODY","30200177","CDM","302","RC","86789","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DENGUE FEVER ANTIBODY, IGG","30200178","CDM","302","RC","86790","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DENGUE FEVER ANTIBODY, IGG","30200178","CDM","302","RC","86790","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DENGUE FEVER ANTIBODY, IGG","30200178","CDM","302","RC","86790","HCPCS","facility","both","","","","564","564","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DENGUE FEVER ANTIBODY, IGG","30200178","CDM","302","RC","86790","HCPCS","facility","both","","","","76","76","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPATITIS E ANTIBODY IGG","30200179","CDM","302","RC","86790","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPATITIS E ANTIBODY IGG","30200179","CDM","302","RC","86790","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEPATITIS E ANTIBODY IGG","30200179","CDM","302","RC","86790","HCPCS","facility","both","","","","75.36","75.36","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEPATITIS E ANTIBODY IGG","30200179","CDM","302","RC","86790","HCPCS","facility","both","","","","96.46","96.46","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEPATITIS E ANTIBODY IGM","30200180","CDM","302","RC","86790","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPATITIS E ANTIBODY IGM","30200180","CDM","302","RC","86790","HCPCS","facility","both","","","","150.06","150.06","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEPATITIS E ANTIBODY IGM","30200180","CDM","302","RC","86790","HCPCS","facility","both","","","","117.23","117.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEPATITIS E ANTIBODY IGM","30200180","CDM","302","RC","86790","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHIKUNGUNYA ANTIBODY W REFLEX","30200181","CDM","302","RC","86790","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHIKUNGUNYA ANTIBODY W REFLEX","30200181","CDM","302","RC","86790","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHIKUNGUNYA ANTIBODY W REFLEX","30200181","CDM","302","RC","86790","HCPCS","facility","both","","","","290","290","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HUNTAVIRUS ANTIBODIES ELISA","30200182","CDM","302","RC","86790","HCPCS","facility","both","","","","167","167","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HUNTAVIRUS ANTIBODIES ELISA","30200182","CDM","302","RC","86790","HCPCS","facility","both","","","","154.91","154.91","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HUNTAVIRUS ANTIBODIES ELISA","30200182","CDM","302","RC","86790","HCPCS","facility","both","","","","198.3","198.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HERPES 8 IGG AB, IFA","30200183","CDM","302","RC","86790","HCPCS","facility","both","","","","348.35","348.35","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HERPES 8 IGG AB, IFA","30200183","CDM","302","RC","86790","HCPCS","facility","both","","","","272.15","272.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HERPES 8 IGG AB, IFA","30200183","CDM","302","RC","86790","HCPCS","facility","both","","","","191","191","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"DEAC 2/8/2017 HC PARAINFLUENZA AB TYPE 1,2,3","30200184","CDM","302","RC","86790","HCPCS","facility","both","","","","442.26","442.26","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 2/8/2017 HC PARAINFLUENZA AB TYPE 1,2,3","30200184","CDM","302","RC","86790","HCPCS","facility","both","","","","421","421","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"DEAC 2/8/2017 HC PARAINFLUENZA AB TYPE 1,2,3","30200184","CDM","302","RC","86790","HCPCS","facility","both","","","","27.97","27.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; VIRUS NES","30200185","CDM","302","RC","86790","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB: THYROGLOBULIN","30200186","CDM","302","RC","86800","HCPCS","facility","both","","","","186","186","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB: THYROGLOBULIN","30200186","CDM","302","RC","86800","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB: THYROGLOBULIN","30200186","CDM","302","RC","86800","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB: THYROGLOBULIN","30200186","CDM","302","RC","86800","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB: THYROGLOBULIN","30200186","CDM","302","RC","86800","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC HEPATITIS C AB","30200187","CDM","302","RC","86803","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC HEPATITIS C AB","30200187","CDM","302","RC","86803","HCPCS","facility","both","","","","28.5","28.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPATITIS C AB","30200187","CDM","302","RC","86803","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEPATITIS C AB","30200187","CDM","302","RC","86803","HCPCS","facility","both","","","","27.5","27.5","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC HEPATITIS C AB","30200187","CDM","302","RC","86803","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEPATITIS C AB","30200187","CDM","302","RC","86803","HCPCS","facility","both","","","","241","241","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEPATITIS C CONFIRMATION","30200188","CDM","302","RC","86804","HCPCS","facility","both","","","","5614","5614","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEPATITIS C CONFIRMATION","30200188","CDM","302","RC","86804","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HLA TYPE; A B C SGL AG","30200189","CDM","302","RC","86812","HCPCS","facility","both","","","","583","583","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA TYPE; A B C SGL AG","30200189","CDM","302","RC","86812","HCPCS","facility","both","","","","94.2","94.2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA TYPE; A B C SGL AG","30200189","CDM","302","RC","86812","HCPCS","facility","both","","","","120.59","120.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA TYPE; A B C SGL AG","30200189","CDM","302","RC","86812","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COOMBS TEST INDIRECT QUAL","30200191","CDM","300","RC","86885","HCPCS","facility","both","","","","278","278","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COOMBS TEST INDIRECT QUAL","30200191","CDM","300","RC","86885","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COOMBS TEST INDIRECT QUAL","30200191","CDM","300","RC","86885","HCPCS","facility","both","","","","25.12","25.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COOMBS TEST INDIRECT QUAL","30200191","CDM","300","RC","86885","HCPCS","facility","both","","","","32.16","32.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FFP THAWING EA UNIT","30200192","CDM","300","RC","86927","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FFP THAWING EA UNIT","30200192","CDM","300","RC","86927","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FFP THAWING EA UNIT","30200192","CDM","300","RC","86927","HCPCS","facility","both","","","","1412","1412","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FFP THAWING EA UNIT","30200192","CDM","300","RC","86927","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SERUM PRETX; DRUG INCUBATE","30200193","CDM","300","RC","86975","HCPCS","facility","both","","","","523","523","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SERUM PRETX; DRUG INCUBATE","30200193","CDM","300","RC","86975","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SERUM PRETX; DRUG INCUBATE","30200193","CDM","300","RC","86975","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SERUM PRETX; DRUG INCUBATE","30200193","CDM","300","RC","86975","HCPCS","facility","both","","","","62","62","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPATITIS DELTA AG EIA","30200194","CDM","306","RC","87380","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEPATITIS DELTA AG EIA","30200194","CDM","306","RC","87380","HCPCS","facility","both","","","","130","130","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPATITIS DELTA AG EIA","30200194","CDM","306","RC","87380","HCPCS","facility","both","","","","216","216","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEPATITIS DELTA AG EIA","30200194","CDM","306","RC","87380","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHLAMYDIA P DIR NA PROBE","30200195","CDM","306","RC","87485","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHLAMYDIA P DIR NA PROBE","30200195","CDM","306","RC","87485","HCPCS","facility","both","","","","265","265","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHLAMYDIA P DIR NA PROBE","30200195","CDM","306","RC","87485","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHLAMYDIA P DIR NA PROBE","30200195","CDM","306","RC","87485","HCPCS","facility","both","","","","189","189","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEP-C NA QUAN","30200196","CDM","306","RC","87522","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEP-C NA QUAN","30200196","CDM","306","RC","87522","HCPCS","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEP-C NA QUAN","30200196","CDM","306","RC","87522","HCPCS","facility","both","","","","42.84","42.84","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC HEP-C NA QUAN","30200196","CDM","306","RC","87522","HCPCS","facility","both","","","","108","108","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC HEP-C NA QUAN","30200196","CDM","306","RC","87522","HCPCS","facility","both","","","","972","972","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEP-C NA QUAN","30200196","CDM","306","RC","87522","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HERPES 6 AMPLIF NA PROBE","30200197","CDM","306","RC","87532","HCPCS","facility","both","","","","460","460","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HERPES 6 AMPLIF NA PROBE","30200197","CDM","306","RC","87532","HCPCS","facility","both","","","","195","195","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HIV-1 NA QUAN","30200198","CDM","306","RC","87536","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HIV-1 NA QUAN","30200198","CDM","306","RC","87536","HCPCS","facility","both","","","","96","96","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HIV-1 NA QUAN","30200198","CDM","306","RC","87536","HCPCS","facility","both","","","","96","96","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC HIV-1 NA QUAN","30200198","CDM","306","RC","87536","HCPCS","facility","both","","","","972","972","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HIV-1 NA QUAN","30200198","CDM","306","RC","87536","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MYCOPLASMA AMPLIF NA PROBE","30200199","CDM","306","RC","87581","HCPCS","facility","both","","","","460","460","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MYCOPLASMA AMPLIF NA PROBE","30200199","CDM","306","RC","87581","HCPCS","facility","both","","","","189","189","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MYCOPLASMA AMPLIF NA PROBE","30200199","CDM","306","RC","87581","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MYCOPLASMA AMPLIF NA PROBE","30200199","CDM","306","RC","87581","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HPV HI RISK TYPES","30200200","CDM","306","RC","87624","HCPCS","facility","both","","","","189","189","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HPV HI RISK TYPES","30200200","CDM","306","RC","87624","HCPCS","facility","both","","","","215","215","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HPV HI RISK TYPES","30200200","CDM","306","RC","87624","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HPV HI RISK TYPES","30200200","CDM","306","RC","87624","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DRUG SCREEN MULTIPLE CLASS","30200201","CDM","301","RC","","","facility","both","","","","162","162","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ELISA HIV-1/HIV-2 SCREEN","30200202","CDM","302","RC","","","facility","both","","","","162","162","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANTI-PHOSPHATIDYLSERINE AB","30200250","CDM","302","RC","86148","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTI-PHOSPHATIDYLSERINE AB","30200250","CDM","302","RC","86148","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTI-PHOSPHATIDYLSERINE AB","30200250","CDM","302","RC","86148","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTI-PHOSPHATIDYLSERINE AB","30200250","CDM","302","RC","86148","HCPCS","facility","both","","","","54","54","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPLEMENT FIXATION EA AG","30200251","CDM","302","RC","86171","HCPCS","facility","both","","","","293","293","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COUNTER IEP EA AG","30200252","CDM","302","RC","86185","HCPCS","facility","both","","","","459","459","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HETEROPHILE AB; TITER AFTER ABSORPT","30200253","CDM","302","RC","86310","HCPCS","facility","both","","","","186","186","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IA INFECTIOUS AGENT SGL STEP","30200254","CDM","302","RC","86318","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IA INFECTIOUS AGENT SGL STEP","30200254","CDM","302","RC","86318","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IA INFECTIOUS AGENT SGL STEP","30200254","CDM","302","RC","86318","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IEP; SERUM","30200255","CDM","302","RC","86320","HCPCS","facility","both","","","","713","713","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IEP; NOT SERUM","30200256","CDM","302","RC","86325","HCPCS","facility","both","","","","474","474","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUNODIFFUSION; NES","30200257","CDM","302","RC","86329","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNODIFFUSION; NES","30200257","CDM","302","RC","86329","HCPCS","facility","both","","","","552","552","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUNODIFFUSION; NES","30200257","CDM","302","RC","86329","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PA; SCREEN EA AB","30200258","CDM","302","RC","86403","HCPCS","facility","both","","","","81","81","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PA; SCREEN EA AB","30200258","CDM","302","RC","86403","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PA; SCREEN EA AB","30200258","CDM","302","RC","86403","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PA; SCREEN EA AB","30200258","CDM","302","RC","86403","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUAN RHEUM FACTOR","30200259","CDM","302","RC","86431","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC QUAN RHEUM FACTOR","30200259","CDM","302","RC","86431","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUAN RHEUM FACTOR","30200259","CDM","302","RC","86431","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC QUAN RHEUM FACTOR","30200259","CDM","302","RC","86431","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; CRYPTOCOCCUS","30200260","CDM","302","RC","86641","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; CRYPTOCOCCUS","30200260","CDM","302","RC","86641","HCPCS","facility","both","","","","171","171","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; CRYPTOCOCCUS","30200260","CDM","302","RC","86641","HCPCS","facility","both","","","","98.39","98.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; CRYPTOCOCCUS","30200260","CDM","302","RC","86641","HCPCS","facility","both","","","","125.95","125.95","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; EB EARLY AG VIRUS","30200261","CDM","302","RC","86663","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; EB EARLY AG VIRUS","30200261","CDM","302","RC","86663","HCPCS","facility","both","","","","156","156","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; EB EARLY AG VIRUS","30200261","CDM","302","RC","86663","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; EB EARLY AG VIRUS","30200261","CDM","302","RC","86663","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; EBNA","30200262","CDM","302","RC","86664","HCPCS","facility","both","","","","186","186","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; EBNA","30200262","CDM","302","RC","86664","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; EBNA","30200262","CDM","302","RC","86664","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; EBNA","30200262","CDM","302","RC","86664","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; FRANCISELLA TULARENSIS","30200263","CDM","302","RC","86668","HCPCS","facility","both","","","","125.95","125.95","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; FRANCISELLA TULARENSIS","30200263","CDM","302","RC","86668","HCPCS","facility","both","","","","160","160","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; FRANCISELLA TULARENSIS","30200263","CDM","302","RC","86668","HCPCS","facility","both","","","","98.39","98.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; HSV NON-SPECIFIC","30200264","CDM","302","RC","86694","HCPCS","facility","both","","","","186","186","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HISTOPLASMA","30200265","CDM","302","RC","86698","HCPCS","facility","both","","","","472","472","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; HISTOPLASMA","30200265","CDM","302","RC","86698","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; HISTOPLASMA","30200265","CDM","302","RC","86698","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; HISTOPLASMA","30200265","CDM","302","RC","86698","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HIV-1/HIV-2 SINGLE RESULT","30200266","CDM","302","RC","86703","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HIV-1/HIV-2 SINGLE RESULT","30200266","CDM","302","RC","86703","HCPCS","facility","both","","","","382","382","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HIV-1/HIV-2 SINGLE RESULT","30200266","CDM","302","RC","86703","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HIV-1/HIV-2 SINGLE RESULT","30200266","CDM","302","RC","86703","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASO ; TITER","30200268","CDM","302","RC","86060","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASO ; TITER","30200268","CDM","302","RC","86060","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASO ; TITER","30200268","CDM","302","RC","86060","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASO ; TITER","30200268","CDM","302","RC","86060","HCPCS","facility","both","","","","240","240","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DNA AB; SS","30200269","CDM","302","RC","86226","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DNA AB; SS","30200269","CDM","302","RC","86226","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DNA AB; SS","30200269","CDM","302","RC","86226","HCPCS","facility","both","","","","143","143","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DNA AB; SS","30200269","CDM","302","RC","86226","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEMAGGLUT INHIBITION TEST","30200270","CDM","302","RC","86280","HCPCS","facility","both","","","","98","98","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; ACTINOMYCES","30200271","CDM","302","RC","86602","HCPCS","facility","both","","","","122","122","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CELL ENUMERATION & ID","30200272","CDM","302","RC","86152","HCPCS","facility","both","","","","667","667","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CELL ENUMERATION & ID","30200272","CDM","302","RC","86152","HCPCS","facility","both","","","","795.51","795.51","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CELL ENUMERATION & ID","30200272","CDM","302","RC","86152","HCPCS","facility","both","","","","2014","2014","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CELL ENUMERATION & ID","30200272","CDM","302","RC","86152","HCPCS","facility","both","","","","1018.26","1018.26","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB ID; LEUKOCYTE AB","30200275","CDM","302","RC","86021","HCPCS","facility","both","","","","289","289","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB ID; LEUKOCYTE AB","30200275","CDM","302","RC","86021","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB ID; LEUKOCYTE AB","30200275","CDM","302","RC","86021","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB ID; LEUKOCYTE AB","30200275","CDM","302","RC","86021","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INVESTIG TRANSFUS REACTION","30200276","CDM","302","RC","86078","HCPCS","facility","both","","","","163","163","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CELL ENUMERATION PHYS INTERP","30200277","CDM","302","RC","86153","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC QUAN HETEROPHILE AB","30200278","CDM","302","RC","86309","HCPCS","facility","both","","","","76","76","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LHR TEST","30200279","CDM","302","RC","86343","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LHR TEST","30200279","CDM","302","RC","86343","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LHR TEST","30200279","CDM","302","RC","86343","HCPCS","facility","both","","","","147","147","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SKIN TEST; TB ID","30200280","CDM","302","RC","86580","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SKIN TEST; TB ID","30200280","CDM","302","RC","86580","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; CAMPYLOBACTER","30200281","CDM","302","RC","86625","HCPCS","facility","both","","","","156","156","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; LYMPHOGRANULOMA VENEREUM","30200282","CDM","302","RC","86729","HCPCS","facility","both","","","","202.5","202.5","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; NOCARDIA","30200283","CDM","302","RC","86744","HCPCS","facility","both","","","","308","308","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; YERSINIA","30200284","CDM","302","RC","86793","HCPCS","facility","both","","","","104","104","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PRA SCREEN","30200285","CDM","310","RC","86807","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PRA SCREEN; QUICK METHOD","30200286","CDM","310","RC","86808","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PRA SCREEN; QUICK METHOD","30200286","CDM","310","RC","86808","HCPCS","facility","both","","","","76","76","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PRA SCREEN; QUICK METHOD","30200286","CDM","310","RC","86808","HCPCS","facility","both","","","","125.95","125.95","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PRA SCREEN; QUICK METHOD","30200286","CDM","310","RC","86808","HCPCS","facility","both","","","","109","109","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC PRA SCREEN; QUICK METHOD","30200286","CDM","310","RC","86808","HCPCS","facility","both","","","","98.39","98.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA TYPE; DR/DQ SGL AG","30200287","CDM","310","RC","86816","HCPCS","facility","both","","","","330","330","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA TYPE; MLC","30200288","CDM","310","RC","86821","HCPCS","facility","both","","","","668","668","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC  S CEREVISIAE AB","30200289","CDM","302","RC","86671","HCPCS","facility","both","","","","140","140","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC  S CEREVISIAE AB","30200289","CDM","302","RC","86671","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  S CEREVISIAE AB","30200289","CDM","302","RC","86671","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  S CEREVISIAE AB","30200289","CDM","302","RC","86671","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC E HISTOLYTICA AB","30200290","CDM","302","RC","86753","HCPCS","facility","both","","","","41","41","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC E HISTOLYTICA AB","30200290","CDM","302","RC","86753","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC E HISTOLYTICA AB","30200290","CDM","302","RC","86753","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC E HISTOLYTICA AB","30200290","CDM","302","RC","86753","HCPCS","facility","both","","","","162","162","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UNLISTED IMMUN PROC (1690)","30200291","CDM","302","RC","86849","HCPCS","facility","both","","","","3180","3180","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED IMMUN PROC (1690)","30200291","CDM","302","RC","86849","HCPCS","facility","both","","","","4528.61","4528.61","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED IMMUN PROC (1690)","30200291","CDM","302","RC","86849","HCPCS","facility","both","","","","3537.91","3537.91","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB, VRUS NES (50)","30200292","CDM","302","RC","86790","HCPCS","facility","both","","","","31","31","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB, VRUS NES (50)","30200292","CDM","302","RC","86790","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB, VRUS NES (50)","30200292","CDM","302","RC","86790","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB, VRUS NES (50)","30200292","CDM","302","RC","86790","HCPCS","facility","both","","","","368","368","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TB AG RESPONSE T-CELL SUSP","30200293","CDM","302","RC","86481","HCPCS","facility","both","","","","105","105","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TB AG RESPONSE T-CELL SUSP","30200293","CDM","302","RC","86481","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TB AG RESPONSE T-CELL SUSP","30200293","CDM","302","RC","86481","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TB AG RESPONSE T-CELL SUSP","30200293","CDM","302","RC","86481","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC TB AG RESPONSE T-CELL SUSP","30200293","CDM","302","RC","86481","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC TB AG RESPONSE T-CELL SUSP","30200293","CDM","302","RC","86481","HCPCS","facility","both","","","","62","62","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; FUNGUS NES (5)","30200295","CDM","302","RC","86671","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; FUNGUS NES (5)","30200295","CDM","302","RC","86671","HCPCS","facility","both","","","","73","73","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; FUNGUS NES (5)","30200295","CDM","302","RC","86671","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; FUNGUS NES (60)","30200296","CDM","302","RC","86671","HCPCS","facility","both","","","","423","423","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; FUNGUS NES (60)","30200296","CDM","302","RC","86671","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; FUNGUS NES (60)","30200296","CDM","302","RC","86671","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; FUNGUS NES (60)","30200296","CDM","302","RC","86671","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; FUNGUS NES (65)","30200297","CDM","302","RC","86671","HCPCS","facility","both","","","","174.17","174.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; FUNGUS NES (65)","30200297","CDM","302","RC","86671","HCPCS","facility","both","","","","136.07","136.07","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; PROTOZOA NES (15)","30200298","CDM","302","RC","86753","HCPCS","facility","both","","","","37","37","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; PROTOZOA NES (15)","30200298","CDM","302","RC","86753","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; PROTOZOA NES (15)","30200298","CDM","302","RC","86753","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; VIRUS  NES (15)","30200299","CDM","302","RC","86790","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; VIRUS  NES (15)","30200299","CDM","302","RC","86790","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; VIRUS  NES (15)","30200299","CDM","302","RC","86790","HCPCS","facility","both","","","","61","61","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; VIRUS NES (35)","30200300","CDM","302","RC","86790","HCPCS","facility","both","","","","142","142","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AB; VIRUS NES (35)","30200300","CDM","302","RC","86790","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; VIRUS NES (35)","30200300","CDM","302","RC","86790","HCPCS","facility","both","","","","62","62","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; VIRUS NES (35)","30200300","CDM","302","RC","86790","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB, VIRUS NES (10)","30200301","CDM","302","RC","86790","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB, VIRUS NES (10)","30200301","CDM","302","RC","86790","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB, VIRUS NES (10)","30200301","CDM","302","RC","86790","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HC AB, VIRUS NES (20)","30200302","CDM","302","RC","86790","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HC AB, VIRUS NES (20)","30200302","CDM","302","RC","86790","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HC AB, VIRUS NES (20)","30200302","CDM","302","RC","86790","HCPCS","facility","both","","","","128","128","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HC AB, VIRUS NES (20)","30200302","CDM","302","RC","86790","HCPCS","facility","both","","","","39.64","39.64","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HC AB, VIRUS NES (20)","30200302","CDM","302","RC","86790","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB, VIRUS NES (165)","30200303","CDM","302","RC","86790","HCPCS","facility","both","","","","442.14","442.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB, VIRUS NES (165)","30200303","CDM","302","RC","86790","HCPCS","facility","both","","","","710","710","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AB, VIRUS NES (165)","30200303","CDM","302","RC","86790","HCPCS","facility","both","","","","345.42","345.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; PROTOZOA NES (20)","30200304","CDM","302","RC","86753","HCPCS","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AB; PROTOZOA NES (20)","30200304","CDM","302","RC","86753","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB; PROTOZOA NES (20)","30200304","CDM","302","RC","86753","HCPCS","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB; PROTOZOA NES (20)","30200304","CDM","302","RC","86753","HCPCS","facility","both","","","","38","38","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; PROTOZOA NES (20)","30200304","CDM","302","RC","86753","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ALLG SPEC IGE RECOMB EA","30200305","CDM","302","RC","86008","HCPCS","facility","both","","","","75.03","75.03","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALLG SPEC IGE RECOMB EA","30200305","CDM","302","RC","86008","HCPCS","facility","both","","","","124","124","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALLG SPEC IGE RECOMB EA","30200305","CDM","302","RC","86008","HCPCS","facility","both","","","","58.62","58.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTIBODY; ZIKA VIRUS, IGM","30200306","CDM","302","RC","86794","HCPCS","facility","both","","","","710","710","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANTIBODY; ZIKA VIRUS, IGM","30200306","CDM","302","RC","86794","HCPCS","facility","both","","","","345.42","345.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTIBODY; ZIKA VIRUS, IGM","30200306","CDM","302","RC","86794","HCPCS","facility","both","","","","442.14","442.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTIBODY; ZIKA VIRUS, IGM","30200306","CDM","302","RC","86794","HCPCS","facility","both","","","","285","285","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; SAR SYNDROME CORONAVIRUS 2 (SARS-COV-2) COVID-19, MULTIPLE STEP","30200307","CDM","302","RC","86769","HCPCS","facility","both","","","","190","190","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AB; SAR SYNDROME CORONAVIRUS 2 (SARS-COV-2) COVID-19, MULTIPLE STEP","30200307","CDM","302","RC","86769","HCPCS","facility","both","","","","36.5","36.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB; SAR SYNDROME CORONAVIRUS 2 (SARS-COV-2) COVID-19, MULTIPLE STEP","30200307","CDM","302","RC","86769","HCPCS","facility","both","","","","40.32","40.32","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB; SAR SYNDROME CORONAVIRUS 2 (SARS-COV-2) COVID-19, MULTIPLE STEP","30200307","CDM","302","RC","86769","HCPCS","facility","both","","","","44.87","44.87","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACTIN ANTIBODY EACH","30200308","CDM","302","RC","86015","HCPCS","facility","both","","","","298","298","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACTIN ANTIBODY EACH","30200308","CDM","302","RC","86015","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACTIN ANTIBODY EACH","30200308","CDM","302","RC","86015","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANCA SCREEN EACH ANTIBODY","30200309","CDM","302","RC","86036","HCPCS","facility","both","","","","289","289","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANCA SCREEN EACH ANTIBODY","30200309","CDM","302","RC","86036","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANCA SCREEN EACH ANTIBODY","30200309","CDM","302","RC","86036","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AQUAPORIN-4 ANTB CBA EACH","30200310","CDM","302","RC","86052","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AQUAPORIN-4 ANTB CBA EACH","30200310","CDM","302","RC","86052","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AQUAPORIN-4 ANTB CBA EACH","30200310","CDM","302","RC","86052","HCPCS","facility","both","","","","322","322","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EMA EACH IG CLASS","30200311","CDM","302","RC","86231","HCPCS","facility","both","","","","322","322","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EMA EACH IG CLASS","30200311","CDM","302","RC","86231","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC EMA EACH IG CLASS","30200311","CDM","302","RC","86231","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DGP ANTIBODY EACH IG CLASS","30200312","CDM","302","RC","86258","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DGP ANTIBODY EACH IG CLASS","30200312","CDM","302","RC","86258","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DGP ANTIBODY EACH IG CLASS","30200312","CDM","302","RC","86258","HCPCS","facility","both","","","","322","322","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOG-IGG1 ANTB CBA EACH","30200313","CDM","302","RC","86362","HCPCS","facility","both","","","","322","322","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOG-IGG1 ANTB CBA EACH","30200313","CDM","302","RC","86362","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOG-IGG1 ANTB CBA EACH","30200313","CDM","302","RC","86362","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISS TRNSGL TMNASE EA IG CLASS","30200314","CDM","302","RC","86364","HCPCS","facility","both","","","","298","298","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TISS TRNSGL TMNASE EA IG CLASS","30200314","CDM","302","RC","86364","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TISS TRNSGL TMNASE EA IG CLASS","30200314","CDM","302","RC","86364","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MITOCHONDRIAL ANTIBODY EACH","30200315","CDM","302","RC","86381","HCPCS","facility","both","","","","322","322","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MITOCHONDRIAL ANTIBODY EACH","30200315","CDM","302","RC","86381","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MITOCHONDRIAL ANTIBODY EACH","30200315","CDM","302","RC","86381","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AQAPRN-4 ANTB FLO CYTMTRY EA","30200318","CDM","302","RC","86053","HCPCS","facility","both","","","","734.8","734.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AQAPRN-4 ANTB FLO CYTMTRY EA","30200318","CDM","302","RC","86053","HCPCS","facility","both","","","","940.55","940.55","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VOLTAGE-GTD CA CHNL ANTB EA","30200320","CDM","302","RC","86596","HCPCS","facility","both","","","","1589.04","1589.04","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VOLTAGE-GTD CA CHNL ANTB EA","30200320","CDM","302","RC","86596","HCPCS","facility","both","","","","1241.41","1241.41","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOG-IGG1 ANTIBODY FLOW CYTOMETRY, EA","30200323","CDM","302","RC","86363","HCPCS","facility","both","","","","491","491","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOG-IGG1 ANTIBODY FLOW CYTOMETRY, EA","30200323","CDM","302","RC","86363","HCPCS","facility","both","","","","380.51","380.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOG-IGG1 ANTIBODY FLOW CYTOMETRY, EA","30200323","CDM","302","RC","86363","HCPCS","facility","both","","","","297.26","297.26","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLUORESCENT NONINFECT AB; SCRN EA AB","30200326","CDM","302","RC","86255","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLUORESCENT NONINFECT AB; SCRN EA AB","30200326","CDM","302","RC","86255","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VOLTAGE-GATED CALCIUM CHANNEL AB, EA (49)","30200327","CDM","302","RC","86596","HCPCS","facility","both","","","","99","99","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VOLTAGE-GATED CALCIUM CHANNEL AB, EA (49)","30200327","CDM","302","RC","86596","HCPCS","facility","both","","","","131.31","131.31","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VOLTAGE-GATED CALCIUM CHANNEL AB, EA (49)","30200327","CDM","302","RC","86596","HCPCS","facility","both","","","","102.58","102.58","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VOLTAGE-GATED CALCIUM CHANNEL AB, EA (33)","30200328","CDM","302","RC","86596","HCPCS","facility","both","","","","69.09","69.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VOLTAGE-GATED CALCIUM CHANNEL AB, EA (33)","30200328","CDM","302","RC","86596","HCPCS","facility","both","","","","88.43","88.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VOLTAGE-GATED CALCIUM CHANNEL AB, EA (33)","30200328","CDM","302","RC","86596","HCPCS","facility","both","","","","68","68","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETYLCHOLINE RECEPTOR (ACHR); BINDING ANTIBODY","30200333","CDM","302","RC","86041","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETYLCHOLINE RECEPTOR (ACHR); BINDING ANTIBODY","30200333","CDM","302","RC","86041","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACETYLCHOLINE RECEPTOR (ACHR); BINDING ANTIBODY","30200333","CDM","302","RC","86041","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACETYLCHOLINE RECEPTOR (ACHR); BLOCKING ANTIBODY","30200334","CDM","302","RC","86042","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACETYLCHOLINE RECEPTOR (ACHR); BLOCKING ANTIBODY","30200334","CDM","302","RC","86042","HCPCS","facility","both","","","","233","233","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACETYLCHOLINE RECEPTOR (ACHR); BLOCKING ANTIBODY","30200334","CDM","302","RC","86042","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACETYLCHOLINE RECEPTOR (ACHR); MODULATING ANTIBODY","30200335","CDM","302","RC","86043","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACETYLCHOLINE RECEPTOR (ACHR); MODULATING ANTIBODY","30200335","CDM","302","RC","86043","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACETYLCHOLINE RECEPTOR (ACHR); MODULATING ANTIBODY","30200335","CDM","302","RC","86043","HCPCS","facility","both","","","","233","233","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUSCLE-SPECIFIC KINASE (MUSK) ANTIBODY","30200336","CDM","302","RC","86366","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MUSCLE-SPECIFIC KINASE (MUSK) ANTIBODY","30200336","CDM","302","RC","86366","HCPCS","facility","both","","","","233","233","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUSCLE-SPECIFIC KINASE (MUSK) ANTIBODY","30200336","CDM","302","RC","86366","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC-ANCA SCREEN EACH ANTIBODY TITER (5)","30200337","CDM","302","RC","86037","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC-ANCA SCREEN EACH ANTIBODY TITER (5)","30200337","CDM","302","RC","86037","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC-ANCA SCREEN EACH ANTIBODY TITER (27)","30200338","CDM","302","RC","86037","HCPCS","facility","both","","","","72.35","72.35","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC-ANCA SCREEN EACH ANTIBODY TITER (27)","30200338","CDM","302","RC","86037","HCPCS","facility","both","","","","56.52","56.52","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOG -IGG1 FACS ASSAY (194)","30200339","CDM","302","RC","86363","HCPCS","facility","both","","","","406.13","406.13","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOG -IGG1 FACS ASSAY (194)","30200339","CDM","302","RC","86363","HCPCS","facility","both","","","","519.85","519.85","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AQAPRN IGG1 FACS ASSAY (145)","30200340","CDM","302","RC","86053","HCPCS","facility","both","","","","303.55","303.55","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AQAPRN IGG1 FACS ASSAY (145)","30200340","CDM","302","RC","86053","HCPCS","facility","both","","","","388.56","388.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STREP PNEUMONIAE IGG AB, 23 SEROTYPES, MULTI IA, QUANT","30200344","CDM","302","RC","86581","HCPCS","facility","both","","","","81.64","81.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STREP PNEUMONIAE IGG AB, 23 SEROTYPES, MULTI IA, QUANT","30200344","CDM","302","RC","86581","HCPCS","facility","both","","","","104.51","104.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STREP PNEUMONIAE IGG AB, 23 SEROTYPES, MULTI IA, QUANT","30200344","CDM","302","RC","86581","HCPCS","facility","both","","","","112","112","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STREP PNEUMONIAE IGG AB, 14 SEROTYPES, MULTI IA, QUANT","30200346","CDM","302","RC","86581","HCPCS","facility","both","","","","112","112","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STREP PNEUMONIAE IGG AB, 14 SEROTYPES, MULTI IA, QUANT","30200346","CDM","302","RC","86581","HCPCS","facility","both","","","","37.52","37.52","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STREP PNEUMONIAE IGG AB, 14 SEROTYPES, MULTI IA, QUANT","30200346","CDM","302","RC","86581","HCPCS","facility","both","","","","29.31","29.31","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC T. CRUZI (CONFIRMATION)","30260007","CDM","302","RC","86753","HCPCS","facility","both","","","","69.66","69.66","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC T. CRUZI (CONFIRMATION)","30260007","CDM","302","RC","86753","HCPCS","facility","both","","","","54.43","54.43","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LAB HEMATOLOGY","30500000","CDM","305","RC","","","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LAB HEMATOLOGY","30500000","CDM","305","RC","","","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OCCULT BLOOD OTHER SOURCES","30500001","CDM","301","RC","82271","HCPCS","facility","both","","","","5.25","5.25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC OCCULT BLOOD OTHER SOURCES","30500001","CDM","301","RC","82271","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OCCULT BLOOD OTHER SOURCES","30500001","CDM","301","RC","82271","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OCCULT BLOOD OTHER SOURCES","30500001","CDM","301","RC","82271","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GONADOTROPIN; FSH","30500002","CDM","301","RC","83001","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC GONADOTROPIN; FSH","30500002","CDM","301","RC","83001","HCPCS","facility","both","","","","612","612","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GONADOTROPIN; FSH","30500002","CDM","301","RC","83001","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GONADOTROPIN; FSH","30500002","CDM","301","RC","83001","HCPCS","facility","both","","","","61","61","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GONADOTROPIN; FSH","30500002","CDM","301","RC","83001","HCPCS","facility","both","","","","18.58","18.58","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC GONADOTROPIN; FSH","30500002","CDM","301","RC","83001","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GONADOTROPIN; LUTEINIZING HORMONE","30500003","CDM","301","RC","83002","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC GONADOTROPIN; LUTEINIZING HORMONE","30500003","CDM","301","RC","83002","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GONADOTROPIN; LUTEINIZING HORMONE","30500003","CDM","301","RC","83002","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GONADOTROPIN; LUTEINIZING HORMONE","30500003","CDM","301","RC","83002","HCPCS","facility","both","","","","18.52","18.52","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC GONADOTROPIN; LUTEINIZING HORMONE","30500003","CDM","301","RC","83002","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GONADOTROPIN; LUTEINIZING HORMONE","30500003","CDM","301","RC","83002","HCPCS","facility","both","","","","607","607","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HGB; PLASMA","30500004","CDM","301","RC","83051","HCPCS","facility","both","","","","272","272","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HGB; PLASMA","30500004","CDM","301","RC","83051","HCPCS","facility","both","","","","32.16","32.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HGB; PLASMA","30500004","CDM","301","RC","83051","HCPCS","facility","both","","","","19.5","19.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HGB; PLASMA","30500004","CDM","301","RC","83051","HCPCS","facility","both","","","","25.12","25.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASSAY PH BODY FLUID NOS","30500005","CDM","301","RC","83986","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASSAY PH BODY FLUID NOS","30500005","CDM","301","RC","83986","HCPCS","facility","both","","","","11","11","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASSAY PH BODY FLUID NOS","30500005","CDM","301","RC","83986","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASSAY PH BODY FLUID NOS","30500005","CDM","301","RC","83986","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROGESTERONE ASSAY","30500006","CDM","301","RC","84144","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROGESTERONE ASSAY","30500006","CDM","301","RC","84144","HCPCS","facility","both","","","","31","31","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PROGESTERONE ASSAY","30500006","CDM","301","RC","84144","HCPCS","facility","both","","","","58","58","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROGESTERONE ASSAY","30500006","CDM","301","RC","84144","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HCG; QUAL","30500007","CDM","301","RC","84703","HCPCS","facility","both","","","","219","219","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HCG; QUAL","30500007","CDM","301","RC","84703","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HCG; QUAL","30500007","CDM","301","RC","84703","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HCG; QUAL","30500007","CDM","301","RC","84703","HCPCS","facility","both","","","","18","18","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC HCG; QUAL","30500007","CDM","301","RC","84703","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HCG; QUAL","30500007","CDM","301","RC","84703","HCPCS","facility","both","","","","17","17","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC WBC W AUTO DIFF","30500008","CDM","305","RC","85004","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC WBC W AUTO DIFF","30500008","CDM","305","RC","85004","HCPCS","facility","both","","","","87","87","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC WBC W AUTO DIFF","30500008","CDM","305","RC","85004","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC WBC W AUTO DIFF","30500008","CDM","305","RC","85004","HCPCS","facility","both","","","","19","19","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BL SMEAR W/DIFF WBC COUNT","30500009","CDM","305","RC","85007","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BL SMEAR W/DIFF WBC COUNT","30500009","CDM","305","RC","85007","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BL SMEAR W/DIFF WBC COUNT","30500009","CDM","305","RC","85007","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC BL SMEAR W/DIFF WBC COUNT","30500009","CDM","305","RC","85007","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BL SMEAR W/DIFF WBC COUNT","30500009","CDM","305","RC","85007","HCPCS","facility","both","","","","87","87","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BL SMEAR W/DIFF WBC COUNT","30500009","CDM","305","RC","85007","HCPCS","facility","both","","","","2.5","2.5","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC BL SMEAR W/O DIFF WBC COUNT","30500010","CDM","305","RC","85008","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BL SMEAR W/O DIFF WBC COUNT","30500010","CDM","305","RC","85008","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BL SMEAR W/O DIFF WBC COUNT","30500010","CDM","305","RC","85008","HCPCS","facility","both","","","","88","88","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BL SMEAR W/O DIFF WBC COUNT","30500010","CDM","305","RC","85008","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MANUAL DIFF WBC COUNT B-COAT","30500011","CDM","305","RC","85009","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEMATOCRIT","30500012","CDM","305","RC","85014","HCPCS","facility","both","","","","2.37","2.37","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC HEMATOCRIT","30500012","CDM","305","RC","85014","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEMATOCRIT","30500012","CDM","305","RC","85014","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEMATOCRIT","30500012","CDM","305","RC","85014","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEMATOCRIT","30500012","CDM","305","RC","85014","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEMATOCRIT","30500012","CDM","305","RC","85014","HCPCS","facility","both","","","","2","2","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC HEMATOCRIT","30500012","CDM","305","RC","85014","HCPCS","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC HEMOGLOBIN","30500013","CDM","305","RC","85018","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEMOGLOBIN","30500013","CDM","305","RC","85018","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEMOGLOBIN","30500013","CDM","305","RC","85018","HCPCS","facility","both","","","","11","11","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEMOGLOBIN","30500013","CDM","305","RC","85018","HCPCS","facility","both","","","","2.37","2.37","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC HEMOGLOBIN","30500013","CDM","305","RC","85018","HCPCS","facility","both","","","","162","162","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPL CBC  W PLT W AUTOM DIFF","30500014","CDM","305","RC","85025","HCPCS","facility","both","","","","220","220","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPL CBC  W PLT W AUTOM DIFF","30500014","CDM","305","RC","85025","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC COMPL CBC  W PLT W AUTOM DIFF","30500014","CDM","305","RC","85025","HCPCS","facility","both","","","","7.77","7.77","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC COMPL CBC  W PLT W AUTOM DIFF","30500014","CDM","305","RC","85025","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPL CBC  W PLT W AUTOM DIFF","30500014","CDM","305","RC","85025","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPL CBC  W PLT W AUTOM DIFF","30500014","CDM","305","RC","85025","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COMPL CBC  W PLT W AUTOM DIFF","30500014","CDM","305","RC","85025","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC COMPL AUTOM CBC W PLT","30500015","CDM","305","RC","85027","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC COMPL AUTOM CBC W PLT","30500015","CDM","305","RC","85027","HCPCS","facility","both","","","","3","3","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC COMPL AUTOM CBC W PLT","30500015","CDM","305","RC","85027","HCPCS","facility","both","","","","6.47","6.47","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC COMPL AUTOM CBC W PLT","30500015","CDM","305","RC","85027","HCPCS","facility","both","","","","198","198","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPL AUTOM CBC W PLT","30500015","CDM","305","RC","85027","HCPCS","facility","both","","","","7.5","7.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPL AUTOM CBC W PLT","30500015","CDM","305","RC","85027","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC COMPL AUTOM CBC W PLT","30500015","CDM","305","RC","85027","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPL AUTOM CBC W PLT","30500015","CDM","305","RC","85027","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AUTOMATED RETICULOCYTE COUNT","30500016","CDM","305","RC","85045","HCPCS","facility","both","","","","106","106","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AUTOMATED WBC","30500017","CDM","305","RC","85048","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AUTOMATED WBC","30500017","CDM","305","RC","85048","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AUTOMATED WBC","30500017","CDM","305","RC","85048","HCPCS","facility","both","","","","18.5","18.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AUTOMATED WBC","30500017","CDM","305","RC","85048","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AUTOMATED PLATELET COUNT","30500018","CDM","305","RC","85049","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AUTOMATED PLATELET COUNT","30500018","CDM","305","RC","85049","HCPCS","facility","both","","","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AUTOMATED PLATELET COUNT","30500018","CDM","305","RC","85049","HCPCS","facility","both","","","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AUTOMATED PLATELET COUNT","30500018","CDM","305","RC","85049","HCPCS","facility","both","","","","2.5","2.5","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC AUTOMATED PLATELET COUNT","30500018","CDM","305","RC","85049","HCPCS","facility","both","","","","11","11","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RETICULATED PLATELET ASSAY","30500019","CDM","305","RC","85055","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RETICULATED PLATELET ASSAY","30500019","CDM","305","RC","85055","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RETICULATED PLATELET ASSAY","30500019","CDM","305","RC","85055","HCPCS","facility","both","","","","316","316","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RETICULATED PLATELET ASSAY","30500019","CDM","305","RC","85055","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BM SMR INTERP","30500020","CDM","305","RC","85097","HCPCS","facility","both","","","","815","815","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROMOGENIC SUBSTRATE ASSAY","30500021","CDM","305","RC","85130","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHROMOGENIC SUBSTRATE ASSAY","30500021","CDM","305","RC","85130","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHROMOGENIC SUBSTRATE ASSAY","30500021","CDM","305","RC","85130","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROMOGENIC SUBSTRATE ASSAY","30500021","CDM","305","RC","85130","HCPCS","facility","both","","","","142","142","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR II PROTHROMBIN SPECIF","30500022","CDM","305","RC","85210","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING; FACTOR II PROTHROMBIN SPECIF","30500022","CDM","305","RC","85210","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING; FACTOR II PROTHROMBIN SPECIF","30500022","CDM","305","RC","85210","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING; FACTOR II PROTHROMBIN SPECIF","30500022","CDM","305","RC","85210","HCPCS","facility","both","","","","244","244","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR V","30500023","CDM","305","RC","85220","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING; FACTOR V","30500023","CDM","305","RC","85220","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING; FACTOR V","30500023","CDM","305","RC","85220","HCPCS","facility","both","","","","540","540","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR V","30500023","CDM","305","RC","85220","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING; FACTOR VII","30500024","CDM","305","RC","85230","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING; FACTOR VII","30500024","CDM","305","RC","85230","HCPCS","facility","both","","","","356","356","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR VII","30500024","CDM","305","RC","85230","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING; FACTOR VII","30500024","CDM","305","RC","85230","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLOOD CLOT FACTOR VIII TEST","30500025","CDM","305","RC","85240","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLOOD CLOT FACTOR VIII TEST","30500025","CDM","305","RC","85240","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLOOD CLOT FACTOR VIII TEST","30500025","CDM","305","RC","85240","HCPCS","facility","both","","","","422","422","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD CLOT FACTOR VIII TEST","30500025","CDM","305","RC","85240","HCPCS","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING; FACTOR VIII RISTOCETIN COFACT","30500026","CDM","305","RC","85245","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING; FACTOR VIII RISTOCETIN COFACT","30500026","CDM","305","RC","85245","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING; FACTOR VIII RISTOCETIN COFACT","30500026","CDM","305","RC","85245","HCPCS","facility","both","","","","543","543","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR VIII RISTOCETIN COFACT","30500026","CDM","305","RC","85245","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING: FACTOR VIII VW FACTOR AG","30500027","CDM","305","RC","85246","HCPCS","facility","both","","","","132","132","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING: FACTOR VIII VW FACTOR AG","30500027","CDM","305","RC","85246","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING: FACTOR VIII VW FACTOR AG","30500027","CDM","305","RC","85246","HCPCS","facility","both","","","","261","261","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING: FACTOR VIII VW FACTOR AG","30500027","CDM","305","RC","85246","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FACTOR 8 VWF MULTIMRIC","30500028","CDM","305","RC","85247","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FACTOR 8 VWF MULTIMRIC","30500028","CDM","305","RC","85247","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FACTOR 8 VWF MULTIMRIC","30500028","CDM","305","RC","85247","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FACTOR 8 VWF MULTIMRIC","30500028","CDM","305","RC","85247","HCPCS","facility","both","","","","209","209","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR IX","30500029","CDM","305","RC","85250","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING; FACTOR IX","30500029","CDM","305","RC","85250","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING; FACTOR IX","30500029","CDM","305","RC","85250","HCPCS","facility","both","","","","422","422","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR IX","30500029","CDM","305","RC","85250","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING; FACTOR X","30500030","CDM","305","RC","85260","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING; FACTOR X","30500030","CDM","305","RC","85260","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING; FACTOR X","30500030","CDM","305","RC","85260","HCPCS","facility","both","","","","422","422","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR X","30500030","CDM","305","RC","85260","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING; FACTOR XI","30500031","CDM","305","RC","85270","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING; FACTOR XI","30500031","CDM","305","RC","85270","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING; FACTOR XI","30500031","CDM","305","RC","85270","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING; FACTOR XI","30500031","CDM","305","RC","85270","HCPCS","facility","both","","","","422","422","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR XII","30500032","CDM","305","RC","85280","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING; FACTOR XII","30500032","CDM","305","RC","85280","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING; FACTOR XII","30500032","CDM","305","RC","85280","HCPCS","facility","both","","","","422","422","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR XII","30500032","CDM","305","RC","85280","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING; FACTOR XIII SCREEN SOLUBLE","30500033","CDM","305","RC","85291","HCPCS","facility","both","","","","210","210","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING; FACTOR XIII SCREEN SOLUBLE","30500033","CDM","305","RC","85291","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING; FACTOR XIII SCREEN SOLUBLE","30500033","CDM","305","RC","85291","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING; FACTOR XIII SCREEN SOLUBLE","30500033","CDM","305","RC","85291","HCPCS","facility","both","","","","96","96","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING: PREKALLIKREIN ASSAY","30500034","CDM","305","RC","85292","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING: PREKALLIKREIN ASSAY","30500034","CDM","305","RC","85292","HCPCS","facility","both","","","","224","224","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING: PREKALLIKREIN ASSAY","30500034","CDM","305","RC","85292","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING: PREKALLIKREIN ASSAY","30500034","CDM","305","RC","85292","HCPCS","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTITHROMBIN III ACTIVITY ASSAY","30500035","CDM","305","RC","85300","HCPCS","facility","both","","","","39.77","39.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTITHROMBIN III ACTIVITY ASSAY","30500035","CDM","305","RC","85300","HCPCS","facility","both","","","","50.91","50.91","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTITHROMBIN III ACTIVITY ASSAY","30500035","CDM","305","RC","85300","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTITHROMBIN III ACTIVITY ASSAY","30500035","CDM","305","RC","85300","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANTITHROMBIN III ANTIGEN ASSAY","30500036","CDM","305","RC","85301","HCPCS","facility","both","","","","53.5","53.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ANTITHROMBIN III ANTIGEN ASSAY","30500036","CDM","305","RC","85301","HCPCS","facility","both","","","","35.59","35.59","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANTITHROMBIN III ANTIGEN ASSAY","30500036","CDM","305","RC","85301","HCPCS","facility","both","","","","130","130","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANTITHROMBIN III ANTIGEN ASSAY","30500036","CDM","305","RC","85301","HCPCS","facility","both","","","","45.55","45.55","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANTITHROMBIN III ANTIGEN ASSAY","30500036","CDM","305","RC","85301","HCPCS","facility","both","","","","130","130","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOTTING INHIBITOR; PROTEIN C AG","30500037","CDM","305","RC","85302","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING INHIBITOR; PROTEIN C AG","30500037","CDM","305","RC","85302","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING INHIBITOR; PROTEIN C AG","30500037","CDM","305","RC","85302","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING INHIBITOR; PROTEIN C AG","30500037","CDM","305","RC","85302","HCPCS","facility","both","","","","140","140","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING INHIBITOR; PROTEIN C ACTIVITY","30500038","CDM","305","RC","85303","HCPCS","facility","both","","","","406","406","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING INHIBITOR; PROTEIN C ACTIVITY","30500038","CDM","305","RC","85303","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING INHIBITOR; PROTEIN C ACTIVITY","30500038","CDM","305","RC","85303","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING INHIBITOR; PROTEIN C ACTIVITY","30500038","CDM","305","RC","85303","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING INHIBITOR; PROTEIN S TOTAL","30500039","CDM","305","RC","85305","HCPCS","facility","both","","","","186","186","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING INHIBITOR; PROTEIN S TOTAL","30500039","CDM","305","RC","85305","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING INHIBITOR; PROTEIN S TOTAL","30500039","CDM","305","RC","85305","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING INHIBITOR; PROTEIN S TOTAL","30500039","CDM","305","RC","85305","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING INHIBITOR PROTEIN S FREE","30500040","CDM","305","RC","85306","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING INHIBITOR PROTEIN S FREE","30500040","CDM","305","RC","85306","HCPCS","facility","both","","","","186","186","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING INHIBITOR PROTEIN S FREE","30500040","CDM","305","RC","85306","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACTIVATED PROTEIN C RESISTANCE","30500041","CDM","305","RC","85307","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACTIVATED PROTEIN C RESISTANCE","30500041","CDM","305","RC","85307","HCPCS","facility","both","","","","248","248","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ACTIVATED PROTEIN C RESISTANCE","30500041","CDM","305","RC","85307","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACTIVATED PROTEIN C RESISTANCE","30500041","CDM","305","RC","85307","HCPCS","facility","both","","","","140","140","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FACTOR INHIBITOR TEST","30500042","CDM","305","RC","85335","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FACTOR INHIBITOR TEST","30500042","CDM","305","RC","85335","HCPCS","facility","both","","","","227","227","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FACTOR INHIBITOR TEST","30500042","CDM","305","RC","85335","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FACTOR INHIBITOR TEST","30500042","CDM","305","RC","85335","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC D-DIMER - QUAN","30500043","CDM","305","RC","85379","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC D-DIMER - QUAN","30500043","CDM","305","RC","85379","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC D-DIMER - QUAN","30500043","CDM","305","RC","85379","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC D-DIMER - QUAN","30500043","CDM","305","RC","85379","HCPCS","facility","both","","","","298","298","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC D-DIMER - QUAN","30500043","CDM","305","RC","85379","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FIBRINOGEN; ACTIVITY","30500044","CDM","305","RC","85384","HCPCS","facility","both","","","","24.11","24.11","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FIBRINOGEN; ACTIVITY","30500044","CDM","305","RC","85384","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FIBRINOGEN; ACTIVITY","30500044","CDM","305","RC","85384","HCPCS","facility","both","","","","17","17","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC FIBRINOGEN; ACTIVITY","30500044","CDM","305","RC","85384","HCPCS","facility","both","","","","18.84","18.84","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FIBRINOGEN; ACTIVITY","30500044","CDM","305","RC","85384","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FIBRINOGEN; ANTIGEN","30500045","CDM","305","RC","85385","HCPCS","facility","both","","","","101","101","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FIBRINOGEN; ANTIGEN","30500045","CDM","305","RC","85385","HCPCS","facility","both","","","","42.87","42.87","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FIBRINOGEN; ANTIGEN","30500045","CDM","305","RC","85385","HCPCS","facility","both","","","","33.49","33.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FIBRINOGEN; ANTIGEN","30500045","CDM","305","RC","85385","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FIBRINOLYSINS OR COAG SCREEN","30500046","CDM","305","RC","85390","HCPCS","facility","both","","","","62","62","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FIBRINOLYSINS OR COAG SCREEN","30500046","CDM","305","RC","85390","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FIBRINOLYSINS OR COAG SCREEN","30500046","CDM","305","RC","85390","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FIBRINOLYSINS OR COAG SCREEN","30500046","CDM","305","RC","85390","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING FUNCT ACTIVITY","30500047","CDM","305","RC","85397","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING FUNCT ACTIVITY","30500047","CDM","305","RC","85397","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING FUNCT ACTIVITY","30500047","CDM","305","RC","85397","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING FUNCT ACTIVITY","30500047","CDM","305","RC","85397","HCPCS","facility","both","","","","272","272","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALPHA-2-ANTIPLASMIN","30500048","CDM","305","RC","85410","HCPCS","facility","both","","","","82.5","82.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ALPHA-2-ANTIPLASMIN","30500048","CDM","305","RC","85410","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ALPHA-2-ANTIPLASMIN","30500048","CDM","305","RC","85410","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ALPHA-2-ANTIPLASMIN","30500048","CDM","305","RC","85410","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PLASMINOGEN ACTIVATOR","30500049","CDM","305","RC","85415","HCPCS","facility","both","","","","47.5","47.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PLASMINOGEN ACTIVATOR","30500049","CDM","305","RC","85415","HCPCS","facility","both","","","","174","174","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLASMINOGEN ACTIVATOR","30500049","CDM","305","RC","85415","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PLASMINOGEN ACTIVATOR","30500049","CDM","305","RC","85415","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FUNCTIONAL PLASMINOGEN","30500050","CDM","305","RC","85420","HCPCS","facility","both","","","","48.15","48.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FUNCTIONAL PLASMINOGEN","30500050","CDM","305","RC","85420","HCPCS","facility","both","","","","61.64","61.64","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FUNCTIONAL PLASMINOGEN","30500050","CDM","305","RC","85420","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FUNCTIONAL PLASMINOGEN","30500050","CDM","305","RC","85420","HCPCS","facility","both","","","","420","420","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLASMINOGEN ANTIGEN LEVEL","30500051","CDM","305","RC","85421","HCPCS","facility","both","","","","42.87","42.87","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PLASMINOGEN ANTIGEN LEVEL","30500051","CDM","305","RC","85421","HCPCS","facility","both","","","","122","122","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLASMINOGEN ANTIGEN LEVEL","30500051","CDM","305","RC","85421","HCPCS","facility","both","","","","33.49","33.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PLASMINOGEN ANTIGEN LEVEL","30500051","CDM","305","RC","85421","HCPCS","facility","both","","","","55.5","55.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEINZ BODIES; DIRECT","30500052","CDM","305","RC","85441","HCPCS","facility","both","","","","21","21","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEINZ BODIES; DIRECT","30500052","CDM","305","RC","85441","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEINZ BODIES; DIRECT","30500052","CDM","305","RC","85441","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEINZ BODIES; DIRECT","30500052","CDM","305","RC","85441","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC K-B STAIN FOR FETAL HGB","30500053","CDM","305","RC","85460","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC K-B STAIN FOR FETAL HGB","30500053","CDM","305","RC","85460","HCPCS","facility","both","","","","61.64","61.64","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC K-B STAIN FOR FETAL HGB","30500053","CDM","305","RC","85460","HCPCS","facility","both","","","","174","174","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC K-B STAIN FOR FETAL HGB","30500053","CDM","305","RC","85460","HCPCS","facility","both","","","","48.15","48.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEMOLYSIN ACID","30500054","CDM","305","RC","85475","HCPCS","facility","both","","","","106","106","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEPARIN ASSAY","30500055","CDM","305","RC","85520","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPARIN ASSAY","30500055","CDM","305","RC","85520","HCPCS","facility","both","","","","61.64","61.64","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEPARIN ASSAY","30500055","CDM","305","RC","85520","HCPCS","facility","both","","","","48.15","48.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEPARIN ASSAY","30500055","CDM","305","RC","85520","HCPCS","facility","both","","","","564","564","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEPARIN NEUTRALIZATION","30500056","CDM","305","RC","85525","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPARIN NEUTRALIZATION","30500056","CDM","305","RC","85525","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEPARIN NEUTRALIZATION","30500056","CDM","305","RC","85525","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEPARIN NEUTRALIZATION","30500056","CDM","305","RC","85525","HCPCS","facility","both","","","","141","141","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IRON STAIN PERIPHERAL BLOOD","30500057","CDM","305","RC","85536","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IRON STAIN PERIPHERAL BLOOD","30500057","CDM","305","RC","85536","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IRON STAIN PERIPHERAL BLOOD","30500057","CDM","305","RC","85536","HCPCS","facility","both","","","","76","76","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEUKOCYTE ALK PHOS W COUNT","30500058","CDM","305","RC","85540","HCPCS","facility","both","","","","192","192","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OSMOTIC FRAGILITY RBC; INCUBATED","30500059","CDM","305","RC","85557","HCPCS","facility","both","","","","62","62","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLT AGGREGATION (IN VITRO) EA AGENT","30500060","CDM","305","RC","85576","HCPCS","facility","both","","","","503","503","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLT AGGREGATION (IN VITRO) EA AGENT","30500060","CDM","305","RC","85576","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PLT AGGREGATION (IN VITRO) EA AGENT","30500060","CDM","305","RC","85576","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PLT AGGREGATION (IN VITRO) EA AGENT","30500060","CDM","305","RC","85576","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PLATELET NEUTRALIZATION","30500061","CDM","305","RC","85597","HCPCS","facility","both","","","","213","213","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROTHROMBIN TIME;","30500062","CDM","305","RC","85610","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC PROTHROMBIN TIME;","30500062","CDM","305","RC","85610","HCPCS","facility","both","","","","14","14","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PROTHROMBIN TIME;","30500062","CDM","305","RC","85610","HCPCS","facility","both","","","","4.29","4.29","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC PROTHROMBIN TIME;","30500062","CDM","305","RC","85610","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC PROTHROMBIN TIME;","30500062","CDM","305","RC","85610","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROTHROMBIN TIME;","30500062","CDM","305","RC","85610","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROTHROMBIN TIME;","30500062","CDM","305","RC","85610","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RUSSELL VIPER VENOM TIME; UNDILUTED","30500063","CDM","305","RC","85612","HCPCS","facility","both","","","","32.16","32.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RUSSELL VIPER VENOM TIME; UNDILUTED","30500063","CDM","305","RC","85612","HCPCS","facility","both","","","","66","66","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RUSSELL VIPER VENOM TIME; UNDILUTED","30500063","CDM","305","RC","85612","HCPCS","facility","both","","","","25.12","25.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RUSSELL VIPER VENOM TIME; UNDILUTED","30500063","CDM","305","RC","85612","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RUSSELL VIPER VENOM TIME; DILUTED","30500064","CDM","305","RC","85613","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RUSSELL VIPER VENOM TIME; DILUTED","30500064","CDM","305","RC","85613","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RUSSELL VIPER VENOM TIME; DILUTED","30500064","CDM","305","RC","85613","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RUSSELL VIPER VENOM TIME; DILUTED","30500064","CDM","305","RC","85613","HCPCS","facility","both","","","","114","114","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC REPTILASE TEST","30500065","CDM","305","RC","85635","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC REPTILASE TEST","30500065","CDM","305","RC","85635","HCPCS","facility","both","","","","84","84","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC REPTILASE TEST","30500065","CDM","305","RC","85635","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC REPTILASE TEST","30500065","CDM","305","RC","85635","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC NONAUTO ERYTHROCYTE SED RATE","30500066","CDM","305","RC","85651","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC NONAUTO ERYTHROCYTE SED RATE","30500066","CDM","305","RC","85651","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NONAUTO ERYTHROCYTE SED RATE","30500066","CDM","305","RC","85651","HCPCS","facility","both","","","","12.56","12.56","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NONAUTO ERYTHROCYTE SED RATE","30500066","CDM","305","RC","85651","HCPCS","facility","both","","","","16.08","16.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AUTOM ERYTHROCYTE SED RATE","30500067","CDM","305","RC","85652","HCPCS","facility","both","","","","32","32","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AUTOM ERYTHROCYTE SED RATE","30500067","CDM","305","RC","85652","HCPCS","facility","both","","","","2.7","2.7","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC AUTOM ERYTHROCYTE SED RATE","30500067","CDM","305","RC","85652","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AUTOM ERYTHROCYTE SED RATE","30500067","CDM","305","RC","85652","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AUTOM ERYTHROCYTE SED RATE","30500067","CDM","305","RC","85652","HCPCS","facility","both","","","","14.5","14.5","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC AUTOM ERYTHROCYTE SED RATE","30500067","CDM","305","RC","85652","HCPCS","facility","both","","","","6","6","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC AUTOM ERYTHROCYTE SED RATE","30500067","CDM","305","RC","85652","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC THROMBIN TIME; PLASMA","30500068","CDM","305","RC","85670","HCPCS","facility","both","","","","114","114","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THROMBIN TIME; PLASMA","30500068","CDM","305","RC","85670","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC THROMBIN TIME; PLASMA","30500068","CDM","305","RC","85670","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC THROMBIN TIME; PLASMA","30500068","CDM","305","RC","85670","HCPCS","facility","both","","","","23","23","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PTT; PLASMA OR WHOLE BLOOD","30500069","CDM","305","RC","85730","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC PTT; PLASMA OR WHOLE BLOOD","30500069","CDM","305","RC","85730","HCPCS","facility","both","","","","6.01","6.01","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC PTT; PLASMA OR WHOLE BLOOD","30500069","CDM","305","RC","85730","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PTT; PLASMA OR WHOLE BLOOD","30500069","CDM","305","RC","85730","HCPCS","facility","both","","","","14.5","14.5","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC PTT; PLASMA OR WHOLE BLOOD","30500069","CDM","305","RC","85730","HCPCS","facility","both","","","","143","143","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PTT; PLASMA OR WHOLE BLOOD","30500069","CDM","305","RC","85730","HCPCS","facility","both","","","","23","23","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PTT; PLASMA OR WHOLE BLOOD","30500069","CDM","305","RC","85730","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VISCOSITY","30500070","CDM","305","RC","85810","HCPCS","facility","both","","","","260","260","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VISCOSITY","30500070","CDM","305","RC","85810","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VISCOSITY","30500070","CDM","305","RC","85810","HCPCS","facility","both","","","","60.5","60.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VISCOSITY","30500070","CDM","305","RC","85810","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEMOLYTIC ANEMIA EVALUATION","30500073","CDM","305","RC","85999","HCPCS","facility","both","","","","837.38","837.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEMOLYTIC ANEMIA EVALUATION","30500073","CDM","305","RC","85999","HCPCS","facility","both","","","","1071.86","1071.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AB ID; PLATELET IG ASSAY","30500075","CDM","302","RC","86023","HCPCS","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AB ID; PLATELET IG ASSAY","30500075","CDM","302","RC","86023","HCPCS","facility","both","","","","132","132","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AB ID; PLATELET IG ASSAY","30500075","CDM","302","RC","86023","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AB ID; PLATELET IG ASSAY","30500075","CDM","302","RC","86023","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC B CELLS TOTAL COUNT","30500076","CDM","302","RC","86355","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC B CELLS TOTAL COUNT","30500076","CDM","302","RC","86355","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC B CELLS TOTAL COUNT","30500076","CDM","302","RC","86355","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC B CELLS TOTAL COUNT","30500076","CDM","302","RC","86355","HCPCS","facility","both","","","","447","447","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC B CELLS TOTAL COUNT","30500076","CDM","302","RC","86355","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NK CELLS TOTAL COUNT","30500077","CDM","302","RC","86357","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NK CELLS TOTAL COUNT","30500077","CDM","302","RC","86357","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC NK CELLS TOTAL COUNT","30500077","CDM","302","RC","86357","HCPCS","facility","both","","","","75","75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC NK CELLS TOTAL COUNT","30500077","CDM","302","RC","86357","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NK CELLS TOTAL COUNT","30500077","CDM","302","RC","86357","HCPCS","facility","both","","","","447","447","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STEM CELLS TOTAL COUNT","30500078","CDM","302","RC","86367","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STEM CELLS TOTAL COUNT","30500078","CDM","302","RC","86367","HCPCS","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC STEM CELLS TOTAL COUNT","30500078","CDM","302","RC","86367","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STEM CELLS TOTAL COUNT","30500078","CDM","302","RC","86367","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC STEM CELLS TOTAL COUNT","30500078","CDM","302","RC","86367","HCPCS","facility","both","","","","447","447","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC AB SCRN EA TECHIQ","30500079","CDM","300","RC","86850","HCPCS","facility","both","","","","25.12","25.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RBC AB SCRN EA TECHIQ","30500079","CDM","300","RC","86850","HCPCS","facility","both","","","","32.16","32.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RBC AB SCRN EA TECHIQ","30500079","CDM","300","RC","86850","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC AB SCRN EA TECHIQ","30500079","CDM","300","RC","86850","HCPCS","facility","both","","","","38.5","38.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CONCENTRATION FOR INFECT AGNT","30500080","CDM","306","RC","87015","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CONCENTRATION FOR INFECT AGNT","30500080","CDM","306","RC","87015","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CONCENTRATION FOR INFECT AGNT","30500080","CDM","306","RC","87015","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CONCENTRATION FOR INFECT AGNT","30500080","CDM","306","RC","87015","HCPCS","facility","both","","","","139","139","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SMEAR FOR EOSINOPHIL","30500081","CDM","305","RC","85999","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SMEAR FOR EOSINOPHIL","30500081","CDM","305","RC","85999","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SMEAR FOR EOSINOPHIL","30500081","CDM","305","RC","85999","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SMEAR FOR EOSINOPHIL","30500081","CDM","305","RC","85999","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLEEDING TIME","30500150","CDM","305","RC","85002","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLEEDING TIME","30500150","CDM","305","RC","85002","HCPCS","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MANUAL RETICULOCYTE COUNT","30500151","CDM","305","RC","85044","HCPCS","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR XIII - FS","30500152","CDM","305","RC","85290","HCPCS","facility","both","","","","154","154","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FIBRIN DEGRADATION PRODUCTS","30500153","CDM","305","RC","85362","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FIBRIN DEGRADATION PRODUCTS","30500153","CDM","305","RC","85362","HCPCS","facility","both","","","","236","236","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC D-DIMER- QUAL/SEMIQUAN","30500154","CDM","305","RC","85378","HCPCS","facility","both","","","","172","172","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEXAGNAL PHOSPH PLTLT NEUTRL","30500155","CDM","305","RC","85598","HCPCS","facility","both","","","","213","213","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEXAGNAL PHOSPH PLTLT NEUTRL","30500155","CDM","305","RC","85598","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEXAGNAL PHOSPH PLTLT NEUTRL","30500155","CDM","305","RC","85598","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEXAGNAL PHOSPH PLTLT NEUTRL","30500155","CDM","305","RC","85598","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC THROMBOPLASTIN INHIBITION TISSUE","30500156","CDM","305","RC","85705","HCPCS","facility","both","","","","410","410","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DIFFICULT CROSS MATCH","30500157","CDM","305","RC","86077","HCPCS","facility","both","","","","175","175","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PT; SUBSTITUTION PLASMA FRACTIONS EA","30500158","CDM","305","RC","85611","HCPCS","facility","both","","","","220","220","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PTT; SUBSTITUTION PLASMA FRACTIONS EA","30500159","CDM","305","RC","85732","HCPCS","facility","both","","","","220","220","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SPUN HEMATOCRIT","30500160","CDM","305","RC","85013","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MANUAL CELL COUNT EACH","30500161","CDM","305","RC","85032","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MANUAL CELL COUNT EACH","30500161","CDM","305","RC","85032","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MANUAL CELL COUNT EACH","30500161","CDM","305","RC","85032","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MANUAL CELL COUNT EACH","30500161","CDM","305","RC","85032","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AUTOMATED RBC COUNT","30500162","CDM","305","RC","85041","HCPCS","facility","both","","","","101","101","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RETICYTE/HGB CONCENTRATE","30500163","CDM","305","RC","85046","HCPCS","facility","both","","","","42.87","42.87","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RETICYTE/HGB CONCENTRATE","30500163","CDM","305","RC","85046","HCPCS","facility","both","","","","33.49","33.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RETICYTE/HGB CONCENTRATE","30500163","CDM","305","RC","85046","HCPCS","facility","both","","","","66","66","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOT RETRACTION","30500164","CDM","305","RC","85170","HCPCS","facility","both","","","","88","88","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR VIII RELATED ANTIGEN","30500165","CDM","305","RC","85244","HCPCS","facility","both","","","","242","242","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOTTING; FACTOR VIII RELATED ANTIGEN","30500165","CDM","305","RC","85244","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOTTING; FACTOR VIII RELATED ANTIGEN","30500165","CDM","305","RC","85244","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CLOTTING; FACTOR VIII RELATED ANTIGEN","30500165","CDM","305","RC","85244","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOTTING; HMW KININOGEN ASSAY","30500166","CDM","305","RC","85293","HCPCS","facility","both","","","","224","224","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THROMBOMODULIN","30500167","CDM","305","RC","85337","HCPCS","facility","both","","","","123","123","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COAG TIME; ACTIVATED","30500168","CDM","305","RC","85347","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COAG TIME; ACTIVATED","30500168","CDM","305","RC","85347","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COAG TIME; ACTIVATED","30500168","CDM","305","RC","85347","HCPCS","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COAG TIME; ACTIVATED","30500168","CDM","305","RC","85347","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC EUGLOBULIN LYSIS","30500169","CDM","305","RC","85360","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC EUGLOBULIN LYSIS","30500169","CDM","305","RC","85360","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC EUGLOBULIN LYSIS","30500169","CDM","305","RC","85360","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC EUGLOBULIN LYSIS","30500169","CDM","305","RC","85360","HCPCS","facility","both","","","","158","158","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEINZ BODIES; INDUCED","30500170","CDM","305","RC","85445","HCPCS","facility","both","","","","68","68","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEPARIN-PROTAMINE TOLERANCE TEST","30500171","CDM","305","RC","85530","HCPCS","facility","both","","","","168","168","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OSMOTIC FRAGILITY RBC; UNINCUBATED","30500172","CDM","305","RC","85555","HCPCS","facility","both","","","","76","76","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OSMOTIC FRAGILITY RBC; UNINCUBATED","30500172","CDM","305","RC","85555","HCPCS","facility","both","","","","43.96","43.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OSMOTIC FRAGILITY RBC; UNINCUBATED","30500172","CDM","305","RC","85555","HCPCS","facility","both","","","","129","129","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC OSMOTIC FRAGILITY RBC; UNINCUBATED","30500172","CDM","305","RC","85555","HCPCS","facility","both","","","","56.27","56.27","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OCCULT BLD IA SCRN","30500173","CDM","305","RC","","","facility","both","","","","188","188","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LAB BACTERIOLOY AND MICROBIOLOGY","30600000","CDM","306","RC","","","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LAB BACTERIOLOY AND MICROBIOLOGY","30600000","CDM","306","RC","","","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASO; SCREEN","30600001","CDM","302","RC","86063","HCPCS","facility","both","","","","32.16","32.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASO; SCREEN","30600001","CDM","302","RC","86063","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ASO; SCREEN","30600001","CDM","302","RC","86063","HCPCS","facility","both","","","","176","176","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASO; SCREEN","30600001","CDM","302","RC","86063","HCPCS","facility","both","","","","25.12","25.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AEROB BACTERIAL BLOOD CULTURE","30600002","CDM","306","RC","87040","HCPCS","facility","both","","","","10.32","10.32","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC AEROB BACTERIAL BLOOD CULTURE","30600002","CDM","306","RC","87040","HCPCS","facility","both","","","","13","13","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC AEROB BACTERIAL BLOOD CULTURE","30600002","CDM","306","RC","87040","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AEROB BACTERIAL BLOOD CULTURE","30600002","CDM","306","RC","87040","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AEROB BACTERIAL BLOOD CULTURE","30600002","CDM","306","RC","87040","HCPCS","facility","both","","","","280","280","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AEROB BACTERIAL BLOOD CULTURE","30600002","CDM","306","RC","87040","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AEROB BACTERIA CULTURE STOOL","30600003","CDM","306","RC","87045","HCPCS","facility","both","","","","17.3","17.3","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AEROB BACTERIA CULTURE STOOL","30600003","CDM","306","RC","87045","HCPCS","facility","both","","","","249","249","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AEROB BACTERIA CULTURE STOOL","30600003","CDM","306","RC","87045","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AEROB BACTERIA CULTURE STOOL","30600003","CDM","306","RC","87045","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AEROBIC STOOL CULTR ADDTL PATHOG EA PLATE","30600004","CDM","306","RC","87046","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AEROBIC STOOL CULTR ADDTL PATHOG EA PLATE","30600004","CDM","306","RC","87046","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AEROBIC STOOL CULTR ADDTL PATHOG EA PLATE","30600004","CDM","306","RC","87046","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AEROBIC STOOL CULTR ADDTL PATHOG EA PLATE","30600004","CDM","306","RC","87046","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BACTERIAL CULTURE - OTHR SOURCE","30600005","CDM","306","RC","87070","HCPCS","facility","both","","","","258","258","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BACTERIAL CULTURE - OTHR SOURCE","30600005","CDM","306","RC","87070","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BACTERIAL CULTURE - OTHR SOURCE","30600005","CDM","306","RC","87070","HCPCS","facility","both","","","","9","9","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC BACTERIAL CULTURE - OTHR SOURCE","30600005","CDM","306","RC","87070","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BACTERIAL CULTURE - OTHR SOURCE","30600005","CDM","306","RC","87070","HCPCS","facility","both","","","","8.62","8.62","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC BACTERIAL CULTURE - OTHR SOURCE","30600005","CDM","306","RC","87070","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC BACTERIAL CULTURE - OTHR SOURCE","30600005","CDM","306","RC","87070","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC BACTERIAL CULTURE - OTHR SOURCE","30600005","CDM","306","RC","87070","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BACT CULT; QUAN AEROBIC","30600006","CDM","306","RC","87071","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC BACT CULT; QUAN AEROBIC","30600006","CDM","306","RC","87071","HCPCS","facility","both","","","","53","53","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BACT CULT; QUAN AEROBIC","30600006","CDM","306","RC","87071","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BACT CULT; QUAN AEROBIC","30600006","CDM","306","RC","87071","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BACT CULT; QUAN AEROBIC","30600006","CDM","306","RC","87071","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANAEROB BACT CULTURE W ID","30600007","CDM","306","RC","87075","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ANAEROB BACT CULTURE W ID","30600007","CDM","306","RC","87075","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ANAEROB BACT CULTURE W ID","30600007","CDM","306","RC","87075","HCPCS","facility","both","","","","314","314","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ANAEROB BACT CULTURE W ID","30600007","CDM","306","RC","87075","HCPCS","facility","both","","","","54","54","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BC - ANAEROBE - ADDTL ID","30600008","CDM","306","RC","87076","HCPCS","facility","both","","","","106","106","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BC - ANAEROBE - ADDTL ID","30600008","CDM","306","RC","87076","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BC - ANAEROBE - ADDTL ID","30600008","CDM","306","RC","87076","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BC - ANAEROBE - ADDTL ID","30600008","CDM","306","RC","87076","HCPCS","facility","both","","","","71.5","71.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BC - AEROBIC - ADDTL ID","30600009","CDM","306","RC","87077","HCPCS","facility","both","","","","179","179","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BC - AEROBIC - ADDTL ID","30600009","CDM","306","RC","87077","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BC - AEROBIC - ADDTL ID","30600009","CDM","306","RC","87077","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC BC - AEROBIC - ADDTL ID","30600009","CDM","306","RC","87077","HCPCS","facility","both","","","","16","16","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BC - AEROBIC - ADDTL ID","30600009","CDM","306","RC","87077","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC BC - AEROBIC - ADDTL ID","30600009","CDM","306","RC","87077","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BC - AEROBIC - ADDTL ID","30600009","CDM","306","RC","87077","HCPCS","facility","both","","","","8.08","8.08","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC CULTURE P PATHOG - SCREEN","30600010","CDM","306","RC","87081","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CULTURE P PATHOG - SCREEN","30600010","CDM","306","RC","87081","HCPCS","facility","both","","","","141","141","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CULTURE P PATHOG - SCREEN","30600010","CDM","306","RC","87081","HCPCS","facility","both","","","","27","27","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CULTURE P PATHOG - SCREEN","30600010","CDM","306","RC","87081","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BACT CULTURE - URINE; QUAN COUNT","30600011","CDM","306","RC","87086","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BACT CULTURE - URINE; QUAN COUNT","30600011","CDM","306","RC","87086","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BACT CULTURE - URINE; QUAN COUNT","30600011","CDM","306","RC","87086","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BACT CULTURE - URINE; QUAN COUNT","30600011","CDM","306","RC","87086","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BACT CULTURE - URINE; QUAN COUNT","30600011","CDM","306","RC","87086","HCPCS","facility","both","","","","8.07","8.07","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC BACT CULTURE - URINE; QUAN COUNT","30600011","CDM","306","RC","87086","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC BACT CULTURE - URINE; QUAN COUNT","30600011","CDM","306","RC","87086","HCPCS","facility","both","","","","37.5","37.5","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC URINE BACTERIA CULTURE","30600012","CDM","306","RC","87088","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC URINE BACTERIA CULTURE","30600012","CDM","306","RC","87088","HCPCS","facility","both","","","","212","212","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC URINE BACTERIA CULTURE","30600012","CDM","306","RC","87088","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC URINE BACTERIA CULTURE","30600012","CDM","306","RC","87088","HCPCS","facility","both","","","","16","16","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CULT FUNGUS W P ID; SKIN HR NL","30600013","CDM","306","RC","87101","HCPCS","facility","both","","","","205","205","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CULT FUNGUS W P ID; SKIN HR NL","30600013","CDM","306","RC","87101","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CULT FUNGUS W P ID; SKIN HR NL","30600013","CDM","306","RC","87101","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CULT FUNGUS W P ID; SKIN HR NL","30600013","CDM","306","RC","87101","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FUNGUS CULTURE NOT BLOOD","30600014","CDM","306","RC","87102","HCPCS","facility","both","","","","53","53","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FUNGUS CULTURE NOT BLOOD","30600014","CDM","306","RC","87102","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC FUNGUS CULTURE NOT BLOOD","30600014","CDM","306","RC","87102","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FUNGUS CULTURE NOT BLOOD","30600014","CDM","306","RC","87102","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FUNGUS CULTURE NOT BLOOD","30600014","CDM","306","RC","87102","HCPCS","facility","both","","","","281","281","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FUNGUS CULTURE BLOOD","30600015","CDM","306","RC","87103","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FUNGUS CULTURE BLOOD","30600015","CDM","306","RC","87103","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FUNGUS CULTURE BLOOD","30600015","CDM","306","RC","87103","HCPCS","facility","both","","","","234","234","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FUNGUS CULTURE BLOOD","30600015","CDM","306","RC","87103","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FUNGUS CULTURE DEF I.D YEAST","30600016","CDM","306","RC","87106","HCPCS","facility","both","","","","281","281","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FUNGUS CULTURE DEF I.D YEAST","30600016","CDM","306","RC","87106","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FUNGUS CULTURE DEF I.D YEAST","30600016","CDM","306","RC","87106","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FUNGUS CULTURE DEF I.D YEAST","30600016","CDM","306","RC","87106","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FUNGUS CULTURE DEF ID  MOLD","30600017","CDM","306","RC","87107","HCPCS","facility","both","","","","267","267","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FUNGUS CULTURE DEF ID  MOLD","30600017","CDM","306","RC","87107","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FUNGUS CULTURE DEF ID  MOLD","30600017","CDM","306","RC","87107","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FUNGUS CULTURE DEF ID  MOLD","30600017","CDM","306","RC","87107","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FUNGUS CULTURE DEF ID  MOLD","30600017","CDM","306","RC","87107","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC CULTURE MYCOPLASMA","30600018","CDM","306","RC","87109","HCPCS","facility","both","","","","36","36","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CULTURE MYCOPLASMA","30600018","CDM","306","RC","87109","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CULTURE MYCOPLASMA","30600018","CDM","306","RC","87109","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CULTURE MYCOPLASMA","30600018","CDM","306","RC","87109","HCPCS","facility","both","","","","1248","1248","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHLAMYDIA CULTURE","30600019","CDM","306","RC","87110","HCPCS","facility","both","","","","416","416","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHLAMYDIA CULTURE","30600019","CDM","306","RC","87110","HCPCS","facility","both","","","","64.9","64.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHLAMYDIA CULTURE","30600019","CDM","306","RC","87110","HCPCS","facility","both","","","","83.07","83.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHLAMYDIA CULTURE","30600019","CDM","306","RC","87110","HCPCS","facility","both","","","","91","91","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CULTURE AFB - ISOL & ID","30600020","CDM","306","RC","87116","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CULTURE AFB - ISOL & ID","30600020","CDM","306","RC","87116","HCPCS","facility","both","","","","333","333","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CULTURE AFB - ISOL & ID","30600020","CDM","306","RC","87116","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CULTURE AFB - ISOL & ID","30600020","CDM","306","RC","87116","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CULT MYCOBACTERIA DEFIN ID EA","30600021","CDM","306","RC","87118","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CULT MYCOBACTERIA DEFIN ID EA","30600021","CDM","306","RC","87118","HCPCS","facility","both","","","","203.65","203.65","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CULT MYCOBACTERIA DEFIN ID EA","30600021","CDM","306","RC","87118","HCPCS","facility","both","","","","159.1","159.1","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CULT MYCOBACTERIA DEFIN ID EA","30600021","CDM","306","RC","87118","HCPCS","facility","both","","","","179","179","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CULTURE; GLC/HPLC","30600022","CDM","306","RC","87143","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CULTURE; GLC/HPLC","30600022","CDM","306","RC","87143","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CULTURE; GLC/HPLC","30600022","CDM","306","RC","87143","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CULTURE; GLC/HPLC","30600022","CDM","306","RC","87143","HCPCS","facility","both","","","","164","164","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CULTURE; IMMUNOLOGIC","30600023","CDM","306","RC","87147","HCPCS","facility","both","","","","281","281","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CULTURE; IMMUNOLOGIC","30600023","CDM","306","RC","87147","HCPCS","facility","both","","","","21","21","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CULTURE; IMMUNOLOGIC","30600023","CDM","306","RC","87147","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CULTURE; IMMUNOLOGIC","30600023","CDM","306","RC","87147","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DNA/RNA DIRECT PROBE","30600024","CDM","306","RC","87149","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DNA/RNA DIRECT PROBE","30600024","CDM","306","RC","87149","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC DNA/RNA DIRECT PROBE","30600024","CDM","306","RC","87149","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DNA/RNA DIRECT PROBE","30600024","CDM","306","RC","87149","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DNA/RNA DIRECT PROBE","30600024","CDM","306","RC","87149","HCPCS","facility","both","","","","262","262","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CULTURE; PULSE FLD GEL ID","30600025","CDM","306","RC","87152","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CULTURE; PULSE FLD GEL ID","30600025","CDM","306","RC","87152","HCPCS","facility","both","","","","142.35","142.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CULTURE; PULSE FLD GEL ID","30600025","CDM","306","RC","87152","HCPCS","facility","both","","","","182.22","182.22","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CULTURE; PULSE FLD GEL ID","30600025","CDM","306","RC","87152","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ADENOVIRUS GENOTYPE","30600027","CDM","306","RC","87153","HCPCS","facility","both","","","","645","645","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ADENOVIRUS GENOTYPE","30600027","CDM","306","RC","87153","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CULTURE; OTHER METHODS","30600028","CDM","306","RC","87158","HCPCS","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CULTURE; OTHER METHODS","30600028","CDM","306","RC","87158","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CULTURE; OTHER METHODS","30600028","CDM","306","RC","87158","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CULTURE; OTHER METHODS","30600028","CDM","306","RC","87158","HCPCS","facility","both","","","","22","22","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PINWORM EXAM","30600029","CDM","306","RC","87172","HCPCS","facility","both","","","","21","21","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PINWORM EXAM","30600029","CDM","306","RC","87172","HCPCS","facility","both","","","","16.08","16.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PINWORM EXAM","30600029","CDM","306","RC","87172","HCPCS","facility","both","","","","139","139","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PINWORM EXAM","30600029","CDM","306","RC","87172","HCPCS","facility","both","","","","12.56","12.56","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OVA & PARASITES DIR SMR W ID","30600030","CDM","306","RC","87177","HCPCS","facility","both","","","","368","368","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC OVA & PARASITES DIR SMR W ID","30600030","CDM","306","RC","87177","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC OVA & PARASITES DIR SMR W ID","30600030","CDM","306","RC","87177","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC OVA & PARASITES DIR SMR W ID","30600030","CDM","306","RC","87177","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SENSITIVITY - AGAR DILUTION/AGENT","30600031","CDM","306","RC","87181","HCPCS","facility","both","","","","16","16","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SENSITIVITY - AGAR DILUTION/AGENT","30600031","CDM","306","RC","87181","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SENSITIVITY - AGAR DILUTION/AGENT","30600031","CDM","306","RC","87181","HCPCS","facility","both","","","","62","62","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SENSITIVITY - AGAR DILUTION/AGENT","30600031","CDM","306","RC","87181","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SENSITIVITY - DISK PER PLATE","30600032","CDM","306","RC","87184","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SENSITIVITY - DISK PER PLATE","30600032","CDM","306","RC","87184","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SENSITIVITY - DISK PER PLATE","30600032","CDM","306","RC","87184","HCPCS","facility","both","","","","26","26","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SENSITIVITY - DISK PER PLATE","30600032","CDM","306","RC","87184","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SENSTITIVITY - ENZYME DETECT","30600033","CDM","306","RC","87185","HCPCS","facility","both","","","","62","62","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SENSTITIVITY - ENZYME DETECT","30600033","CDM","306","RC","87185","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SENSTITIVITY - ENZYME DETECT","30600033","CDM","306","RC","87185","HCPCS","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SENSTITIVITY - ENZYME DETECT","30600033","CDM","306","RC","87185","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MICROBE SUSCEPTIBILITIES MIC","30600034","CDM","306","RC","87186","HCPCS","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC MICROBE SUSCEPTIBILITIES MIC","30600034","CDM","306","RC","87186","HCPCS","facility","both","","","","120.35","120.35","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MICROBE SUSCEPTIBILITIES MIC","30600034","CDM","306","RC","87186","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MICROBE SUSCEPTIBILITIES MIC","30600034","CDM","306","RC","87186","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MICROBE SUSCEPTIBILITIES MIC","30600034","CDM","306","RC","87186","HCPCS","facility","both","","","","951","951","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MICROBE SUSCEPTIBILITIES MIC","30600034","CDM","306","RC","87186","HCPCS","facility","both","","","","8.65","8.65","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC SENSITIVITY - MACROBROTH EA AGNT","30600035","CDM","306","RC","87188","HCPCS","facility","both","","","","85","85","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SENSITIVITY - MACROBROTH EA AGNT","30600035","CDM","306","RC","87188","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SENSITIVITY - MACROBROTH EA AGNT","30600035","CDM","306","RC","87188","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SENSITIVITY - MACROBROTH EA AGNT","30600035","CDM","306","RC","87188","HCPCS","facility","both","","","","75","75","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SERUM BACTERICIDAL TITER","30600036","CDM","306","RC","87197","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SERUM BACTERICIDAL TITER","30600036","CDM","306","RC","87197","HCPCS","facility","both","","","","120.59","120.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SERUM BACTERICIDAL TITER","30600036","CDM","306","RC","87197","HCPCS","facility","both","","","","449","449","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SERUM BACTERICIDAL TITER","30600036","CDM","306","RC","87197","HCPCS","facility","both","","","","94.2","94.2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SMEAR - GRAM OR GIEMSA","30600037","CDM","306","RC","87205","HCPCS","facility","both","","","","17","17","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SMEAR - GRAM OR GIEMSA","30600037","CDM","306","RC","87205","HCPCS","facility","both","","","","4.27","4.27","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC SMEAR - GRAM OR GIEMSA","30600037","CDM","306","RC","87205","HCPCS","facility","both","","","","9","9","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC SMEAR - GRAM OR GIEMSA","30600037","CDM","306","RC","87205","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SMEAR - GRAM OR GIEMSA","30600037","CDM","306","RC","87205","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SMEAR - GRAM OR GIEMSA","30600037","CDM","306","RC","87205","HCPCS","facility","both","","","","104","104","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SMEAR; FLUORESCENT OR AFB STAIN","30600038","CDM","306","RC","87206","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SMEAR; FLUORESCENT OR AFB STAIN","30600038","CDM","306","RC","87206","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SMEAR; FLUORESCENT OR AFB STAIN","30600038","CDM","306","RC","87206","HCPCS","facility","both","","","","17","17","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SMEAR; FLUORESCENT OR AFB STAIN","30600038","CDM","306","RC","87206","HCPCS","facility","both","","","","122","122","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SMEAR SPECIAL STAIN","30600039","CDM","306","RC","87207","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SMEAR SPECIAL STAIN","30600039","CDM","306","RC","87207","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SMEAR SPECIAL STAIN","30600039","CDM","306","RC","87207","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SMEAR SPECIAL STAIN","30600039","CDM","306","RC","87207","HCPCS","facility","both","","","","269","269","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SMEAR - INFECTIOUS WET MOUNT","30600040","CDM","306","RC","87210","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SMEAR - INFECTIOUS WET MOUNT","30600040","CDM","306","RC","87210","HCPCS","facility","both","","","","148","148","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SMEAR - INFECTIOUS WET MOUNT","30600040","CDM","306","RC","87210","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SMEAR - INFECTIOUS WET MOUNT","30600040","CDM","306","RC","87210","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KOH FOR FUNGI/PARASITES/MITES","30600041","CDM","306","RC","87220","HCPCS","facility","both","","","","7.5","7.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC KOH FOR FUNGI/PARASITES/MITES","30600041","CDM","306","RC","87220","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KOH FOR FUNGI/PARASITES/MITES","30600041","CDM","306","RC","87220","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC KOH FOR FUNGI/PARASITES/MITES","30600041","CDM","306","RC","87220","HCPCS","facility","both","","","","122","122","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VIRUS ISOLATE; TISSUE CULT INOC","30600042","CDM","306","RC","87252","HCPCS","facility","both","","","","19","19","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC VIRUS ISOLATE; TISSUE CULT INOC","30600042","CDM","306","RC","87252","HCPCS","facility","both","","","","474","474","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VIRUS ISOLATE; TISSUE CULT INOC","30600042","CDM","306","RC","87252","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VIRUS ISOLATE; TISSUE CULT INOC","30600042","CDM","306","RC","87252","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VIRUS ISOLATE; TISSUE CULT INOC","30600042","CDM","306","RC","87252","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VIRUS ISOLATE; ADDTL OR ID","30600043","CDM","306","RC","87253","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VIRUS ISOLATE; ADDTL OR ID","30600043","CDM","306","RC","87253","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VIRUS ISOLATE; ADDTL OR ID","30600043","CDM","306","RC","87253","HCPCS","facility","both","","","","511","511","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VIRUS ISOLATE; ADDTL OR ID","30600043","CDM","306","RC","87253","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC VIRUS ISOL SHELL VIAL TECHN","30600044","CDM","306","RC","87254","HCPCS","facility","both","","","","393","393","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VIRUS ISOL SHELL VIAL TECHN","30600044","CDM","306","RC","87254","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VIRUS ISOL SHELL VIAL TECHN","30600044","CDM","306","RC","87254","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VIRUS ISOL SHELL VIAL TECHN","30600044","CDM","306","RC","87254","HCPCS","facility","both","","","","42.75","42.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GENET VIRUS ISOLATE HSV","30600045","CDM","306","RC","87255","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENET VIRUS ISOLATE HSV","30600045","CDM","306","RC","87255","HCPCS","facility","both","","","","95","95","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GENET VIRUS ISOLATE HSV","30600045","CDM","306","RC","87255","HCPCS","facility","both","","","","445","445","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GENET VIRUS ISOLATE HSV","30600045","CDM","306","RC","87255","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ADENOVIRUS AG BY IF","30600046","CDM","306","RC","87260","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADENOVIRUS AG BY IF","30600046","CDM","306","RC","87260","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ADENOVIRUS AG BY IF","30600046","CDM","306","RC","87260","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ADENOVIRUS AG BY IF","30600046","CDM","306","RC","87260","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ADENOVIRUS AG BY IF","30600046","CDM","306","RC","87260","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BORDATELLA P AG BY DFA","30600047","CDM","306","RC","87265","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BORDATELLA P AG BY DFA","30600047","CDM","306","RC","87265","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BORDATELLA P AG BY DFA","30600047","CDM","306","RC","87265","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BORDATELLA P AG BY DFA","30600047","CDM","306","RC","87265","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INFLUENZA B AG BY IF","30600048","CDM","306","RC","87275","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC INFLUENZA B AG BY IF","30600048","CDM","306","RC","87275","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INFLUENZA B AG BY IF","30600048","CDM","306","RC","87275","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFLUENZA B AG BY IF","30600048","CDM","306","RC","87275","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INFLUENZA B AG BY IF","30600048","CDM","306","RC","87275","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INFLUENZA A AG BY DFA","30600049","CDM","306","RC","87276","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INFLUENZA A AG BY DFA","30600049","CDM","306","RC","87276","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INFLUENZA A AG BY DFA","30600049","CDM","306","RC","87276","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFLUENZA A AG BY DFA","30600049","CDM","306","RC","87276","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INFLUENZA A AG BY DFA","30600049","CDM","306","RC","87276","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LEGIONELLA P AG BY DFA","30600050","CDM","306","RC","87278","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LEGIONELLA P AG BY DFA","30600050","CDM","306","RC","87278","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LEGIONELLA P AG BY DFA","30600050","CDM","306","RC","87278","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEGIONELLA P AG BY DFA","30600050","CDM","306","RC","87278","HCPCS","facility","both","","","","343","343","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PARAINFLUENZA AG BY DFA","30600051","CDM","306","RC","87279","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PARAINFLUENZA AG BY DFA","30600051","CDM","306","RC","87279","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PARAINFLUENZA AG BY DFA","30600051","CDM","306","RC","87279","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PARAINFLUENZA AG BY DFA","30600051","CDM","306","RC","87279","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PARAINFLUENZA AG BY DFA","30600051","CDM","306","RC","87279","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RSV AG BY IF","30600052","CDM","306","RC","87280","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RSV AG BY IF","30600052","CDM","306","RC","87280","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RSV AG BY IF","30600052","CDM","306","RC","87280","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RSV AG BY IF","30600052","CDM","306","RC","87280","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RSV AG BY IF","30600052","CDM","306","RC","87280","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PNEUMOCYSTIS C AG BY IF","30600053","CDM","306","RC","87281","HCPCS","facility","both","","","","115.14","115.14","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PNEUMOCYSTIS C AG BY IF","30600053","CDM","306","RC","87281","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PNEUMOCYSTIS C AG BY IF","30600053","CDM","306","RC","87281","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VARICELLA ZOSTER AG BY DFA","30600054","CDM","306","RC","87290","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VARICELLA ZOSTER AG BY DFA","30600054","CDM","306","RC","87290","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VARICELLA ZOSTER AG BY DFA","30600054","CDM","306","RC","87290","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC VARICELLA ZOSTER AG BY DFA","30600054","CDM","306","RC","87290","HCPCS","facility","both","","","","55","55","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC INF AGENT MULTI ORG AG BY IF","30600055","CDM","306","RC","87300","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INF AGENT MULTI ORG AG BY IF","30600055","CDM","306","RC","87300","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INF AGENT MULTI ORG AG BY IF","30600055","CDM","306","RC","87300","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INF AGENT MULTI ORG AG BY IF","30600055","CDM","306","RC","87300","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ADENOVIRUS AG EIA","30600056","CDM","306","RC","87301","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ADENOVIRUS AG EIA","30600056","CDM","306","RC","87301","HCPCS","facility","both","","","","66","66","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ADENOVIRUS AG EIA","30600056","CDM","306","RC","87301","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ADENOVIRUS AG EIA","30600056","CDM","306","RC","87301","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 2/8/2017 HC GALACTOMANNAN ASSAY","30600057","CDM","306","RC","87305","HCPCS","facility","both","","","","253","253","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"DEAC 2/8/2017 HC GALACTOMANNAN ASSAY","30600057","CDM","306","RC","87305","HCPCS","facility","both","","","","57.46","57.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 2/8/2017 HC GALACTOMANNAN ASSAY","30600057","CDM","306","RC","87305","HCPCS","facility","both","","","","49.9","49.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PLATELIA ASPERGILLUS, BAL","30600058","CDM","306","RC","87305","HCPCS","facility","both","","","","375","375","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASPERGILLUS AG EIA","30600059","CDM","306","RC","87305","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASPERGILLUS AG EIA","30600059","CDM","306","RC","87305","HCPCS","facility","both","","","","372","372","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ASPERGILLUS AG EIA","30600059","CDM","306","RC","87305","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASPERGILLUS AG EIA","30600059","CDM","306","RC","87305","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CRYPTOCOCCUS NEOFORM AG EIA","30600060","CDM","306","RC","87327","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GIARDIA AG EIA","30600061","CDM","306","RC","87329","HCPCS","facility","both","","","","36.5","36.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GIARDIA AG EIA","30600061","CDM","306","RC","87329","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GIARDIA AG EIA","30600061","CDM","306","RC","87329","HCPCS","facility","both","","","","104","104","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GIARDIA AG EIA","30600061","CDM","306","RC","87329","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC E COLI 0157 AG EIA","30600062","CDM","306","RC","87335","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC E COLI 0157 AG EIA","30600062","CDM","306","RC","87335","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC E COLI 0157 AG EIA","30600062","CDM","306","RC","87335","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC E COLI 0157 AG EIA","30600062","CDM","306","RC","87335","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HPYLORI STOOL EIA","30600063","CDM","306","RC","87338","HCPCS","facility","both","","","","14.38","14.38","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC HPYLORI STOOL EIA","30600063","CDM","306","RC","87338","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HPYLORI STOOL EIA","30600063","CDM","306","RC","87338","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HPYLORI STOOL EIA","30600063","CDM","306","RC","87338","HCPCS","facility","both","","","","520","520","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HPYLORI STOOL EIA","30600063","CDM","306","RC","87338","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEPATITIS B SURFACE AG EIA","30600064","CDM","306","RC","87340","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEPATITIS B SURFACE AG EIA","30600064","CDM","306","RC","87340","HCPCS","facility","both","","","","10.33","10.33","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC HEPATITIS B SURFACE AG EIA","30600064","CDM","306","RC","87340","HCPCS","facility","both","","","","21","21","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPATITIS B SURFACE AG EIA","30600064","CDM","306","RC","87340","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC HEPATITIS B SURFACE AG EIA","30600064","CDM","306","RC","87340","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEPATITIS B SURFACE AG EIA","30600064","CDM","306","RC","87340","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC HEPATITIS B SURFACE AG EIA","30600064","CDM","306","RC","87340","HCPCS","facility","both","","","","192","192","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEPATITIS B SURFACE AG EIA NEUTRALIZATION","30600065","CDM","306","RC","87341","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEPATITIS B SURFACE AG EIA NEUTRALIZATION","30600065","CDM","306","RC","87341","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEPATITIS B SURFACE AG EIA NEUTRALIZATION","30600065","CDM","306","RC","87341","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEPATITIS B SURFACE AG EIA NEUTRALIZATION","30600065","CDM","306","RC","87341","HCPCS","facility","both","","","","38","38","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPATITIS B SURFACE AG EIA NEUTRALIZATION","30600065","CDM","306","RC","87341","HCPCS","facility","both","","","","10.33","10.33","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC HEPATITIS BE AG EIA","30600066","CDM","306","RC","87350","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPATITIS BE AG EIA","30600066","CDM","306","RC","87350","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEPATITIS BE AG EIA","30600066","CDM","306","RC","87350","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEPATITIS BE AG EIA","30600066","CDM","306","RC","87350","HCPCS","facility","both","","","","293","293","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HISTOPLASMA CAPSUL AG EIA","30600067","CDM","306","RC","87385","HCPCS","facility","both","","","","105","105","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HISTOPLASMA CAPSUL AG EIA","30600067","CDM","306","RC","87385","HCPCS","facility","both","","","","445","445","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HISTOPLASMA CAPSUL AG EIA","30600067","CDM","306","RC","87385","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HISTOPLASMA CAPSUL AG EIA","30600067","CDM","306","RC","87385","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ROTAVIRUS AG EIA","30600068","CDM","306","RC","87425","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ROTAVIRUS AG EIA","30600068","CDM","306","RC","87425","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ROTAVIRUS AG EIA","30600068","CDM","306","RC","87425","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ROTAVIRUS AG EIA","30600068","CDM","306","RC","87425","HCPCS","facility","both","","","","93.5","93.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC STREP A AG EIA","30600069","CDM","306","RC","87430","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STREP A AG EIA","30600069","CDM","306","RC","87430","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STREP A AG EIA","30600069","CDM","306","RC","87430","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC STREP A AG EIA","30600069","CDM","306","RC","87430","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IA BY EIA - MULTI STEP","30600070","CDM","306","RC","87449","HCPCS","facility","both","","","","86","86","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IA BY EIA - MULTI STEP","30600070","CDM","306","RC","87449","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHLAMYDIA T AMPLIF NA PROBE","30600071","CDM","306","RC","87491","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHLAMYDIA T AMPLIF NA PROBE","30600071","CDM","306","RC","87491","HCPCS","facility","both","","","","120.59","120.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHLAMYDIA T AMPLIF NA PROBE","30600071","CDM","306","RC","87491","HCPCS","facility","both","","","","94.2","94.2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHLAMYDIA T AMPLIF NA PROBE","30600071","CDM","306","RC","87491","HCPCS","facility","both","","","","247","247","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHLAMYDIA T AMPLIF NA PROBE","30600071","CDM","306","RC","87491","HCPCS","facility","both","","","","35.09","35.09","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC C DIFF AMPLIFIED PROBE","30600072","CDM","306","RC","87493","HCPCS","facility","both","","","","189","189","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC C DIFF AMPLIFIED PROBE","30600072","CDM","306","RC","87493","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC C DIFF AMPLIFIED PROBE","30600072","CDM","306","RC","87493","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC C DIFF AMPLIFIED PROBE","30600072","CDM","306","RC","87493","HCPCS","facility","both","","","","319","319","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOMEGALOV AMPLIF NA PROBE","30600073","CDM","306","RC","87496","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOMEGALOV AMPLIF NA PROBE","30600073","CDM","306","RC","87496","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOMEGALOV AMPLIF NA PROBE","30600073","CDM","306","RC","87496","HCPCS","facility","both","","","","1053","1053","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOMEGALOV AMPLIF NA PROBE","30600073","CDM","306","RC","87496","HCPCS","facility","both","","","","189","189","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYTOMEGALOVIRUS NA QUAN","30600074","CDM","306","RC","87497","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOMEGALOVIRUS NA QUAN","30600074","CDM","306","RC","87497","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYTOMEGALOVIRUS NA QUAN","30600074","CDM","306","RC","87497","HCPCS","facility","both","","","","370","370","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOMEGALOVIRUS NA QUAN","30600074","CDM","306","RC","87497","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ENTEROVIRUS DNA AMP PROBE","30600075","CDM","306","RC","87498","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ENTEROVIRUS DNA AMP PROBE","30600075","CDM","306","RC","87498","HCPCS","facility","both","","","","189","189","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ENTEROVIRUS DNA AMP PROBE","30600075","CDM","306","RC","87498","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ENTEROVIRUS DNA AMP PROBE","30600075","CDM","306","RC","87498","HCPCS","facility","both","","","","804","804","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEP-B NA QUAN","30600076","CDM","306","RC","87517","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEP-B NA QUAN","30600076","CDM","306","RC","87517","HCPCS","facility","both","","","","971","971","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEP-B NA QUAN","30600076","CDM","306","RC","87517","HCPCS","facility","both","","","","155","155","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC HEP-B NA QUAN","30600076","CDM","306","RC","87517","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEP-B NA QUAN","30600076","CDM","306","RC","87517","HCPCS","facility","both","","","","255","255","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEP-C AMPLIF NA PROBE","30600077","CDM","306","RC","87521","HCPCS","facility","both","","","","458","458","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HEP-C AMPLIF NA PROBE","30600077","CDM","306","RC","87521","HCPCS","facility","both","","","","293.09","293.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEP-C AMPLIF NA PROBE","30600077","CDM","306","RC","87521","HCPCS","facility","both","","","","375.15","375.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEP-C AMPLIF NA PROBE","30600077","CDM","306","RC","87521","HCPCS","facility","both","","","","86","86","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HERPES S AMPLIF NA PROBE","30600078","CDM","306","RC","87529","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HERPES S AMPLIF NA PROBE","30600078","CDM","306","RC","87529","HCPCS","facility","both","","","","46","46","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HERPES S AMPLIF NA PROBE","30600078","CDM","306","RC","87529","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HERPES S AMPLIF NA PROBE","30600078","CDM","306","RC","87529","HCPCS","facility","both","","","","590","590","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HIV-1 AMPLIF NA PROBE","30600079","CDM","306","RC","87535","HCPCS","facility","both","","","","576","576","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HIV-1 AMPLIF NA PROBE","30600079","CDM","306","RC","87535","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HIV-1 AMPLIF NA PROBE","30600079","CDM","306","RC","87535","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HIV-1 AMPLIF NA PROBE","30600079","CDM","306","RC","87535","HCPCS","facility","both","","","","86","86","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LEGIONELLA AMPLIF NA PROBE","30600080","CDM","306","RC","87541","HCPCS","facility","both","","","","215","215","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LEGIONELLA AMPLIF NA PROBE","30600080","CDM","306","RC","87541","HCPCS","facility","both","","","","460","460","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEGIONELLA AMPLIF NA PROBE","30600080","CDM","306","RC","87541","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEGIONELLA AMPLIF NA PROBE","30600080","CDM","306","RC","87541","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MYCOBACTERIA T DIR NA PROBE","30600081","CDM","306","RC","87555","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MYCOBACTERIA T DIR NA PROBE","30600081","CDM","306","RC","87555","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MYCOBACTERIA T DIR NA PROBE","30600081","CDM","306","RC","87555","HCPCS","facility","both","","","","265","265","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MYCOBACTERIA T DIR NA PROBE","30600081","CDM","306","RC","87555","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MYCOBACTERIA T AMPLIF NA PROBE","30600082","CDM","306","RC","87556","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MYCOBACTERIA T AMPLIF NA PROBE","30600082","CDM","306","RC","87556","HCPCS","facility","both","","","","489","489","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MYCOBACTERIA T AMPLIF NA PROBE","30600082","CDM","306","RC","87556","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MYCOBACTERIA T AMPLIF NA PROBE","30600082","CDM","306","RC","87556","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NEISSERIA AMPLIF NA PROBE","30600083","CDM","306","RC","87591","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC NEISSERIA AMPLIF NA PROBE","30600083","CDM","306","RC","87591","HCPCS","facility","both","","","","94.2","94.2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NEISSERIA AMPLIF NA PROBE","30600083","CDM","306","RC","87591","HCPCS","facility","both","","","","120.59","120.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NEISSERIA AMPLIF NA PROBE","30600083","CDM","306","RC","87591","HCPCS","facility","both","","","","247","247","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MR-STAPH DNA AMP PROBE","30600084","CDM","306","RC","87641","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MR-STAPH DNA AMP PROBE","30600084","CDM","306","RC","87641","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MR-STAPH DNA AMP PROBE","30600084","CDM","306","RC","87641","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MR-STAPH DNA AMP PROBE","30600084","CDM","306","RC","87641","HCPCS","facility","both","","","","76","76","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TRICHOMONAS VAGIN DIR PROBE","30600085","CDM","306","RC","87660","HCPCS","facility","both","","","","120.59","120.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRICHOMONAS VAGIN DIR PROBE","30600085","CDM","306","RC","87660","HCPCS","facility","both","","","","249","249","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TRICHOMONAS VAGIN DIR PROBE","30600085","CDM","306","RC","87660","HCPCS","facility","both","","","","94.2","94.2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DIR NA PROBE NOS AGENT","30600086","CDM","306","RC","87797","HCPCS","facility","both","","","","262","262","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AMPLIF NA PROBE NOS AGENT","30600087","CDM","306","RC","87798","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC AMPLIF NA PROBE NOS AGENT","30600087","CDM","306","RC","87798","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AMPLIF NA PROBE NOS AGENT","30600087","CDM","306","RC","87798","HCPCS","facility","both","","","","705","705","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AMPLIF NA PROBE NOS AGENT","30600087","CDM","306","RC","87798","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NA QUAN NOS AGENT","30600088","CDM","306","RC","87799","HCPCS","facility","both","","","","180","180","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC NA QUAN NOS AGENT","30600088","CDM","306","RC","87799","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NA QUAN NOS AGENT","30600088","CDM","306","RC","87799","HCPCS","facility","both","","","","879","879","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NA QUAN NOS AGENT","30600088","CDM","306","RC","87799","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DNA/RNA; MULTI ORG - AMP PR","30600089","CDM","306","RC","87801","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DNA/RNA; MULTI ORG - AMP PR","30600089","CDM","306","RC","87801","HCPCS","facility","both","","","","918","918","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DNA/RNA; MULTI ORG - AMP PR","30600089","CDM","306","RC","87801","HCPCS","facility","both","","","","254","254","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DNA/RNA; MULTI ORG - AMP PR","30600089","CDM","306","RC","87801","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AGENT NOS ASSAY W/OPTIC","30600090","CDM","306","RC","87899","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC AGENT NOS ASSAY W/OPTIC","30600090","CDM","306","RC","87899","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC AGENT NOS ASSAY W/OPTIC","30600090","CDM","306","RC","87899","HCPCS","facility","both","","","","215","215","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC AGENT NOS ASSAY W/OPTIC","30600090","CDM","306","RC","87899","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC AGENT NOS ASSAY W/OPTIC","30600090","CDM","306","RC","87899","HCPCS","facility","both","","","","60.5","60.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GENOTYPE DNA HIV REVERSE T","30600091","CDM","306","RC","87901","HCPCS","facility","both","","","","1502","1502","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GENOTYPE DNA HIV REVERSE T","30600091","CDM","306","RC","87901","HCPCS","facility","both","","","","711.77","711.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GENOTYPE DNA HIV REVERSE T","30600091","CDM","306","RC","87901","HCPCS","facility","both","","","","911.08","911.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENOTYPE DNA HIV REVERSE T","30600091","CDM","306","RC","87901","HCPCS","facility","both","","","","370","370","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPATITIS C - DNA OR RNA","30600092","CDM","306","RC","87902","HCPCS","facility","both","","","","311","311","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEPATITIS C - DNA OR RNA","30600092","CDM","306","RC","87902","HCPCS","facility","both","","","","257.45","257.45","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC HEPATITIS C - DNA OR RNA","30600092","CDM","306","RC","87902","HCPCS","facility","both","","","","301","301","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC HEPATITIS C - DNA OR RNA","30600092","CDM","306","RC","87902","HCPCS","facility","both","","","","911.08","911.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEPATITIS C - DNA OR RNA","30600092","CDM","306","RC","87902","HCPCS","facility","both","","","","711.77","711.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEPATITIS C - DNA OR RNA","30600092","CDM","306","RC","87902","HCPCS","facility","both","","","","1126","1126","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PHENOTYPE DNA HIV W/CULTURE; 1-10 DRUGS","30600093","CDM","306","RC","87903","HCPCS","facility","both","","","","911.08","911.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHENOTYPE DNA HIV W/CULTURE; 1-10 DRUGS","30600093","CDM","306","RC","87903","HCPCS","facility","both","","","","711.77","711.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PHENOTYPE DNA HIV W/CULTURE; 1-10 DRUGS","30600093","CDM","306","RC","87903","HCPCS","facility","both","","","","6354","6354","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IDENT BY DNA SEQUENCE","30600095","CDM","306","RC","87153","HCPCS","facility","both","","","","142.35","142.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IDENT BY DNA SEQUENCE","30600095","CDM","306","RC","87153","HCPCS","facility","both","","","","182.22","182.22","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IDENT BY DNA SEQUENCE","30600095","CDM","306","RC","87153","HCPCS","facility","both","","","","518","518","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IDENT BY DNA SEQUENCE","30600095","CDM","306","RC","87153","HCPCS","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CMV GENOTYPE","30600096","CDM","306","RC","87153","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CMV GENOTYPE","30600096","CDM","306","RC","87153","HCPCS","facility","both","","","","361.76","361.76","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CMV GENOTYPE","30600096","CDM","306","RC","87153","HCPCS","facility","both","","","","282.61","282.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CMV GENOTYPE","30600096","CDM","306","RC","87153","HCPCS","facility","both","","","","571","571","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEGIONELLA AG","30600097","CDM","306","RC","87449","HCPCS","facility","both","","","","55.5","55.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LEGIONELLA AG","30600097","CDM","306","RC","87449","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LEGIONELLA AG","30600097","CDM","306","RC","87449","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEGIONELLA AG","30600097","CDM","306","RC","87449","HCPCS","facility","both","","","","86","86","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STREP PNUMO AG","30600098","CDM","306","RC","87449","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STREP PNUMO AG","30600098","CDM","306","RC","87449","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC STREP PNUMO AG","30600098","CDM","306","RC","87449","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STREP PNUMO AG","30600098","CDM","306","RC","87449","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CRYPT AG TITER","30600099","CDM","306","RC","87449","HCPCS","facility","both","","","","52","52","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CRYPT AG TITER","30600099","CDM","306","RC","87449","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CRYPT AG TITER","30600099","CDM","306","RC","87449","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CRYPT AG TITER","30600099","CDM","306","RC","87449","HCPCS","facility","both","","","","106","106","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ARTHROPOD IDENT","30600100","CDM","306","RC","87999","HCPCS","facility","both","","","","267","267","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHLAMYDIA CULTURE","30600150","CDM","306","RC","87110","HCPCS","facility","both","","","","416","416","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CRYPTOSPOR AG BY IFA","30600151","CDM","306","RC","87272","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOSTRIDIUM AG EIA","30600152","CDM","306","RC","87324","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLOSTRIDIUM AG EIA","30600152","CDM","306","RC","87324","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CLOSTRIDIUM AG EIA","30600152","CDM","306","RC","87324","HCPCS","facility","both","","","","238","238","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOSTRIDIUM AG EIA","30600152","CDM","306","RC","87324","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CRYPTOSPORIDIUM AG EIA","30600153","CDM","306","RC","87328","HCPCS","facility","both","","","","122","122","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HIV-1 AG EIA","30600154","CDM","306","RC","87390","HCPCS","facility","both","","","","577","577","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INFLUENZA A/B AG EIA","30600155","CDM","306","RC","87400","HCPCS","facility","both","","","","126","126","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INFLUENZA A/B AG EIA","30600155","CDM","306","RC","87400","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RESP SYNCYTIAL AG EIA","30600156","CDM","306","RC","87420","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RESP SYNCYTIAL AG EIA","30600156","CDM","306","RC","87420","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHLAMYDIA P AMPLIF NA PROBE","30600157","CDM","306","RC","87486","HCPCS","facility","both","","","","628","628","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHLAMYDIA T DIR NA PROBE","30600158","CDM","306","RC","87490","HCPCS","facility","both","","","","262","262","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MYCOBACTERIA A AMPLIF NA PROBE","30600159","CDM","306","RC","87561","HCPCS","facility","both","","","","942","942","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INFLUENZA IA W DO","30600160","CDM","306","RC","87804","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC INFLUENZA IA W DO","30600160","CDM","306","RC","87804","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INFLUENZA IA W DO","30600160","CDM","306","RC","87804","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INFLUENZA IA W DO","30600160","CDM","306","RC","87804","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHENOTYPE IFECT AGENT DRUG (160)","30600161","CDM","306","RC","87900","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PHENOTYPE IFECT AGENT DRUG (160)","30600161","CDM","306","RC","87900","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHENOTYPE IFECT AGENT DRUG (160)","30600161","CDM","306","RC","87900","HCPCS","facility","both","","","","762","762","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CULTURE; IF EA ANTISERUM","30600164","CDM","306","RC","87140","HCPCS","facility","both","","","","73","73","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MACROSCOPIC EXAM PARASITE","30600166","CDM","306","RC","87169","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MACROSCOPIC EXAM PARASITE","30600166","CDM","306","RC","87169","HCPCS","facility","both","","","","14.5","14.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MACROSCOPIC EXAM PARASITE","30600166","CDM","306","RC","87169","HCPCS","facility","both","","","","262","262","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MACROSCOPIC EXAM PARASITE","30600166","CDM","306","RC","87169","HCPCS","facility","both","","","","29","29","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MACROSCOPIC EXAM PARASITE","30600166","CDM","306","RC","87169","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NOS INFECTIOUS AG BY IF","30600168","CDM","306","RC","87299","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC NOS INFECTIOUS AG BY IF","30600168","CDM","306","RC","87299","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NOS INFECTIOUS AG BY IF","30600168","CDM","306","RC","87299","HCPCS","facility","both","","","","146","146","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NOS INFECTIOUS AG BY IF","30600168","CDM","306","RC","87299","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ENTAMOEB HIST GROUP AG EIA","30600170","CDM","306","RC","87337","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BARTONELLA AMPLIF NAP","30600171","CDM","306","RC","87471","HCPCS","facility","both","","","","458","458","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BARTONELLA AMPLIF NAP","30600171","CDM","306","RC","87471","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BARTONELLA AMPLIF NAP","30600171","CDM","306","RC","87471","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEP-B AMPLIF NA PROBE","30600172","CDM","306","RC","87516","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEP-B AMPLIF NA PROBE","30600172","CDM","306","RC","87516","HCPCS","facility","both","","","","86","86","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HEP-B AMPLIF NA PROBE","30600172","CDM","306","RC","87516","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEP-B AMPLIF NA PROBE","30600172","CDM","306","RC","87516","HCPCS","facility","both","","","","458","458","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HERPES S NA QUAN","30600173","CDM","306","RC","87530","HCPCS","facility","both","","","","116","116","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HERPES S NA QUAN","30600173","CDM","306","RC","87530","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HERPES S NA QUAN","30600173","CDM","306","RC","87530","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HERPES S NA QUAN","30600173","CDM","306","RC","87530","HCPCS","facility","both","","","","372","372","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NEISSERIA DIR NA PROBE","30600174","CDM","306","RC","87590","HCPCS","facility","both","","","","262","262","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DARK FIELD; W SPEC COLLECT","30600175","CDM","306","RC","87164","HCPCS","facility","both","","","","163","163","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MACROSCOPIC EXAM ARTHROPOD","30600176","CDM","306","RC","87168","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MACROSCOPIC EXAM ARTHROPOD","30600176","CDM","306","RC","87168","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MACROSCOPIC EXAM ARTHROPOD","30600176","CDM","306","RC","87168","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MACROSCOPIC EXAM ARTHROPOD","30600176","CDM","306","RC","87168","HCPCS","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SENSITIVITY - MLC EA PLATE","30600177","CDM","306","RC","87187","HCPCS","facility","both","","","","136","136","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SENSITIVITY - MYCOBACT EA AGNT","30600178","CDM","306","RC","87190","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SENSITIVITY - MYCOBACT EA AGNT","30600178","CDM","306","RC","87190","HCPCS","facility","both","","","","6","6","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SENSITIVITY - MYCOBACT EA AGNT","30600178","CDM","306","RC","87190","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SENSITIVITY - MYCOBACT EA AGNT","30600178","CDM","306","RC","87190","HCPCS","facility","both","","","","73","73","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TOXIN ASSAY TISSUE CULTURE","30600179","CDM","306","RC","87230","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TOXIN ASSAY TISSUE CULTURE","30600179","CDM","306","RC","87230","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TOXIN ASSAY TISSUE CULTURE","30600179","CDM","306","RC","87230","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TOXIN ASSAY TISSUE CULTURE","30600179","CDM","306","RC","87230","HCPCS","facility","both","","","","227","227","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC VIRUS ISOLATE; EMBRYO EGG INJ","30600180","CDM","306","RC","87250","HCPCS","facility","both","","","","256","256","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOMEGALOVIRUS AG EIA","30600181","CDM","306","RC","87332","HCPCS","facility","both","","","","214","214","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HIV-1 AG W/HIV-1 & HIV-2 AB","30600182","CDM","306","RC","87389","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HIV-1 AG W/HIV-1 & HIV-2 AB","30600182","CDM","306","RC","87389","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HIV-1 AG W/HIV-1 & HIV-2 AB","30600182","CDM","306","RC","87389","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HIV-1 AG W/HIV-1 & HIV-2 AB","30600182","CDM","306","RC","87389","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: BMC NIDA CLIENT FEE SCHEDULE"
"HC HIV-1 AG W/HIV-1 & HIV-2 AB","30600182","CDM","306","RC","87389","HCPCS","facility","both","","","","99","99","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HIV-1 AG W/HIV-1 & HIV-2 AB","30600182","CDM","306","RC","87389","HCPCS","facility","both","","","","24.08","24.08","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC HIV-1 AG W/HIV-1 & HIV-2 AB","30600182","CDM","306","RC","87389","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC SHIGA-LIKE TOXIN AG EIA","30600183","CDM","306","RC","87427","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SHIGA-LIKE TOXIN AG EIA","30600183","CDM","306","RC","87427","HCPCS","facility","both","","","","17.3","17.3","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SHIGA-LIKE TOXIN AG EIA","30600183","CDM","306","RC","87427","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SHIGA-LIKE TOXIN AG EIA","30600183","CDM","306","RC","87427","HCPCS","facility","both","","","","212","212","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INFLUENZA DNA AMP PROB 1+","30600184","CDM","306","RC","87501","HCPCS","facility","both","","","","667","667","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HERPES 6 NA QUAN","30600185","CDM","306","RC","87533","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HERPES 6 NA QUAN","30600185","CDM","306","RC","87533","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HERPES 6 NA QUAN","30600185","CDM","306","RC","87533","HCPCS","facility","both","","","","370","370","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HERPES 6 NA QUAN","30600185","CDM","306","RC","87533","HCPCS","facility","both","","","","122","122","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HIV-2 PROBE&REVRSE TRNSCRIPJ","30600186","CDM","306","RC","87538","HCPCS","facility","both","","","","458","458","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEGIONELLA DIR NA PROBE","30600187","CDM","306","RC","87540","HCPCS","facility","both","","","","371","371","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MYCOBACTERIA DIR NA PROBE","30600188","CDM","306","RC","87550","HCPCS","facility","both","","","","262","262","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RESP VIRUS 6-11 TARGETS","30600189","CDM","306","RC","87632","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RESP VIRUS 6-11 TARGETS","30600189","CDM","306","RC","87632","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RESP VIRUS 6-11 TARGETS","30600189","CDM","306","RC","87632","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RESP VIRUS 6-11 TARGETS","30600189","CDM","306","RC","87632","HCPCS","facility","both","","","","2789","2789","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STAPH A DNA AMP PROBE","30600190","CDM","306","RC","87640","HCPCS","facility","both","","","","458","458","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STREP B DNA AMP PROBE","30600191","CDM","306","RC","87653","HCPCS","facility","both","","","","458","458","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STREP B DNA AMP PROBE","30600191","CDM","306","RC","87653","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STREP B DNA AMP PROBE","30600191","CDM","306","RC","87653","HCPCS","facility","both","","","","127","127","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC STREP B DNA AMP PROBE","30600191","CDM","306","RC","87653","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DIR NA PROBE MULTI ORGANISMS","30600192","CDM","306","RC","87800","HCPCS","facility","both","","","","108","108","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DIR NA PROBE MULTI ORGANISMS","30600192","CDM","306","RC","87800","HCPCS","facility","both","","","","522","522","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STREP B IA W DO","30600193","CDM","306","RC","87802","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CLOSTRIDIUM DIFF IA W DO","30600194","CDM","306","RC","87803","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RSV IA W DIR OBSERV","30600195","CDM","306","RC","87807","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STREP A ASSAY W/OPTIC","30600196","CDM","306","RC","87880","HCPCS","facility","both","","","","189","189","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STREP A ASSAY W/OPTIC","30600196","CDM","306","RC","87880","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STREP A ASSAY W/OPTIC","30600196","CDM","306","RC","87880","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC STREP A ASSAY W/OPTIC","30600196","CDM","306","RC","87880","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENOTYPE CYTOMEGALOVIRUS","30600197","CDM","306","RC","87910","HCPCS","facility","both","","","","645","645","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GENOTYPE DNA HEPATITIS B","30600198","CDM","306","RC","87912","HCPCS","facility","both","","","","3363","3363","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GENOTYPE DNA HEPATITIS B","30600198","CDM","306","RC","87912","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GENOTYPE DNA HEPATITIS B","30600198","CDM","306","RC","87912","HCPCS","facility","both","","","","211","211","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GENOTYPE DNA HEPATITIS B","30600198","CDM","306","RC","87912","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRICHOMONAS ASSAY W/OPTIC","30600199","CDM","306","RC","87808","HCPCS","facility","both","","","","84","84","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TRICHOMONAS ASSAY W/OPTIC","30600199","CDM","306","RC","87808","HCPCS","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HOMOGENIZATION, TISSUE, FOR CULTURE","30600200","CDM","306","RC","87176","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HOMOGENIZATION, TISSUE, FOR CULTURE","30600200","CDM","306","RC","87176","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HOMOGENIZATION, TISSUE, FOR CULTURE","30600200","CDM","306","RC","87176","HCPCS","facility","both","","","","76","76","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IA BY EIA-MULTISTEP (250","30600201","CDM","306","RC","87449","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IA BY EIA-MULTISTEP (250","30600201","CDM","306","RC","87449","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RESP VIRUS 3-5 TARGETS","30600202","CDM","306","RC","87631","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RESP VIRUS 3-5 TARGETS","30600202","CDM","306","RC","87631","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RESP VIRUS 3-5 TARGETS","30600202","CDM","306","RC","87631","HCPCS","facility","both","","","","540","540","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RESP VIRUS 3-5 TARGETS","30600202","CDM","306","RC","87631","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  GENOTYPE DNA HIV OTH REGION (180)","30600203","CDM","306","RC","87906","HCPCS","facility","both","","","","482.33","482.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  GENOTYPE DNA HIV OTH REGION (180)","30600203","CDM","306","RC","87906","HCPCS","facility","both","","","","376.81","376.81","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  GENOTYPE DNA HIV OTH REGION (180)","30600203","CDM","306","RC","87906","HCPCS","facility","both","","","","360","360","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  GENOTYPE DNA HIV OTH REGION (185)","30600204","CDM","306","RC","87906","HCPCS","facility","both","","","","495.74","495.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  GENOTYPE DNA HIV OTH REGION (185)","30600204","CDM","306","RC","87906","HCPCS","facility","both","","","","376.75","376.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  GENOTYPE DNA HIV OTH REGION (185)","30600204","CDM","306","RC","87906","HCPCS","facility","both","","","","387.29","387.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  GENOTYPE DNA HIV OTH REGION (260)","30600205","CDM","306","RC","87906","HCPCS","facility","both","","","","696.71","696.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  GENOTYPE DNA HIV OTH REGION (260)","30600205","CDM","306","RC","87906","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  GENOTYPE DNA HIV OTH REGION (260)","30600205","CDM","306","RC","87906","HCPCS","facility","both","","","","544.29","544.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  GENOTYPE DNA HIV OTH REGION (340)","30600206","CDM","306","RC","87906","HCPCS","facility","both","","","","911.08","911.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  GENOTYPE DNA HIV OTH REGION (340)","30600206","CDM","306","RC","87906","HCPCS","facility","both","","","","611","611","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  GENOTYPE DNA HIV OTH REGION (340)","30600206","CDM","306","RC","87906","HCPCS","facility","both","","","","711.77","711.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  GENOTYPE DNA HIV OTH REGION (490)","30600207","CDM","306","RC","87906","HCPCS","facility","both","","","","870","870","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  GENOTYPE DNA HIV OTH REGION (490)","30600207","CDM","306","RC","87906","HCPCS","facility","both","","","","1313.03","1313.03","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  GENOTYPE DNA HIV OTH REGION (490)","30600207","CDM","306","RC","87906","HCPCS","facility","both","","","","1025.79","1025.79","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  GENOTYPE DNA HIV OTH REGION (1430)","30600208","CDM","306","RC","87906","HCPCS","facility","both","","","","3831.9","3831.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  GENOTYPE DNA HIV OTH REGION (1430)","30600208","CDM","306","RC","87906","HCPCS","facility","both","","","","2845","2845","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  GENOTYPE DNA HIV OTH REGION (1430)","30600208","CDM","306","RC","87906","HCPCS","facility","both","","","","2993.62","2993.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  GENOTYPE DNA HEPATITIS B (100)","30600209","CDM","306","RC","87912","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  GENOTYPE DNA HEPATITIS B (100)","30600209","CDM","306","RC","87912","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PHENOTYPE HIV 1-5 ADDON","30600210","CDM","306","RC","87904","HCPCS","facility","both","","","","711.77","711.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PHENOTYPE HIV 1-5 ADDON","30600210","CDM","306","RC","87904","HCPCS","facility","both","","","","911.08","911.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INFECT AGENT DET,GI 3-5 TARGET","30600211","CDM","306","RC","87505","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INFECT AGENT DET,GI 3-5 TARGET","30600211","CDM","306","RC","87505","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC INFECT AGENT DET,GI 3-5 TARGET","30600211","CDM","306","RC","87505","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INFECT AGENT DET,GI 3-5 TARGET","30600211","CDM","306","RC","87505","HCPCS","facility","both","","","","775","775","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IA BY EIA-MULTISTEP (125)","30600212","CDM","306","RC","87449","HCPCS","facility","both","","","","334.96","334.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IA BY EIA-MULTISTEP (125)","30600212","CDM","306","RC","87449","HCPCS","facility","both","","","","261.68","261.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IA BY EIA-MULTISTEP (125)","30600212","CDM","306","RC","87449","HCPCS","facility","both","","","","170","170","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SMEAR COMPLEX STAIN","30600213","CDM","306","RC","87209","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SMEAR COMPLEX STAIN","30600213","CDM","306","RC","87209","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SMEAR COMPLEX STAIN","30600213","CDM","306","RC","87209","HCPCS","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFEC AGENT DET,GI  6-11 TARGETS","30600214","CDM","306","RC","87506","HCPCS","facility","both","","","","1550","1550","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFEC AGENT DET,GI  6-11 TARGETS","30600214","CDM","306","RC","87506","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INFEC AGENT DET,GI  6-11 TARGETS","30600214","CDM","306","RC","87506","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INFEC AGENT DET,GI  6-11 TARGETS","30600214","CDM","306","RC","87506","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC INFEC AGENT DET,GI  12-25 TARGETS","30600215","CDM","306","RC","87507","HCPCS","facility","both","","","","376.81","376.81","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INFEC AGENT DET,GI  12-25 TARGETS","30600215","CDM","306","RC","87507","HCPCS","facility","both","","","","482.33","482.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INFEC AGENT DET,GI  12-25 TARGETS","30600215","CDM","306","RC","87507","HCPCS","facility","both","","","","2327","2327","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOTYPE DNA HIV OTH REION (620)","30600216","CDM","306","RC","87906","HCPCS","facility","both","","","","1661.39","1661.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENOTYPE DNA HIV OTH REION (620)","30600216","CDM","306","RC","87906","HCPCS","facility","both","","","","1088","1088","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GENOTYPE DNA HIV OTH REION (620)","30600216","CDM","306","RC","87906","HCPCS","facility","both","","","","1297.93","1297.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  ZIKA VIRUS DNA/RNA AMP PROBE","30600217","CDM","306","RC","87662","HCPCS","facility","both","","","","705","705","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  ZIKA VIRUS DNA/RNA AMP PROBE","30600217","CDM","306","RC","87662","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  ZIKA VIRUS DNA/RNA AMP PROBE","30600217","CDM","306","RC","87662","HCPCS","facility","both","","","","405","405","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC  ZIKA VIRUS DNA/RNA AMP PROBE","30600217","CDM","306","RC","87662","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STREP A AMPLIF NA PROBE","30600218","CDM","306","RC","87651","HCPCS","facility","both","","","","42","42","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC STREP A AMPLIF NA PROBE","30600218","CDM","306","RC","87651","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STREP A AMPLIF NA PROBE","30600218","CDM","306","RC","87651","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STREP A AMPLIF NA PROBE","30600218","CDM","306","RC","87651","HCPCS","facility","both","","","","337","337","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CANDIDA NA AMPLIFIED PROBE","30600219","CDM","306","RC","87481","HCPCS","facility","both","","","","161","161","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CANDIDA NA AMPLIFIED PROBE","30600219","CDM","306","RC","87481","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CANDIDA NA AMPLIFIED PROBE","30600219","CDM","306","RC","87481","HCPCS","facility","both","","","","71","71","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CANDIDA NA AMPLIFIED PROBE","30600219","CDM","306","RC","87481","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHENOTYPE INFECT AGENT DRUG (80)","30600220","CDM","306","RC","87900","HCPCS","facility","both","","","","167.48","167.48","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PHENOTYPE INFECT AGENT DRUG (80)","30600220","CDM","306","RC","87900","HCPCS","facility","both","","","","214.37","214.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHENOTYPE INFECT AGENT DRUG (80)","30600220","CDM","306","RC","87900","HCPCS","facility","both","","","","482","482","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOTYPE DNA HIV OTHER REGION (75)","30600221","CDM","306","RC","87906","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GENOTYPE DNA HIV OTHER REGION (75)","30600221","CDM","306","RC","87906","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENOTYPE DNA HIV OTHER REGION (75)","30600221","CDM","306","RC","87906","HCPCS","facility","both","","","","402","402","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHENOTYPE INFECT AGENT DRUG (1)","30600222","CDM","306","RC","87900","HCPCS","facility","both","","","","429","429","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHENOTYPE INFECT AGENT DRUG (1)","30600222","CDM","306","RC","87900","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHENOTYPE INFECT AGENT DRUG (1)","30600222","CDM","306","RC","87900","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HPV HIGH-RISK TYPES (275)","30600223","CDM","306","RC","87624","HCPCS","facility","both","","","","701","701","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HPV HIGH-RISK TYPES (275)","30600223","CDM","306","RC","87624","HCPCS","facility","both","","","","736.9","736.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HPV HIGH-RISK TYPES (275)","30600223","CDM","306","RC","87624","HCPCS","facility","both","","","","575.7","575.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HIV-2 QUANT & REV TRANSCRIP","30600224","CDM","306","RC","87539","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HIV-2 QUANT & REV TRANSCRIP","30600224","CDM","306","RC","87539","HCPCS","facility","both","","","","335","335","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DNA/RNA AMPLIFIED PROBE","30600225","CDM","306","RC","87150","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DNA/RNA AMPLIFIED PROBE","30600225","CDM","306","RC","87150","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DNA/RNA AMPLIFIED PROBE","30600225","CDM","306","RC","87150","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DNA/RNA AMPLIFIED PROBE","30600225","CDM","306","RC","87150","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GENOTYPE DNA HIV OTHER REGION (40)","30600226","CDM","306","RC","87906","HCPCS","facility","both","","","","402","402","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOTYPE DNA HIV OTHER REGION (40)","30600226","CDM","306","RC","87906","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GENOTYPE DNA HIV OTHER REGION (40)","30600226","CDM","306","RC","87906","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENOTYPE DNA HIV OTHER REGION (40)","30600226","CDM","306","RC","87906","HCPCS","facility","both","","","","360","360","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RESP VIRUS 12-25 TARGETS","30600227","CDM","306","RC","87633","HCPCS","facility","both","","","","1180","1180","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RESP VIRUS 12-25 TARGETS","30600227","CDM","306","RC","87633","HCPCS","facility","both","","","","482.33","482.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RESP VIRUS 12-25 TARGETS","30600227","CDM","306","RC","87633","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RESP VIRUS 12-25 TARGETS","30600227","CDM","306","RC","87633","HCPCS","facility","both","","","","376.81","376.81","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL","30600228","CDM","306","RC","","","facility","both","","","","239","239","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL","30600228","CDM","306","RC","","","facility","both","","","","58.99","58.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL","30600228","CDM","306","RC","","","facility","both","","","","189","189","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL","30600228","CDM","306","RC","","","facility","both","","","","51.31","51.31","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CDC-CORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL","30600229","CDM","306","RC","","","facility","both","","","","51.31","51.31","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CDC-CORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL","30600229","CDM","306","RC","","","facility","both","","","","51.31","51.31","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CDC-CORONAVIRUS REAL TIME RT-PCR DIAGNOSTIC TEST PANEL","30600229","CDM","306","RC","","","facility","both","","","","166","166","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/25 HC SARS-COV-2 (120)","30600230","CDM","306","RC","87635","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"DEAC 7/1/25 HC SARS-COV-2 (120)","30600230","CDM","306","RC","87635","HCPCS","facility","both","","","","53.39","53.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"DEAC 7/1/25 HC SARS-COV-2 (120)","30600230","CDM","306","RC","87635","HCPCS","facility","both","","","","47.97","47.97","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 7/1/25 HC SARS-COV-2 (120)","30600230","CDM","306","RC","87635","HCPCS","facility","both","","","","254","254","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RSV DNA/RNA AMP PROBE (2)","30600231","CDM","306","RC","87634","HCPCS","facility","both","","","","359","359","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RSV DNA/RNA AMP PROBE (2)","30600231","CDM","306","RC","87634","HCPCS","facility","both","","","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RSV DNA/RNA AMP PROBE (2)","30600231","CDM","306","RC","87634","HCPCS","facility","both","","","","5.36","5.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INFLUENZA DNA AMP PROBE","30600232","CDM","306","RC","87502","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INFLUENZA DNA AMP PROBE","30600232","CDM","306","RC","87502","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC INFLUENZA DNA AMP PROBE","30600232","CDM","306","RC","87502","HCPCS","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFLUENZA DNA AMP PROBE","30600232","CDM","306","RC","87502","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SARSCOV CORONAVIRUS AG IA","30600233","CDM","306","RC","87426","HCPCS","facility","both","","","","204","204","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SARSCOV CORONAVIRUS AG IA","30600233","CDM","306","RC","87426","HCPCS","facility","both","","","","42.87","42.87","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SARSCOV CORONAVIRUS AG IA","30600233","CDM","306","RC","87426","HCPCS","facility","both","","","","33.49","33.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 7/1/25 HC SARSCOV2 &INF A&B & RSV","30600234","CDM","306","RC","87637","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 7/1/25 HC SARSCOV2 &INF A&B & RSV","30600234","CDM","306","RC","87637","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"DEAC 7/1/25 HC SARSCOV2 &INF A&B & RSV","30600234","CDM","306","RC","87637","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"DEAC 7/1/25 HC SARSCOV2 &INF A&B & RSV","30600234","CDM","306","RC","87637","HCPCS","facility","both","","","","518","518","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NFCT DS BV&VAGINITIS DNA ALG","30600235","CDM","306","RC","81514","HCPCS","facility","both","","","","1872","1872","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NFCT DS BV&VAGINITIS DNA ALG","30600235","CDM","306","RC","81514","HCPCS","facility","both","","","","442.14","442.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NFCT DS BV&VAGINITIS DNA ALG","30600235","CDM","306","RC","81514","HCPCS","facility","both","","","","345.42","345.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NFCT DS BV&VAGINITIS DNA ALG","30600235","CDM","306","RC","81514","HCPCS","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"DEAC 05/12/2023 HC COV-19 AMP PRB HGH THRUPUT WITHIN 2 DAYS COLLECT","30600236","CDM","306","RC","","","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 05/12/2023 HC COV-19 AMP PRB HGH THRUPUT WITHIN 2 DAYS COLLECT","30600236","CDM","306","RC","","","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 05/12/2023 HC COV-19 AMP PRB HGH THRUPUT WITHIN 2 DAYS COLLECT","30600236","CDM","306","RC","","","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC M. GENITALIUM AMP PROBE","30600237","CDM","306","RC","87563","HCPCS","facility","both","","","","120.59","120.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC M. GENITALIUM AMP PROBE","30600237","CDM","306","RC","87563","HCPCS","facility","both","","","","94.2","94.2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC M. GENITALIUM AMP PROBE","30600237","CDM","306","RC","87563","HCPCS","facility","both","","","","942","942","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CUL TYP D BLD PTHGN 6+TRGT","30600238","CDM","306","RC","87154","HCPCS","facility","both","","","","252","252","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CUL TYP D BLD PTHGN 6+TRGT","30600238","CDM","306","RC","87154","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CUL TYP D BLD PTHGN 6+TRGT","30600238","CDM","306","RC","87154","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID; ORTHOPOXVIRUS, AMPLIFIED PROBE TECHNIQUE, EA","30600239","CDM","306","RC","87593","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID; ORTHOPOXVIRUS, AMPLIFIED PROBE TECHNIQUE, EA","30600239","CDM","306","RC","87593","HCPCS","facility","both","","","","56","56","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFECTIOUS AGENT DETECTION BY NUCLEIC ACID; ORTHOPOXVIRUS, AMPLIFIED PROBE TECHNIQUE, EA","30600239","CDM","306","RC","87593","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SARS-COV-2 (24)","30600248","CDM","306","RC","87635","HCPCS","facility","both","","","","64.31","64.31","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SARS-COV-2 (24)","30600248","CDM","306","RC","87635","HCPCS","facility","both","","","","50.27","50.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SARS-COV-2 (24)","30600248","CDM","306","RC","87635","HCPCS","facility","both","","","","230","230","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SARSCOV2 &INF A&B & RSV (39)","30600249","CDM","306","RC","87637","HCPCS","facility","both","","","","105.67","105.67","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SARSCOV2 &INF A&B & RSV (39)","30600249","CDM","306","RC","87637","HCPCS","facility","both","","","","81.68","81.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SARSCOV2 &INF A&B & RSV (39)","30600249","CDM","306","RC","87637","HCPCS","facility","both","","","","470","470","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYCOBACTERIUM SP,DNA PROBE","30660015","CDM","306","RC","87551","HCPCS","facility","both","","","","535.93","535.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MYCOBACTERIUM SP,DNA PROBE","30660015","CDM","306","RC","87551","HCPCS","facility","both","","","","418.68","418.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RALTEGRAVIR RESISITANCE, HIV-1","30660018","CDM","306","RC","87906","HCPCS","facility","both","","","","441","441","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RALTEGRAVIR RESISITANCE, HIV-1","30660018","CDM","306","RC","87906","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RALTEGRAVIR RESISITANCE, HIV-1","30660018","CDM","306","RC","87906","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INFECT DS (BACTERIAL/VIRAL), TRAIL IP-10 C-REACT PRTN SERUM (41)","30660055","CDM","306","RC","","","facility","both","","","","861","861","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFECT DS (BACTERIAL/VIRAL), TRAIL IP-10 C-REACT PRTN SERUM (41)","30660055","CDM","306","RC","","","facility","both","","","","109.87","109.87","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INFECT DS (BACTERIAL/VIRAL), TRAIL IP-10 C-REACT PRTN SERUM (41)","30660055","CDM","306","RC","","","facility","both","","","","85.83","85.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC URINE VOL MEASURE EA","30700050","CDM","307","RC","81050","HCPCS","facility","both","","","","44","44","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC N-AUTOM URINE DIP W MICRO","30700051","CDM","307","RC","81000","HCPCS","facility","both","","","","38","38","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC POCT URINALYSIS BY DIPSTICK/TABLET REAGENT NON AUTOMATED W/O MICRO","30770001","CDM","307","RC","81002","HCPCS","facility","both","","","","7.11","7.11","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  LAB OTHER","30900000","CDM","309","RC","","","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  LAB OTHER","30900000","CDM","309","RC","","","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LYMPHOCYTOTOX VC;  W TITRATE","30900001","CDM","310","RC","86805","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LYMPHOCYTOTOX VC;  W TITRATE","30900001","CDM","310","RC","86805","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LYMPHOCYTOTOX VC;  W TITRATE","30900001","CDM","310","RC","86805","HCPCS","facility","both","","","","398","398","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA TYPE; A B C MULTI AG","30900002","CDM","310","RC","86813","HCPCS","facility","both","","","","2783","2783","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA TYPE; A B C MULTI AG","30900002","CDM","310","RC","86813","HCPCS","facility","both","","","","250","250","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HLA TYPE; DR/DQ MULTI AG","30900003","CDM","310","RC","86817","HCPCS","facility","both","","","","280","280","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC HLA TYPE; DR/DQ MULTI AG","30900003","CDM","310","RC","86817","HCPCS","facility","both","","","","762","762","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA X-MATCH NON-CYTOTOXIC","30900004","CDM","302","RC","86825","HCPCS","facility","both","","","","1184.41","1184.41","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA X-MATCH NON-CYTOTOXIC","30900004","CDM","302","RC","86825","HCPCS","facility","both","","","","925.29","925.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA X-MATCH NON-CYTOTOXIC","30900004","CDM","302","RC","86825","HCPCS","facility","both","","","","948","948","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FROZEN BLOOD THAW","30900005","CDM","300","RC","86931","HCPCS","facility","both","","","","804","804","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TISSUE CULTURE; LYMPHOCYTE","30900006","CDM","311","RC","88230","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TISSUE CULTURE; LYMPHOCYTE","30900006","CDM","311","RC","88230","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISSUE CULTURE; LYMPHOCYTE","30900006","CDM","311","RC","88230","HCPCS","facility","both","","","","1007","1007","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TISSUE CULTURE; LYMPHOCYTE","30900006","CDM","311","RC","88230","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHROM ANALY; 5 CELLS","30900007","CDM","319","RC","88261","HCPCS","facility","both","","","","2621","2621","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROM ANALY; SITU AF CELLS FROM 6-12 COL","30900008","CDM","319","RC","88269","HCPCS","facility","both","","","","680","680","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHROM ANALY; SITU AF CELLS FROM 6-12 COL","30900008","CDM","319","RC","88269","HCPCS","facility","both","","","","628.03","628.03","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROM ANALY; SITU AF CELLS FROM 6-12 COL","30900008","CDM","319","RC","88269","HCPCS","facility","both","","","","803.9","803.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHROM ANALY; SITU AF CELLS FROM 6-12 COL","30900008","CDM","319","RC","88269","HCPCS","facility","both","","","","2467","2467","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MCG; DNA PROBE EA","30900009","CDM","311","RC","88271","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MCG; DNA PROBE EA","30900009","CDM","311","RC","88271","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MCG; DNA PROBE EA","30900009","CDM","311","RC","88271","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MCG; DNA PROBE EA","30900009","CDM","311","RC","88271","HCPCS","facility","both","","","","147","147","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COLLECT SWEAT FOR TEST","30900010","CDM","300","RC","89230","HCPCS","facility","both","","","","304","304","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COLLECT SWEAT FOR TEST","30900010","CDM","300","RC","89230","HCPCS","facility","both","","","","24.5","24.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COLLECT SWEAT FOR TEST","30900010","CDM","300","RC","89230","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COLLECT SWEAT FOR TEST","30900010","CDM","300","RC","89230","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NB SCREEN PANEL -REQ DC","30900011","CDM","309","RC","","","facility","both","","","","115","115","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NB SCREEN PANEL -REQ DC","30900011","CDM","309","RC","","","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MPL W515 & S505 MUTATION","30900012","CDM","310","RC","81402","HCPCS","facility","both","","","","357","357","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MPL W515 & S505 MUTATION","30900012","CDM","310","RC","81402","HCPCS","facility","both","","","","366.35","366.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MPL W515 & S505 MUTATION","30900012","CDM","310","RC","81402","HCPCS","facility","both","","","","1783","1783","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MPL W515 & S505 MUTATION","30900012","CDM","310","RC","81402","HCPCS","facility","both","","","","468.94","468.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CELIAC GENE TEST","30900013","CDM","310","RC","81382","HCPCS","facility","both","","","","1576","1576","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CELIAC GENE TEST","30900013","CDM","310","RC","81382","HCPCS","facility","both","","","","94.37","94.37","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PML RARA","30900014","CDM","310","RC","81315","HCPCS","facility","both","","","","577.79","577.79","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PML RARA","30900014","CDM","310","RC","81315","HCPCS","facility","both","","","","1584","1584","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PML RARA","30900014","CDM","310","RC","81315","HCPCS","facility","both","","","","188.5","188.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PML RARA","30900014","CDM","310","RC","81315","HCPCS","facility","both","","","","739.58","739.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC JAK2 (V617F) MUTATION","30900015","CDM","310","RC","81270","HCPCS","facility","both","","","","322","322","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC JAK2 (V617F) MUTATION","30900015","CDM","310","RC","81270","HCPCS","facility","both","","","","525.22","525.22","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC JAK2 (V617F) MUTATION","30900015","CDM","310","RC","81270","HCPCS","facility","both","","","","410.32","410.32","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC JAK2 (V617F) MUTATION","30900015","CDM","310","RC","81270","HCPCS","facility","both","","","","1672","1672","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYSTIC FIBROSIS SCREEN","30900016","CDM","310","RC","81220","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYSTIC FIBROSIS SCREEN","30900016","CDM","310","RC","81220","HCPCS","facility","both","","","","772","772","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYSTIC FIBROSIS SCREEN","30900016","CDM","310","RC","81220","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PROMETHEUS CROHN'S PROGNOSTIC","30900017","CDM","310","RC","81479","HCPCS","facility","both","","","","2122","2122","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STR MARKERS SPECIMEN ANAL (175)","30900018","CDM","310","RC","81265","HCPCS","facility","both","","","","366.35","366.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STR MARKERS SPECIMEN ANAL (175)","30900018","CDM","310","RC","81265","HCPCS","facility","both","","","","468.94","468.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KRAS GENE (115)","30900019","CDM","310","RC","81275","HCPCS","facility","both","","","","308.16","308.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KRAS GENE (115)","30900019","CDM","310","RC","81275","HCPCS","facility","both","","","","240.74","240.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (130)","30900020","CDM","310","RC","81401","HCPCS","facility","both","","","","348.35","348.35","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (130)","30900020","CDM","310","RC","81401","HCPCS","facility","both","","","","272.15","272.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (395)","30900021","CDM","310","RC","81401","HCPCS","facility","both","","","","826.9","826.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (395)","30900021","CDM","310","RC","81401","HCPCS","facility","both","","","","1058.47","1058.47","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (260)","30900022","CDM","310","RC","81403","HCPCS","facility","both","","","","495","495","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (260)","30900022","CDM","310","RC","81403","HCPCS","facility","both","","","","544.29","544.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (260)","30900022","CDM","310","RC","81403","HCPCS","facility","both","","","","696.71","696.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (435)","30900023","CDM","310","RC","81404","HCPCS","facility","both","","","","910.64","910.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (435)","30900023","CDM","310","RC","81404","HCPCS","facility","both","","","","3074","3074","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 5 (435)","30900023","CDM","310","RC","81404","HCPCS","facility","both","","","","1165.65","1165.65","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (300)","30900024","CDM","310","RC","81404","HCPCS","facility","both","","","","803.9","803.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (300)","30900024","CDM","310","RC","81404","HCPCS","facility","both","","","","628.03","628.03","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (570)","30900025","CDM","310","RC","81405","HCPCS","facility","both","","","","1000","1000","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (570)","30900025","CDM","310","RC","81405","HCPCS","facility","both","","","","1193.26","1193.26","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (570)","30900025","CDM","310","RC","81405","HCPCS","facility","both","","","","1527.41","1527.41","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC APC GENE PART OF PANEL","30900026","CDM","310","RC","81201","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC APC GENE PART OF PANEL","30900026","CDM","310","RC","81201","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BCR/ABL MJR BP PART OF PANEL","30900027","CDM","310","RC","81206","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BCR/ABL MJR BP PART OF PANEL","30900027","CDM","310","RC","81206","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BCR/ABL OT BP PART OF PANEL","30900028","CDM","310","RC","81209","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BCR/ABL OT BP PART OF PANEL","30900028","CDM","310","RC","81209","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BRCA PART OF PANEL","30900029","CDM","309","RC","81211","HCPCS","facility","both","","","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BRCA PART OF PANEL","30900029","CDM","309","RC","81211","HCPCS","facility","both","","","","2","2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CFTR GENE COM VARIAN (50)","30900030","CDM","310","RC","81220","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CFTR GENE COM VARIAN (50)","30900030","CDM","310","RC","81220","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CFTR GENE COM VARIAN (190)","30900031","CDM","310","RC","81220","HCPCS","facility","both","","","","397.75","397.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CFTR GENE COM VARIAN (190)","30900031","CDM","310","RC","81220","HCPCS","facility","both","","","","509.13","509.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CFTR GENE COM VARIAN (300)","30900032","CDM","310","RC","81220","HCPCS","facility","both","","","","628.03","628.03","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CFTR GENE COM VARIAN (300)","30900032","CDM","310","RC","81220","HCPCS","facility","both","","","","803.9","803.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CFTR DEL/DUP PART OF PANEL","30900033","CDM","310","RC","81222","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CFTR DEL/DUP PART OF PANEL","30900033","CDM","310","RC","81222","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CFTR GENE FULL SEQUENCE (1250)","30900034","CDM","310","RC","81223","HCPCS","facility","both","","","","2616.79","2616.79","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CFTR GENE FULL SEQUENCE (1250)","30900034","CDM","310","RC","81223","HCPCS","facility","both","","","","3349.57","3349.57","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CFTR GENE FULL SEQUENCE (1630)","30900035","CDM","310","RC","81223","HCPCS","facility","both","","","","4367.83","4367.83","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CFTR GENE FULL SEQUENCE (1630)","30900035","CDM","310","RC","81223","HCPCS","facility","both","","","","3412.3","3412.3","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CFTR GENE INTRON POLY T (170)","30900036","CDM","310","RC","81224","HCPCS","facility","both","","","","355.88","355.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CFTR GENE INTRON POLY T (170)","30900036","CDM","310","RC","81224","HCPCS","facility","both","","","","455.54","455.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOGEN MCRARRAY COPY NMBR (860)","30900037","CDM","310","RC","81228","HCPCS","facility","both","","","","2304.5","2304.5","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOGEN MCRARRAY COPY NMBR (860)","30900037","CDM","310","RC","81228","HCPCS","facility","both","","","","1800.35","1800.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOGEN MCRARRAY COPY NMBR (2000)","30900038","CDM","310","RC","81228","HCPCS","facility","both","","","","4186.87","4186.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOGEN MCRARRAY COPY NMBR (2000)","30900038","CDM","310","RC","81228","HCPCS","facility","both","","","","5627","5627","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYTOGEN MCRARRAY COPY NMBR (2000)","30900038","CDM","310","RC","81228","HCPCS","facility","both","","","","5359.31","5359.31","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOGEN M ARRAY COPY NO&SNP (640)","30900039","CDM","310","RC","81229","HCPCS","facility","both","","","","1714.97","1714.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOGEN M ARRAY COPY NO&SNP (640)","30900039","CDM","310","RC","81229","HCPCS","facility","both","","","","1339.8","1339.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOGEN M ARRAY COPY NO&SNP (640)","30900039","CDM","310","RC","81229","HCPCS","facility","both","","","","4526","4526","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOGEN M ARRAY COPY NO&SNP (640)","30900039","CDM","310","RC","81229","HCPCS","facility","both","","","","1042","1042","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC EGFR GENE   (220)","30900040","CDM","310","RC","81235","HCPCS","facility","both","","","","1586","1586","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC EGFR GENE   (220)","30900040","CDM","310","RC","81235","HCPCS","facility","both","","","","460.55","460.55","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC EGFR GENE   (220)","30900040","CDM","310","RC","81235","HCPCS","facility","both","","","","589.53","589.53","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FANCC GENE  (70)","30900041","CDM","310","RC","81242","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FANCC GENE  (70)","30900041","CDM","310","RC","81242","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FANCC  GENE (140)","30900042","CDM","310","RC","81242","HCPCS","facility","both","","","","375.15","375.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FANCC  GENE (140)","30900042","CDM","310","RC","81242","HCPCS","facility","both","","","","293.09","293.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FMR1 GENE DETECTION (100)","30900043","CDM","310","RC","81243","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FMR1 GENE DETECTION (100)","30900043","CDM","310","RC","81243","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FMR1 GENE DETECTION (225)","30900044","CDM","310","RC","81243","HCPCS","facility","both","","","","471.02","471.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FMR1 GENE DETECTION (225)","30900044","CDM","310","RC","81243","HCPCS","facility","both","","","","602.93","602.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FMR1 GENE DETECTION (225)","30900044","CDM","310","RC","81243","HCPCS","facility","both","","","","415","415","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FMR1 GENE CHARACTERIZ (20)","30900045","CDM","310","RC","81244","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FMR1 GENE CHARACTERIZ (20)","30900045","CDM","310","RC","81244","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FMR1 GENE CHARACTERIZ (20)","30900045","CDM","310","RC","81244","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FMR1 GENE CHARACTERIZ (20)","30900045","CDM","310","RC","81244","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLT3 GENE ( 410)","30900046","CDM","310","RC","81245","HCPCS","facility","both","","","","862.5","862.5","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLT3 GENE ( 410)","30900046","CDM","310","RC","81245","HCPCS","facility","both","","","","1104.02","1104.02","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLT3 GENE PART OF PANEL)","30900047","CDM","310","RC","81246","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLT3 GENE PART OF PANEL)","30900047","CDM","310","RC","81246","HCPCS","facility","both","","","","399","399","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FLT3 GENE PART OF PANEL)","30900047","CDM","310","RC","81246","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GBA GENE (165)","30900048","CDM","310","RC","81251","HCPCS","facility","both","","","","442.14","442.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GBA GENE (165)","30900048","CDM","310","RC","81251","HCPCS","facility","both","","","","345.42","345.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IGK GENE PART OF PANEL","30900049","CDM","310","RC","81264","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IGK GENE PART OF PANEL","30900049","CDM","310","RC","81264","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STR MARKERS SPECIMEN ANAL (200)","30900050","CDM","310","RC","81265","HCPCS","facility","both","","","","535.93","535.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STR MARKERS SPECIMEN ANAL (200)","30900050","CDM","310","RC","81265","HCPCS","facility","both","","","","145","145","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC STR MARKERS SPECIMEN ANAL (200)","30900050","CDM","310","RC","81265","HCPCS","facility","both","","","","418.68","418.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STR MARKERS SPECIMEN ANAL (230)","30900051","CDM","310","RC","81265","HCPCS","facility","both","","","","616.32","616.32","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STR MARKERS SPECIMEN ANAL (230)","30900051","CDM","310","RC","81265","HCPCS","facility","both","","","","481.49","481.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STR MARKERS SPECIMEN ANAL (315)","30900052","CDM","310","RC","81265","HCPCS","facility","both","","","","659.44","659.44","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STR MARKERS SPECIMEN ANAL (315)","30900052","CDM","310","RC","81265","HCPCS","facility","both","","","","844.09","844.09","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STR MARKERS SPECIMEN ANAL (985)","30900053","CDM","310","RC","81265","HCPCS","facility","both","","","","2639.46","2639.46","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STR MARKERS SPECIMEN ANAL (985)","30900053","CDM","310","RC","81265","HCPCS","facility","both","","","","2062.04","2062.04","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC JAK2 GENE (1020)","30900054","CDM","310","RC","81270","HCPCS","facility","both","","","","2733.25","2733.25","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC JAK2 GENE (1020)","30900054","CDM","310","RC","81270","HCPCS","facility","both","","","","2135.31","2135.31","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MLH1 GENE PART OF PANEL","30900055","CDM","310","RC","81292","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MLH1 GENE PART OF PANEL","30900055","CDM","310","RC","81292","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MSH2 GENE FULL SEQ  (2670)","30900056","CDM","310","RC","81295","HCPCS","facility","both","","","","7154.68","7154.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MSH2 GENE FULL SEQ  (2670)","30900056","CDM","310","RC","81295","HCPCS","facility","both","","","","5589.48","5589.48","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MSH2 GENE FULL SEQ  (3310)","30900057","CDM","310","RC","81295","HCPCS","facility","both","","","","6929.28","6929.28","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MSH2 GENE FULL SEQ  (3310)","30900057","CDM","310","RC","81295","HCPCS","facility","both","","","","8869.66","8869.66","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MSH6 GENE PART OF PANEL","30900058","CDM","310","RC","81298","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MSH6 GENE PART OF PANEL","30900058","CDM","310","RC","81298","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PCA3 (260)","30900059","CDM","310","RC","81313","HCPCS","facility","both","","","","520","520","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PCA3 (260)","30900059","CDM","310","RC","81313","HCPCS","facility","both","","","","544.29","544.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PCA3 (260)","30900059","CDM","310","RC","81313","HCPCS","facility","both","","","","696.71","696.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PML/RARA BP PART OF PANEL","30900060","CDM","310","RC","81315","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PML/RARA BP PART OF PANEL","30900060","CDM","310","RC","81315","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PTEN GENE PART OF PANEL","30900061","CDM","310","RC","81321","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PTEN GENE PART OF PANEL","30900061","CDM","310","RC","81321","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PMPP22 GENE DUP/DELET (1380)","30900062","CDM","310","RC","81324","HCPCS","facility","both","","","","3697.92","3697.92","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PMPP22 GENE DUP/DELET (1380)","30900062","CDM","310","RC","81324","HCPCS","facility","both","","","","2888.94","2888.94","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PMPP22 GENE DUP/DELET (4700)","30900063","CDM","310","RC","81324","HCPCS","facility","both","","","","9839.15","9839.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PMPP22 GENE DUP/DELET (4700)","30900063","CDM","310","RC","81324","HCPCS","facility","both","","","","12594.37","12594.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 1 (65)","30900064","CDM","310","RC","81400","HCPCS","facility","both","","","","174.17","174.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 1 (65)","30900064","CDM","310","RC","81400","HCPCS","facility","both","","","","136.07","136.07","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 1 (65)","30900064","CDM","310","RC","81400","HCPCS","facility","both","","","","654","654","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 1 (140)","30900065","CDM","310","RC","81400","HCPCS","facility","both","","","","293.09","293.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 1 (140)","30900065","CDM","310","RC","81400","HCPCS","facility","both","","","","375.15","375.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 1 (205)","30900066","CDM","310","RC","81400","HCPCS","facility","both","","","","429.16","429.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 1 (205)","30900066","CDM","310","RC","81400","HCPCS","facility","both","","","","549.33","549.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LVEL 1 (240)","30900067","CDM","310","RC","81400","HCPCS","facility","both","","","","485","485","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LVEL 1 (240)","30900067","CDM","310","RC","81400","HCPCS","facility","both","","","","502.42","502.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LVEL 1 (240)","30900067","CDM","310","RC","81400","HCPCS","facility","both","","","","643.12","643.12","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (95)","30900068","CDM","310","RC","81401","HCPCS","facility","both","","","","254.57","254.57","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (95)","30900068","CDM","310","RC","81401","HCPCS","facility","both","","","","198.87","198.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (150)","30900069","CDM","310","RC","81401","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (150)","30900069","CDM","310","RC","81401","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (150)","30900069","CDM","310","RC","81401","HCPCS","facility","both","","","","236","236","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (170)","30900070","CDM","310","RC","81401","HCPCS","facility","both","","","","345","345","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (170)","30900070","CDM","310","RC","81401","HCPCS","facility","both","","","","455.54","455.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (170)","30900070","CDM","310","RC","81401","HCPCS","facility","both","","","","355.88","355.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (190)","30900071","CDM","310","RC","81401","HCPCS","facility","both","","","","397.75","397.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (190)","30900071","CDM","310","RC","81401","HCPCS","facility","both","","","","509.13","509.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (195)","30900072","CDM","310","RC","81401","HCPCS","facility","both","","","","522.54","522.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (195)","30900072","CDM","310","RC","81401","HCPCS","facility","both","","","","396","396","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (195)","30900072","CDM","310","RC","81401","HCPCS","facility","both","","","","408.22","408.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (200)","30900073","CDM","310","RC","81401","HCPCS","facility","both","","","","375","375","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (200)","30900073","CDM","310","RC","81401","HCPCS","facility","both","","","","418.68","418.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (200)","30900073","CDM","310","RC","81401","HCPCS","facility","both","","","","535.93","535.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (205)","30900074","CDM","310","RC","81401","HCPCS","facility","both","","","","549.33","549.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (205)","30900074","CDM","310","RC","81401","HCPCS","facility","both","","","","343","343","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (205)","30900074","CDM","310","RC","81401","HCPCS","facility","both","","","","429.16","429.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (215)","30900075","CDM","310","RC","81401","HCPCS","facility","both","","","","450.09","450.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (215)","30900075","CDM","310","RC","81401","HCPCS","facility","both","","","","432","432","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (215)","30900075","CDM","310","RC","81401","HCPCS","facility","both","","","","576.13","576.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (220)","30900076","CDM","310","RC","81401","HCPCS","facility","both","","","","589.53","589.53","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (220)","30900076","CDM","310","RC","81401","HCPCS","facility","both","","","","460.55","460.55","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (225)","30900077","CDM","310","RC","81401","HCPCS","facility","both","","","","471.02","471.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (225)","30900077","CDM","310","RC","81401","HCPCS","facility","both","","","","602.93","602.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (250)","30900078","CDM","310","RC","81401","HCPCS","facility","both","","","","275","275","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (250)","30900078","CDM","310","RC","81401","HCPCS","facility","both","","","","523.36","523.36","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (250)","30900078","CDM","310","RC","81401","HCPCS","facility","both","","","","669.91","669.91","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (265)","30900079","CDM","310","RC","81401","HCPCS","facility","both","","","","554.76","554.76","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (265)","30900079","CDM","310","RC","81401","HCPCS","facility","both","","","","710.1","710.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (275)","30900080","CDM","310","RC","81401","HCPCS","facility","both","","","","736.9","736.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (275)","30900080","CDM","310","RC","81401","HCPCS","facility","both","","","","575.7","575.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (275)","30900080","CDM","310","RC","81401","HCPCS","facility","both","","","","1662","1662","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (290)","30900081","CDM","310","RC","81401","HCPCS","facility","both","","","","607.1","607.1","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (290)","30900081","CDM","310","RC","81401","HCPCS","facility","both","","","","777.1","777.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (290)","30900081","CDM","310","RC","81401","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (300)","30900082","CDM","310","RC","81401","HCPCS","facility","both","","","","435","435","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (300)","30900082","CDM","310","RC","81401","HCPCS","facility","both","","","","803.9","803.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (300)","30900082","CDM","310","RC","81401","HCPCS","facility","both","","","","628.03","628.03","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (310)","30900083","CDM","310","RC","81401","HCPCS","facility","both","","","","648.96","648.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (310)","30900083","CDM","310","RC","81401","HCPCS","facility","both","","","","830.7","830.7","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (315)","30900084","CDM","310","RC","81401","HCPCS","facility","both","","","","844.09","844.09","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (315)","30900084","CDM","310","RC","81401","HCPCS","facility","both","","","","659.44","659.44","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (320)","30900085","CDM","310","RC","81401","HCPCS","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (320)","30900085","CDM","310","RC","81401","HCPCS","facility","both","","","","857.5","857.5","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (320)","30900085","CDM","310","RC","81401","HCPCS","facility","both","","","","669.9","669.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (320)","30900085","CDM","310","RC","81401","HCPCS","facility","both","","","","2153","2153","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (380)","30900086","CDM","310","RC","81401","HCPCS","facility","both","","","","755","755","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (380)","30900086","CDM","310","RC","81401","HCPCS","facility","both","","","","1018.26","1018.26","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (380)","30900086","CDM","310","RC","81401","HCPCS","facility","both","","","","795.51","795.51","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (400)","30900087","CDM","310","RC","81401","HCPCS","facility","both","","","","837.38","837.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (400)","30900087","CDM","310","RC","81401","HCPCS","facility","both","","","","1071.86","1071.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (780)","30900088","CDM","310","RC","81401","HCPCS","facility","both","","","","1632.88","1632.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (780)","30900088","CDM","310","RC","81401","HCPCS","facility","both","","","","2090.13","2090.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (835)","30900089","CDM","310","RC","81401","HCPCS","facility","both","","","","2237.51","2237.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (835)","30900089","CDM","310","RC","81401","HCPCS","facility","both","","","","1748.02","1748.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 3 (95)","30900090","CDM","310","RC","81402","HCPCS","facility","both","","","","198.87","198.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 3 (95)","30900090","CDM","310","RC","81402","HCPCS","facility","both","","","","270","270","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 3 (95)","30900090","CDM","310","RC","81402","HCPCS","facility","both","","","","254.57","254.57","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 3 (245)","30900091","CDM","310","RC","81402","HCPCS","facility","both","","","","512.89","512.89","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 3 (245)","30900091","CDM","310","RC","81402","HCPCS","facility","both","","","","420","420","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 3 (245)","30900091","CDM","310","RC","81402","HCPCS","facility","both","","","","656.51","656.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (115)","30900092","CDM","310","RC","81403","HCPCS","facility","both","","","","308.16","308.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (115)","30900092","CDM","310","RC","81403","HCPCS","facility","both","","","","240.74","240.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (130)","30900093","CDM","310","RC","81403","HCPCS","facility","both","","","","348.35","348.35","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (130)","30900093","CDM","310","RC","81403","HCPCS","facility","both","","","","272.15","272.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (130)","30900093","CDM","310","RC","81403","HCPCS","facility","both","","","","250","250","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (135)","30900094","CDM","310","RC","81403","HCPCS","facility","both","","","","282.61","282.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (135)","30900094","CDM","310","RC","81403","HCPCS","facility","both","","","","361.76","361.76","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (135)","30900094","CDM","310","RC","81403","HCPCS","facility","both","","","","316","316","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (145)","30900095","CDM","310","RC","81403","HCPCS","facility","both","","","","270","270","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (145)","30900095","CDM","310","RC","81403","HCPCS","facility","both","","","","388.56","388.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (145)","30900095","CDM","310","RC","81403","HCPCS","facility","both","","","","303.55","303.55","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (165)","30900096","CDM","310","RC","81403","HCPCS","facility","both","","","","345.42","345.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (165)","30900096","CDM","310","RC","81403","HCPCS","facility","both","","","","442.14","442.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (165)","30900096","CDM","310","RC","81403","HCPCS","facility","both","","","","345","345","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (180)","30900097","CDM","310","RC","81403","HCPCS","facility","both","","","","376.81","376.81","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (180)","30900097","CDM","310","RC","81403","HCPCS","facility","both","","","","482.33","482.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (180)","30900097","CDM","310","RC","81403","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (190)","30900098","CDM","310","RC","81403","HCPCS","facility","both","","","","397.75","397.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (190)","30900098","CDM","310","RC","81403","HCPCS","facility","both","","","","509.13","509.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (210)","30900099","CDM","310","RC","81403","HCPCS","facility","both","","","","550","550","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (210)","30900099","CDM","310","RC","81403","HCPCS","facility","both","","","","562.73","562.73","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (210)","30900099","CDM","310","RC","81403","HCPCS","facility","both","","","","439.62","439.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (220)","30900100","CDM","310","RC","81403","HCPCS","facility","both","","","","589.53","589.53","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (220)","30900100","CDM","310","RC","81403","HCPCS","facility","both","","","","515","515","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (220)","30900100","CDM","310","RC","81403","HCPCS","facility","both","","","","460.55","460.55","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (255)","30900101","CDM","310","RC","81403","HCPCS","facility","both","","","","533.83","533.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (255)","30900101","CDM","310","RC","81403","HCPCS","facility","both","","","","683.3","683.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (280)","30900102","CDM","310","RC","81403","HCPCS","facility","both","","","","750.3","750.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (280)","30900102","CDM","310","RC","81403","HCPCS","facility","both","","","","586.16","586.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (325)","30900103","CDM","310","RC","81403","HCPCS","facility","both","","","","870.89","870.89","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (325)","30900103","CDM","310","RC","81403","HCPCS","facility","both","","","","680.37","680.37","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (330","30900104","CDM","310","RC","81403","HCPCS","facility","both","","","","500","500","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (330","30900104","CDM","310","RC","81403","HCPCS","facility","both","","","","884.29","884.29","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (330","30900104","CDM","310","RC","81403","HCPCS","facility","both","","","","690.83","690.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (335)","30900105","CDM","310","RC","81403","HCPCS","facility","both","","","","701.3","701.3","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (335)","30900105","CDM","310","RC","81403","HCPCS","facility","both","","","","897.69","897.69","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVE 4 (345)","30900106","CDM","310","RC","81403","HCPCS","facility","both","","","","924.48","924.48","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVE 4 (345)","30900106","CDM","310","RC","81403","HCPCS","facility","both","","","","722.23","722.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (405)","30900107","CDM","310","RC","81403","HCPCS","facility","both","","","","837.38","837.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (405)","30900107","CDM","310","RC","81403","HCPCS","facility","both","","","","1071.86","1071.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (435)","30900108","CDM","310","RC","81403","HCPCS","facility","both","","","","910.64","910.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (435)","30900108","CDM","310","RC","81403","HCPCS","facility","both","","","","1165.65","1165.65","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (455)","30900109","CDM","310","RC","81403","HCPCS","facility","both","","","","952.51","952.51","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (455)","30900109","CDM","310","RC","81403","HCPCS","facility","both","","","","1219.24","1219.24","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (500)","30900110","CDM","310","RC","81403","HCPCS","facility","both","","","","1339.83","1339.83","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (500)","30900110","CDM","310","RC","81403","HCPCS","facility","both","","","","1046.72","1046.72","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (530)","30900111","CDM","310","RC","81403","HCPCS","facility","both","","","","1420.21","1420.21","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (530)","30900111","CDM","310","RC","81403","HCPCS","facility","both","","","","1109.52","1109.52","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (530)","30900111","CDM","310","RC","81403","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (540)","30900112","CDM","310","RC","81403","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (540)","30900112","CDM","310","RC","81403","HCPCS","facility","both","","","","1447.01","1447.01","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (540)","30900112","CDM","310","RC","81403","HCPCS","facility","both","","","","1130.45","1130.45","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (590)","30900113","CDM","310","RC","81403","HCPCS","facility","both","","","","1235.13","1235.13","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (590)","30900113","CDM","310","RC","81403","HCPCS","facility","both","","","","1581","1581","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (655)","30900114","CDM","310","RC","81403","HCPCS","facility","both","","","","1755.17","1755.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (655)","30900114","CDM","310","RC","81403","HCPCS","facility","both","","","","1371.21","1371.21","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (655)","30900114","CDM","310","RC","81403","HCPCS","facility","both","","","","2165","2165","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (690)","30900115","CDM","310","RC","81403","HCPCS","facility","both","","","","1848.96","1848.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (690)","30900115","CDM","310","RC","81403","HCPCS","facility","both","","","","1444.47","1444.47","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (810)","30900116","CDM","310","RC","81403","HCPCS","facility","both","","","","540","540","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 4 (810)","30900116","CDM","310","RC","81403","HCPCS","facility","both","","","","2170.53","2170.53","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (810)","30900116","CDM","310","RC","81403","HCPCS","facility","both","","","","1695.69","1695.69","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (2070)","30900117","CDM","310","RC","81403","HCPCS","facility","both","","","","5546.88","5546.88","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (2070)","30900117","CDM","310","RC","81403","HCPCS","facility","both","","","","4333.42","4333.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (3400)","30900118","CDM","310","RC","81403","HCPCS","facility","both","","","","9110.83","9110.83","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (3400)","30900118","CDM","310","RC","81403","HCPCS","facility","both","","","","7117.69","7117.69","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (290)","30900119","CDM","310","RC","81404","HCPCS","facility","both","","","","607.1","607.1","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (290)","30900119","CDM","310","RC","81404","HCPCS","facility","both","","","","777.1","777.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (290)","30900119","CDM","310","RC","81404","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 5 (305)","30900120","CDM","310","RC","81404","HCPCS","facility","both","","","","830.7","830.7","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (305)","30900120","CDM","310","RC","81404","HCPCS","facility","both","","","","648.96","648.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (325)","30900121","CDM","310","RC","81404","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 5 (325)","30900121","CDM","310","RC","81404","HCPCS","facility","both","","","","870.89","870.89","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (325)","30900121","CDM","310","RC","81404","HCPCS","facility","both","","","","680.37","680.37","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (335)","30900122","CDM","310","RC","81404","HCPCS","facility","both","","","","701.3","701.3","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (335)","30900122","CDM","310","RC","81404","HCPCS","facility","both","","","","897.69","897.69","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (360)","30900123","CDM","310","RC","81404","HCPCS","facility","both","","","","964.68","964.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (360)","30900123","CDM","310","RC","81404","HCPCS","facility","both","","","","753.64","753.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (360)","30900123","CDM","310","RC","81404","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 5 (370)","30900124","CDM","310","RC","81404","HCPCS","facility","both","","","","991.47","991.47","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (370)","30900124","CDM","310","RC","81404","HCPCS","facility","both","","","","774.57","774.57","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (380)","30900125","CDM","310","RC","81404","HCPCS","facility","both","","","","795.51","795.51","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (380)","30900125","CDM","310","RC","81404","HCPCS","facility","both","","","","1018.26","1018.26","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (380)","30900125","CDM","310","RC","81404","HCPCS","facility","both","","","","675","675","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 5 (395)","30900126","CDM","310","RC","81404","HCPCS","facility","both","","","","1058.47","1058.47","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (395)","30900126","CDM","310","RC","81404","HCPCS","facility","both","","","","826.9","826.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (400)","30900127","CDM","310","RC","81404","HCPCS","facility","both","","","","1071.86","1071.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (400)","30900127","CDM","310","RC","81404","HCPCS","facility","both","","","","837.38","837.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (405)","30900128","CDM","310","RC","81404","HCPCS","facility","both","","","","847.84","847.84","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (405)","30900128","CDM","310","RC","81404","HCPCS","facility","both","","","","1085.26","1085.26","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (405)","30900128","CDM","310","RC","81404","HCPCS","facility","both","","","","765","765","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 5 (440)","30900129","CDM","310","RC","81404","HCPCS","facility","both","","","","1179.04","1179.04","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (440)","30900129","CDM","310","RC","81404","HCPCS","facility","both","","","","921.12","921.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (440)","30900129","CDM","310","RC","81404","HCPCS","facility","both","","","","765","765","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 5 (450)","30900130","CDM","310","RC","81404","HCPCS","facility","both","","","","1205.84","1205.84","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (450)","30900130","CDM","310","RC","81404","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 5 (450)","30900130","CDM","310","RC","81404","HCPCS","facility","both","","","","942.05","942.05","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (480)","30900131","CDM","310","RC","81404","HCPCS","facility","both","","","","1004.85","1004.85","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (480)","30900131","CDM","310","RC","81404","HCPCS","facility","both","","","","515","515","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 5 (480)","30900131","CDM","310","RC","81404","HCPCS","facility","both","","","","1286.23","1286.23","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (500)","30900132","CDM","310","RC","81404","HCPCS","facility","both","","","","1339.83","1339.83","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (500)","30900132","CDM","310","RC","81404","HCPCS","facility","both","","","","640","640","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 5 (500)","30900132","CDM","310","RC","81404","HCPCS","facility","both","","","","1046.72","1046.72","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (535)","30900133","CDM","310","RC","81404","HCPCS","facility","both","","","","1119.99","1119.99","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (535)","30900133","CDM","310","RC","81404","HCPCS","facility","both","","","","1100","1100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 5 (535)","30900133","CDM","310","RC","81404","HCPCS","facility","both","","","","1433.61","1433.61","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (735)","30900134","CDM","310","RC","81404","HCPCS","facility","both","","","","1538.67","1538.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (735)","30900134","CDM","310","RC","81404","HCPCS","facility","both","","","","1969.54","1969.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (735)","30900134","CDM","310","RC","81404","HCPCS","facility","both","","","","1375","1375","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 5 (1180)","30900135","CDM","310","RC","81404","HCPCS","facility","both","","","","2470.25","2470.25","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (1180)","30900135","CDM","310","RC","81404","HCPCS","facility","both","","","","3161.99","3161.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (2440)","30900136","CDM","310","RC","81404","HCPCS","facility","both","","","","6538.36","6538.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (2440)","30900136","CDM","310","RC","81404","HCPCS","facility","both","","","","5107.99","5107.99","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (130)","30900137","CDM","310","RC","81405","HCPCS","facility","both","","","","272.15","272.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (130)","30900137","CDM","310","RC","81405","HCPCS","facility","both","","","","348.35","348.35","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (130)","30900137","CDM","310","RC","81405","HCPCS","facility","both","","","","250","250","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (140)","30900138","CDM","310","RC","81405","HCPCS","facility","both","","","","280","280","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (140)","30900138","CDM","310","RC","81405","HCPCS","facility","both","","","","375.15","375.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (140)","30900138","CDM","310","RC","81405","HCPCS","facility","both","","","","293.09","293.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (190)","30900139","CDM","310","RC","81405","HCPCS","facility","both","","","","509.13","509.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (190)","30900139","CDM","310","RC","81405","HCPCS","facility","both","","","","397.75","397.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (190)","30900139","CDM","310","RC","81405","HCPCS","facility","both","","","","395","395","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (200)","30900140","CDM","310","RC","81405","HCPCS","facility","both","","","","418.68","418.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (200)","30900140","CDM","310","RC","81405","HCPCS","facility","both","","","","535.93","535.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (215)","30900141","CDM","310","RC","81405","HCPCS","facility","both","","","","576.13","576.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (215)","30900141","CDM","310","RC","81405","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (215)","30900141","CDM","310","RC","81405","HCPCS","facility","both","","","","450.09","450.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (240)","30900142","CDM","310","RC","81405","HCPCS","facility","both","","","","643.12","643.12","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (240)","30900142","CDM","310","RC","81405","HCPCS","facility","both","","","","502.42","502.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (275)","30900143","CDM","310","RC","81405","HCPCS","facility","both","","","","575.7","575.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (275)","30900143","CDM","310","RC","81405","HCPCS","facility","both","","","","736.9","736.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (275)","30900143","CDM","310","RC","81405","HCPCS","facility","both","","","","545","545","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (305)","30900144","CDM","310","RC","81405","HCPCS","facility","both","","","","638.5","638.5","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (305)","30900144","CDM","310","RC","81405","HCPCS","facility","both","","","","817.29","817.29","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (305)","30900144","CDM","310","RC","81405","HCPCS","facility","both","","","","545","545","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (310)","30900145","CDM","310","RC","81405","HCPCS","facility","both","","","","648.96","648.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (310)","30900145","CDM","310","RC","81405","HCPCS","facility","both","","","","644","644","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (310)","30900145","CDM","310","RC","81405","HCPCS","facility","both","","","","830.7","830.7","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (350)","30900146","CDM","310","RC","81405","HCPCS","facility","both","","","","937.88","937.88","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (350)","30900146","CDM","310","RC","81405","HCPCS","facility","both","","","","669","669","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (350)","30900146","CDM","310","RC","81405","HCPCS","facility","both","","","","732.7","732.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (360)","30900147","CDM","310","RC","81405","HCPCS","facility","both","","","","753.64","753.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (360)","30900147","CDM","310","RC","81405","HCPCS","facility","both","","","","740","740","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (360)","30900147","CDM","310","RC","81405","HCPCS","facility","both","","","","964.68","964.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (455)","30900148","CDM","310","RC","81405","HCPCS","facility","both","","","","1219.24","1219.24","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (455)","30900148","CDM","310","RC","81405","HCPCS","facility","both","","","","952.51","952.51","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (460)","30900149","CDM","310","RC","81405","HCPCS","facility","both","","","","1232.64","1232.64","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (460)","30900149","CDM","310","RC","81405","HCPCS","facility","both","","","","962.98","962.98","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (515)","30900150","CDM","310","RC","81405","HCPCS","facility","both","","","","1380.02","1380.02","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (515)","30900150","CDM","310","RC","81405","HCPCS","facility","both","","","","725","725","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (515)","30900150","CDM","310","RC","81405","HCPCS","facility","both","","","","1078.12","1078.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (530)","30900151","CDM","310","RC","81405","HCPCS","facility","both","","","","1109.52","1109.52","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (530)","30900151","CDM","310","RC","81405","HCPCS","facility","both","","","","1045","1045","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (530)","30900151","CDM","310","RC","81405","HCPCS","facility","both","","","","1420.21","1420.21","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (540)","30900152","CDM","310","RC","81405","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (540)","30900152","CDM","310","RC","81405","HCPCS","facility","both","","","","1447.01","1447.01","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (540)","30900152","CDM","310","RC","81405","HCPCS","facility","both","","","","1130.45","1130.45","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (630)","30900153","CDM","310","RC","81405","HCPCS","facility","both","","","","1318.86","1318.86","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (630)","30900153","CDM","310","RC","81405","HCPCS","facility","both","","","","800","800","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (630)","30900153","CDM","310","RC","81405","HCPCS","facility","both","","","","1688.17","1688.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (640)","30900154","CDM","310","RC","81405","HCPCS","facility","both","","","","1339.8","1339.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (640)","30900154","CDM","310","RC","81405","HCPCS","facility","both","","","","1035","1035","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (640)","30900154","CDM","310","RC","81405","HCPCS","facility","both","","","","1714.97","1714.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (660)","30900155","CDM","310","RC","81405","HCPCS","facility","both","","","","1768.57","1768.57","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (660)","30900155","CDM","310","RC","81405","HCPCS","facility","both","","","","1381.67","1381.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (685)","30900156","CDM","310","RC","81405","HCPCS","facility","both","","","","1434","1434","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (685)","30900156","CDM","310","RC","81405","HCPCS","facility","both","","","","1835.57","1835.57","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (685)","30900156","CDM","310","RC","81405","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (705)","30900157","CDM","310","RC","81405","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (705)","30900157","CDM","310","RC","81405","HCPCS","facility","both","","","","1475.87","1475.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (705)","30900157","CDM","310","RC","81405","HCPCS","facility","both","","","","1889.16","1889.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (725)","30900158","CDM","310","RC","81405","HCPCS","facility","both","","","","1517.74","1517.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (725)","30900158","CDM","310","RC","81405","HCPCS","facility","both","","","","1942.75","1942.75","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (750)","30900159","CDM","310","RC","81405","HCPCS","facility","both","","","","1570.08","1570.08","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (750)","30900159","CDM","310","RC","81405","HCPCS","facility","both","","","","1445","1445","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (750)","30900159","CDM","310","RC","81405","HCPCS","facility","both","","","","2009.74","2009.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (800)","30900160","CDM","310","RC","81405","HCPCS","facility","both","","","","1674.75","1674.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (800)","30900160","CDM","310","RC","81405","HCPCS","facility","both","","","","2143.73","2143.73","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (1030)","30900161","CDM","310","RC","81405","HCPCS","facility","both","","","","2156.24","2156.24","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (1030)","30900161","CDM","310","RC","81405","HCPCS","facility","both","","","","2760.04","2760.04","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (1030)","30900161","CDM","310","RC","81405","HCPCS","facility","both","","","","2730","2730","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 6 (2660)","30900162","CDM","310","RC","81405","HCPCS","facility","both","","","","7127.88","7127.88","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (2660)","30900162","CDM","310","RC","81405","HCPCS","facility","both","","","","5568.54","5568.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (105)","30900163","CDM","310","RC","81406","HCPCS","facility","both","","","","219.81","219.81","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (105)","30900163","CDM","310","RC","81406","HCPCS","facility","both","","","","281.36","281.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (130)","30900164","CDM","310","RC","81406","HCPCS","facility","both","","","","272.15","272.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (130)","30900164","CDM","310","RC","81406","HCPCS","facility","both","","","","300","300","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (130)","30900164","CDM","310","RC","81406","HCPCS","facility","both","","","","348.35","348.35","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (140)","30900165","CDM","310","RC","81406","HCPCS","facility","both","","","","225","225","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (140)","30900165","CDM","310","RC","81406","HCPCS","facility","both","","","","375.15","375.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (140)","30900165","CDM","310","RC","81406","HCPCS","facility","both","","","","293.09","293.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (200)","30900166","CDM","310","RC","81406","HCPCS","facility","both","","","","535.93","535.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (200)","30900166","CDM","310","RC","81406","HCPCS","facility","both","","","","418.68","418.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (205)","30900167","CDM","310","RC","81406","HCPCS","facility","both","","","","395","395","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (205)","30900167","CDM","310","RC","81406","HCPCS","facility","both","","","","429.16","429.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (205)","30900167","CDM","310","RC","81406","HCPCS","facility","both","","","","549.33","549.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (215)","30900168","CDM","310","RC","81406","HCPCS","facility","both","","","","445","445","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (215)","30900168","CDM","310","RC","81406","HCPCS","facility","both","","","","576.13","576.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (215)","30900168","CDM","310","RC","81406","HCPCS","facility","both","","","","450.09","450.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (240)","30900169","CDM","310","RC","81406","HCPCS","facility","both","","","","502.42","502.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (240)","30900169","CDM","310","RC","81406","HCPCS","facility","both","","","","643.12","643.12","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (240)","30900169","CDM","310","RC","81406","HCPCS","facility","both","","","","495","495","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (260)","30900170","CDM","310","RC","81406","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (260)","30900170","CDM","310","RC","81406","HCPCS","facility","both","","","","544.29","544.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (260)","30900170","CDM","310","RC","81406","HCPCS","facility","both","","","","696.71","696.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (305)","30900171","CDM","310","RC","81406","HCPCS","facility","both","","","","545","545","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (305)","30900171","CDM","310","RC","81406","HCPCS","facility","both","","","","817.29","817.29","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (305)","30900171","CDM","310","RC","81406","HCPCS","facility","both","","","","638.5","638.5","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (315)","30900172","CDM","310","RC","81406","HCPCS","facility","both","","","","844.09","844.09","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (315)","30900172","CDM","310","RC","81406","HCPCS","facility","both","","","","645","645","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (315)","30900172","CDM","310","RC","81406","HCPCS","facility","both","","","","659.44","659.44","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (415)","30900173","CDM","310","RC","81406","HCPCS","facility","both","","","","868.77","868.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (415)","30900173","CDM","310","RC","81406","HCPCS","facility","both","","","","1112.06","1112.06","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (500)","30900174","CDM","310","RC","81406","HCPCS","facility","both","","","","640","640","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (500)","30900174","CDM","310","RC","81406","HCPCS","facility","both","","","","1046.72","1046.72","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (500)","30900174","CDM","310","RC","81406","HCPCS","facility","both","","","","1339.83","1339.83","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (540)","30900175","CDM","310","RC","81406","HCPCS","facility","both","","","","1420.21","1420.21","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (540)","30900175","CDM","310","RC","81406","HCPCS","facility","both","","","","650","650","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (540)","30900175","CDM","310","RC","81406","HCPCS","facility","both","","","","1109.52","1109.52","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (530)","30900176","CDM","310","RC","81406","HCPCS","facility","both","","","","1447.01","1447.01","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (530)","30900176","CDM","310","RC","81406","HCPCS","facility","both","","","","1130.45","1130.45","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (530)","30900176","CDM","310","RC","81406","HCPCS","facility","both","","","","890","890","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (615)","30900177","CDM","310","RC","81406","HCPCS","facility","both","","","","1647.99","1647.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (615)","30900177","CDM","310","RC","81406","HCPCS","facility","both","","","","1287.47","1287.47","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (625)","30900178","CDM","310","RC","81406","HCPCS","facility","both","","","","1674.79","1674.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (625)","30900178","CDM","310","RC","81406","HCPCS","facility","both","","","","1308.4","1308.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (630)","30900179","CDM","310","RC","81406","HCPCS","facility","both","","","","1688.17","1688.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (630)","30900179","CDM","310","RC","81406","HCPCS","facility","both","","","","1318.86","1318.86","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (630)","30900179","CDM","310","RC","81406","HCPCS","facility","both","","","","800","800","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (640)","30900180","CDM","310","RC","81406","HCPCS","facility","both","","","","715","715","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (640)","30900180","CDM","310","RC","81406","HCPCS","facility","both","","","","1714.97","1714.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (640)","30900180","CDM","310","RC","81406","HCPCS","facility","both","","","","1339.8","1339.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (655)","30900181","CDM","310","RC","81406","HCPCS","facility","both","","","","1265","1265","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (655)","30900181","CDM","310","RC","81406","HCPCS","facility","both","","","","1755.17","1755.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (655)","30900181","CDM","310","RC","81406","HCPCS","facility","both","","","","1371.21","1371.21","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (670)","30900182","CDM","310","RC","81406","HCPCS","facility","both","","","","1025","1025","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (670)","30900182","CDM","310","RC","81406","HCPCS","facility","both","","","","1402.6","1402.6","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (670)","30900182","CDM","310","RC","81406","HCPCS","facility","both","","","","1795.37","1795.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (685)","30900183","CDM","310","RC","81406","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (685)","30900183","CDM","310","RC","81406","HCPCS","facility","both","","","","1835.57","1835.57","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (685)","30900183","CDM","310","RC","81406","HCPCS","facility","both","","","","1434","1434","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (715)","30900184","CDM","310","RC","81406","HCPCS","facility","both","","","","1915.96","1915.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (715)","30900184","CDM","310","RC","81406","HCPCS","facility","both","","","","1371","1371","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (715)","30900184","CDM","310","RC","81406","HCPCS","facility","both","","","","1496.8","1496.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (725)","30900185","CDM","310","RC","81406","HCPCS","facility","both","","","","1942.75","1942.75","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (725)","30900185","CDM","310","RC","81406","HCPCS","facility","both","","","","1517.74","1517.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (735)","30900186","CDM","310","RC","81406","HCPCS","facility","both","","","","1969.54","1969.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (735)","30900186","CDM","310","RC","81406","HCPCS","facility","both","","","","1025","1025","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (735)","30900186","CDM","310","RC","81406","HCPCS","facility","both","","","","1538.67","1538.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (800)","30900187","CDM","310","RC","81406","HCPCS","facility","both","","","","1674.75","1674.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (800)","30900187","CDM","310","RC","81406","HCPCS","facility","both","","","","975","975","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (800)","30900187","CDM","310","RC","81406","HCPCS","facility","both","","","","2143.73","2143.73","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (830)","30900188","CDM","310","RC","81406","HCPCS","facility","both","","","","1737.56","1737.56","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (830)","30900188","CDM","310","RC","81406","HCPCS","facility","both","","","","2224.11","2224.11","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (985)","30900189","CDM","310","RC","81406","HCPCS","facility","both","","","","1610","1610","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (985)","30900189","CDM","310","RC","81406","HCPCS","facility","both","","","","2639.46","2639.46","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (985)","30900189","CDM","310","RC","81406","HCPCS","facility","both","","","","2062.04","2062.04","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (1100)","30900190","CDM","310","RC","81406","HCPCS","facility","both","","","","2045","2045","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (1100)","30900190","CDM","310","RC","81406","HCPCS","facility","both","","","","2302.78","2302.78","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (1100)","30900190","CDM","310","RC","81406","HCPCS","facility","both","","","","2947.62","2947.62","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (1130)","30900191","CDM","310","RC","81406","HCPCS","facility","both","","","","3028","3028","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (1130)","30900191","CDM","310","RC","81406","HCPCS","facility","both","","","","2365.59","2365.59","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (1180)","30900192","CDM","310","RC","81406","HCPCS","facility","both","","","","2470.25","2470.25","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (1180)","30900192","CDM","310","RC","81406","HCPCS","facility","both","","","","3161.99","3161.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (1400)","30900193","CDM","310","RC","81406","HCPCS","facility","both","","","","3751.51","3751.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (1400)","30900193","CDM","310","RC","81406","HCPCS","facility","both","","","","2930.81","2930.81","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (1400)","30900193","CDM","310","RC","81406","HCPCS","facility","both","","","","1920","1920","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 7 (1640)","30900194","CDM","310","RC","81406","HCPCS","facility","both","","","","3433.24","3433.24","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 7 (1640)","30900194","CDM","310","RC","81406","HCPCS","facility","both","","","","4394.63","4394.63","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 7 (1640)","30900194","CDM","310","RC","81406","HCPCS","facility","both","","","","2655","2655","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 8 (165)","30900195","CDM","310","RC","81407","HCPCS","facility","both","","","","345.42","345.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 8 (165)","30900195","CDM","310","RC","81407","HCPCS","facility","both","","","","442.14","442.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 8 (165)","30900195","CDM","310","RC","81407","HCPCS","facility","both","","","","301","301","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 8 (710)","30900196","CDM","310","RC","81407","HCPCS","facility","both","","","","1360","1360","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 8 (710)","30900196","CDM","310","RC","81407","HCPCS","facility","both","","","","1902.56","1902.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 8 (710)","30900196","CDM","310","RC","81407","HCPCS","facility","both","","","","1486.34","1486.34","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 8 (790)","30900197","CDM","310","RC","81407","HCPCS","facility","both","","","","1653.82","1653.82","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 8 (790)","30900197","CDM","310","RC","81407","HCPCS","facility","both","","","","2116.93","2116.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 8 (790)","30900197","CDM","310","RC","81407","HCPCS","facility","both","","","","1350","1350","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 8 (890)","30900198","CDM","310","RC","81407","HCPCS","facility","both","","","","1820","1820","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 8 (890)","30900198","CDM","310","RC","81407","HCPCS","facility","both","","","","2384.89","2384.89","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 8 (890)","30900198","CDM","310","RC","81407","HCPCS","facility","both","","","","1863.16","1863.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 8 (1000)","30900199","CDM","310","RC","81407","HCPCS","facility","both","","","","2679.66","2679.66","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 8 (1000)","30900199","CDM","310","RC","81407","HCPCS","facility","both","","","","1500","1500","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 8 (1000)","30900199","CDM","310","RC","81407","HCPCS","facility","both","","","","2093.44","2093.44","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 8 (1140)","30900200","CDM","310","RC","81407","HCPCS","facility","both","","","","1725","1725","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 8 (1140)","30900200","CDM","310","RC","81407","HCPCS","facility","both","","","","3054.8","3054.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 8 (1140)","30900200","CDM","310","RC","81407","HCPCS","facility","both","","","","2386.52","2386.52","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 8 (875)","30900201","CDM","310","RC","81407","HCPCS","facility","both","","","","1685","1685","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 8 (875)","30900201","CDM","310","RC","81407","HCPCS","facility","both","","","","2344.7","2344.7","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 8 (875)","30900201","CDM","310","RC","81407","HCPCS","facility","both","","","","1831.76","1831.76","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 8 (1565)","30900202","CDM","310","RC","81407","HCPCS","facility","both","","","","4180.26","4180.26","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 8 (1565)","30900202","CDM","310","RC","81407","HCPCS","facility","both","","","","3265.76","3265.76","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 8 (1625)","30900203","CDM","310","RC","81407","HCPCS","facility","both","","","","4341.04","4341.04","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 8 (1625)","30900203","CDM","310","RC","81407","HCPCS","facility","both","","","","3391.37","3391.37","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 8 (1830)","30900204","CDM","310","RC","81407","HCPCS","facility","both","","","","2770","2770","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 8 (1830)","30900204","CDM","310","RC","81407","HCPCS","facility","both","","","","4903.76","4903.76","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 8 (1830)","30900204","CDM","310","RC","81407","HCPCS","facility","both","","","","3830.99","3830.99","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 8 (2000)","30900205","CDM","310","RC","81407","HCPCS","facility","both","","","","4186.87","4186.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 8 (2000)","30900205","CDM","310","RC","81407","HCPCS","facility","both","","","","5359.31","5359.31","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 8 (2000)","30900205","CDM","310","RC","81407","HCPCS","facility","both","","","","38.5","38.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 8 (3430)","30900206","CDM","310","RC","81407","HCPCS","facility","both","","","","7180.49","7180.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 8 (3430)","30900206","CDM","310","RC","81407","HCPCS","facility","both","","","","9191.21","9191.21","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (930)","30900207","CDM","310","RC","81408","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 9 (930)","30900207","CDM","310","RC","81408","HCPCS","facility","both","","","","2492.07","2492.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (930)","30900207","CDM","310","RC","81408","HCPCS","facility","both","","","","1946.89","1946.89","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 9 (935)","30900208","CDM","310","RC","81408","HCPCS","facility","both","","","","2505.48","2505.48","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (935)","30900208","CDM","310","RC","81408","HCPCS","facility","both","","","","1957.37","1957.37","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 9 (935)","30900208","CDM","310","RC","81408","HCPCS","facility","both","","","","1915","1915","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 9 (970)","30900209","CDM","310","RC","81408","HCPCS","facility","both","","","","2030.63","2030.63","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 9 (970)","30900209","CDM","310","RC","81408","HCPCS","facility","both","","","","2599.27","2599.27","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (975)","30900210","CDM","310","RC","81408","HCPCS","facility","both","","","","2612.66","2612.66","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (975)","30900210","CDM","310","RC","81408","HCPCS","facility","both","","","","1995","1995","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 9 (975)","30900210","CDM","310","RC","81408","HCPCS","facility","both","","","","2041.11","2041.11","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 9 (1050)","30900211","CDM","310","RC","81408","HCPCS","facility","both","","","","2198.11","2198.11","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 9 (1050)","30900211","CDM","310","RC","81408","HCPCS","facility","both","","","","2813.64","2813.64","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (1080)","30900212","CDM","310","RC","81408","HCPCS","facility","both","","","","2894.03","2894.03","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (1080)","30900212","CDM","310","RC","81408","HCPCS","facility","both","","","","2260.91","2260.91","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 9 (1170)","30900213","CDM","310","RC","81408","HCPCS","facility","both","","","","2395","2395","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 9 (1170)","30900213","CDM","310","RC","81408","HCPCS","facility","both","","","","3135.2","3135.2","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (1170)","30900213","CDM","310","RC","81408","HCPCS","facility","both","","","","2449.32","2449.32","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 9 (1240)","30900214","CDM","310","RC","81408","HCPCS","facility","both","","","","3322.77","3322.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (1240)","30900214","CDM","310","RC","81408","HCPCS","facility","both","","","","2115","2115","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 9 (1240)","30900214","CDM","310","RC","81408","HCPCS","facility","both","","","","2595.86","2595.86","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 9 (1295)","30900215","CDM","310","RC","81408","HCPCS","facility","both","","","","3456.76","3456.76","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (1295)","30900215","CDM","310","RC","81408","HCPCS","facility","both","","","","2700.53","2700.53","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 9 (1390)","30900216","CDM","310","RC","81408","HCPCS","facility","both","","","","3724.72","3724.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (1390)","30900216","CDM","310","RC","81408","HCPCS","facility","both","","","","2365","2365","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 9 (1390)","30900216","CDM","310","RC","81408","HCPCS","facility","both","","","","2909.88","2909.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 9 (3405)","30900217","CDM","310","RC","81408","HCPCS","facility","both","","","","9110.83","9110.83","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (3405)","30900217","CDM","310","RC","81408","HCPCS","facility","both","","","","7117.69","7117.69","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FETAL CHRMOML ANEUPLOIDY (390)","30900218","CDM","310","RC","81420","HCPCS","facility","both","","","","615","615","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FETAL CHRMOML ANEUPLOIDY (390)","30900218","CDM","310","RC","81420","HCPCS","facility","both","","","","816.44","816.44","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FETAL CHRMOML ANEUPLOIDY (390)","30900218","CDM","310","RC","81420","HCPCS","facility","both","","","","1045.06","1045.06","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYS (1150)","30900219","CDM","310","RC","81450","HCPCS","facility","both","","","","3081.6","3081.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYS (1150)","30900219","CDM","310","RC","81450","HCPCS","facility","both","","","","6628","6628","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYS (1150)","30900219","CDM","310","RC","81450","HCPCS","facility","both","","","","1920","1920","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYS (1150)","30900219","CDM","310","RC","81450","HCPCS","facility","both","","","","2407.46","2407.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (115)","30900220","CDM","310","RC","81479","HCPCS","facility","both","","","","245","245","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (115)","30900220","CDM","310","RC","81479","HCPCS","facility","both","","","","308.16","308.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (115)","30900220","CDM","310","RC","81479","HCPCS","facility","both","","","","240.74","240.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (120)","30900221","CDM","310","RC","81479","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (120)","30900221","CDM","310","RC","81479","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (130)","30900222","CDM","310","RC","81479","HCPCS","facility","both","","","","210","210","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (130)","30900222","CDM","310","RC","81479","HCPCS","facility","both","","","","348.35","348.35","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (130)","30900222","CDM","310","RC","81479","HCPCS","facility","both","","","","272.15","272.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (135)","30900223","CDM","310","RC","81479","HCPCS","facility","both","","","","282.61","282.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (135)","30900223","CDM","310","RC","81479","HCPCS","facility","both","","","","451","451","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (135)","30900223","CDM","310","RC","81479","HCPCS","facility","both","","","","361.76","361.76","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (160)","30900224","CDM","310","RC","81479","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (160)","30900224","CDM","310","RC","81479","HCPCS","facility","both","","","","315","315","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (160)","30900224","CDM","310","RC","81479","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (185)","30900225","CDM","310","RC","81479","HCPCS","facility","both","","","","387.29","387.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (185)","30900225","CDM","310","RC","81479","HCPCS","facility","both","","","","425","425","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (185)","30900225","CDM","310","RC","81479","HCPCS","facility","both","","","","495.74","495.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (200)","30900226","CDM","310","RC","81479","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (200)","30900226","CDM","310","RC","81479","HCPCS","facility","both","","","","418.68","418.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (200)","30900226","CDM","310","RC","81479","HCPCS","facility","both","","","","1250","1250","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UNLISTED MOL PATH (200)","30900226","CDM","310","RC","81479","HCPCS","facility","both","","","","535.93","535.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (205)","30900227","CDM","310","RC","81479","HCPCS","facility","both","","","","18","18","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (205)","30900227","CDM","310","RC","81479","HCPCS","facility","both","","","","429.16","429.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (205)","30900227","CDM","310","RC","81479","HCPCS","facility","both","","","","549.33","549.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (210)","30900228","CDM","310","RC","81479","HCPCS","facility","both","","","","562.73","562.73","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (210)","30900228","CDM","310","RC","81479","HCPCS","facility","both","","","","439.62","439.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (210)","30900228","CDM","310","RC","81479","HCPCS","facility","both","","","","395","395","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (220)","30900229","CDM","310","RC","81479","HCPCS","facility","both","","","","589.53","589.53","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (220)","30900229","CDM","310","RC","81479","HCPCS","facility","both","","","","300","300","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (220)","30900229","CDM","310","RC","81479","HCPCS","facility","both","","","","460.55","460.55","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (240)","30900230","CDM","310","RC","81479","HCPCS","facility","both","","","","502.42","502.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (240)","30900230","CDM","310","RC","81479","HCPCS","facility","both","","","","397","397","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (240)","30900230","CDM","310","RC","81479","HCPCS","facility","both","","","","643.12","643.12","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (250)","30900231","CDM","310","RC","81479","HCPCS","facility","both","","","","669.91","669.91","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (250)","30900231","CDM","310","RC","81479","HCPCS","facility","both","","","","523.36","523.36","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (250)","30900231","CDM","310","RC","81479","HCPCS","facility","both","","","","375","375","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (255)","30900232","CDM","310","RC","81479","HCPCS","facility","both","","","","683.3","683.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (255)","30900232","CDM","310","RC","81479","HCPCS","facility","both","","","","533.83","533.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (255)","30900232","CDM","310","RC","81479","HCPCS","facility","both","","","","545","545","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (260)","30900233","CDM","310","RC","81479","HCPCS","facility","both","","","","544.29","544.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (260)","30900233","CDM","310","RC","81479","HCPCS","facility","both","","","","696.71","696.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (260)","30900233","CDM","310","RC","81479","HCPCS","facility","both","","","","545","545","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (280)","30900234","CDM","310","RC","81479","HCPCS","facility","both","","","","560","560","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (280)","30900234","CDM","310","RC","81479","HCPCS","facility","both","","","","750.3","750.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (280)","30900234","CDM","310","RC","81479","HCPCS","facility","both","","","","586.16","586.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (290)","30900235","CDM","310","RC","81479","HCPCS","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (290)","30900235","CDM","310","RC","81479","HCPCS","facility","both","","","","607.1","607.1","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (290)","30900235","CDM","310","RC","81479","HCPCS","facility","both","","","","777.1","777.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (295)","30900236","CDM","310","RC","81479","HCPCS","facility","both","","","","790.5","790.5","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (295)","30900236","CDM","310","RC","81479","HCPCS","facility","both","","","","580","580","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (295)","30900236","CDM","310","RC","81479","HCPCS","facility","both","","","","617.57","617.57","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (310)","30900237","CDM","310","RC","81479","HCPCS","facility","both","","","","648.96","648.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (310)","30900237","CDM","310","RC","81479","HCPCS","facility","both","","","","545","545","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (310)","30900237","CDM","310","RC","81479","HCPCS","facility","both","","","","830.7","830.7","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (315)","30900238","CDM","310","RC","81479","HCPCS","facility","both","","","","844.09","844.09","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (315)","30900238","CDM","310","RC","81479","HCPCS","facility","both","","","","659.44","659.44","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (330)","30900239","CDM","310","RC","81479","HCPCS","facility","both","","","","690.83","690.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (330)","30900239","CDM","310","RC","81479","HCPCS","facility","both","","","","475","475","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (330)","30900239","CDM","310","RC","81479","HCPCS","facility","both","","","","884.29","884.29","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (345)","30900240","CDM","310","RC","81479","HCPCS","facility","both","","","","545","545","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (345)","30900240","CDM","310","RC","81479","HCPCS","facility","both","","","","924.48","924.48","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (345)","30900240","CDM","310","RC","81479","HCPCS","facility","both","","","","722.23","722.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (350)","30900241","CDM","310","RC","81479","HCPCS","facility","both","","","","732.7","732.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (350)","30900241","CDM","310","RC","81479","HCPCS","facility","both","","","","2786","2786","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UNLISTED MOL PATH (350)","30900241","CDM","310","RC","81479","HCPCS","facility","both","","","","937.88","937.88","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (350)","30900241","CDM","310","RC","81479","HCPCS","facility","both","","","","675","675","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (385)","30900242","CDM","310","RC","81479","HCPCS","facility","both","","","","1031.67","1031.67","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (385)","30900242","CDM","310","RC","81479","HCPCS","facility","both","","","","805.97","805.97","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (395)","30900243","CDM","310","RC","81479","HCPCS","facility","both","","","","826.9","826.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (395)","30900243","CDM","310","RC","81479","HCPCS","facility","both","","","","1058.47","1058.47","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (395)","30900243","CDM","310","RC","81479","HCPCS","facility","both","","","","644","644","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (435)","30900244","CDM","310","RC","81479","HCPCS","facility","both","","","","910.64","910.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (435)","30900244","CDM","310","RC","81479","HCPCS","facility","both","","","","1165.65","1165.65","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (440)","30900245","CDM","310","RC","81479","HCPCS","facility","both","","","","785","785","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (440)","30900245","CDM","310","RC","81479","HCPCS","facility","both","","","","1179.04","1179.04","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (440)","30900245","CDM","310","RC","81479","HCPCS","facility","both","","","","921.12","921.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (455)","30900246","CDM","310","RC","81479","HCPCS","facility","both","","","","952.51","952.51","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (455)","30900246","CDM","310","RC","81479","HCPCS","facility","both","","","","2594","2594","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UNLISTED MOL PATH (455)","30900246","CDM","310","RC","81479","HCPCS","facility","both","","","","1219.24","1219.24","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (460)","30900247","CDM","310","RC","81479","HCPCS","facility","both","","","","962.98","962.98","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (460)","30900247","CDM","310","RC","81479","HCPCS","facility","both","","","","1232.64","1232.64","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (465)","30900248","CDM","310","RC","81479","HCPCS","facility","both","","","","815","815","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (465)","30900248","CDM","310","RC","81479","HCPCS","facility","both","","","","973.45","973.45","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (465)","30900248","CDM","310","RC","81479","HCPCS","facility","both","","","","1246.04","1246.04","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (470)","30900249","CDM","310","RC","81479","HCPCS","facility","both","","","","983.92","983.92","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (470)","30900249","CDM","310","RC","81479","HCPCS","facility","both","","","","625","625","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (470)","30900249","CDM","310","RC","81479","HCPCS","facility","both","","","","1259.44","1259.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (480)","30900250","CDM","310","RC","81479","HCPCS","facility","both","","","","1286.23","1286.23","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (480)","30900250","CDM","310","RC","81479","HCPCS","facility","both","","","","798","798","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (480)","30900250","CDM","310","RC","81479","HCPCS","facility","both","","","","1004.85","1004.85","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (480)","30900250","CDM","310","RC","81479","HCPCS","facility","both","","","","3393","3393","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UNLISTED MOL PATH (485)","30900251","CDM","310","RC","81479","HCPCS","facility","both","","","","1015.32","1015.32","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (485)","30900251","CDM","310","RC","81479","HCPCS","facility","both","","","","1299.63","1299.63","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (500)","30900252","CDM","310","RC","81479","HCPCS","facility","both","","","","1339.83","1339.83","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (500)","30900252","CDM","310","RC","81479","HCPCS","facility","both","","","","770","770","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (500)","30900252","CDM","310","RC","81479","HCPCS","facility","both","","","","1046.72","1046.72","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (510)","30900253","CDM","310","RC","81479","HCPCS","facility","both","","","","1067.65","1067.65","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (510)","30900253","CDM","310","RC","81479","HCPCS","facility","both","","","","770","770","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (510)","30900253","CDM","310","RC","81479","HCPCS","facility","both","","","","1366.63","1366.63","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (520)","30900254","CDM","310","RC","81479","HCPCS","facility","both","","","","1393.43","1393.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (520)","30900254","CDM","310","RC","81479","HCPCS","facility","both","","","","1088.58","1088.58","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (530)","30900255","CDM","310","RC","81479","HCPCS","facility","both","","","","1420.21","1420.21","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (530)","30900255","CDM","310","RC","81479","HCPCS","facility","both","","","","930","930","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (530)","30900255","CDM","310","RC","81479","HCPCS","facility","both","","","","1109.52","1109.52","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (570)","30900256","CDM","310","RC","81479","HCPCS","facility","both","","","","1527.41","1527.41","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (570)","30900256","CDM","310","RC","81479","HCPCS","facility","both","","","","1193.26","1193.26","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (575)","30900257","CDM","310","RC","81479","HCPCS","facility","both","","","","1540.8","1540.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (575)","30900257","CDM","310","RC","81479","HCPCS","facility","both","","","","933","933","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (575)","30900257","CDM","310","RC","81479","HCPCS","facility","both","","","","1203.73","1203.73","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (585)","30900258","CDM","310","RC","81479","HCPCS","facility","both","","","","1567.6","1567.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (585)","30900258","CDM","310","RC","81479","HCPCS","facility","both","","","","1224.66","1224.66","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (600)","30900259","CDM","310","RC","81479","HCPCS","facility","both","","","","1070","1070","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (600)","30900259","CDM","310","RC","81479","HCPCS","facility","both","","","","1256.06","1256.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (600)","30900259","CDM","310","RC","81479","HCPCS","facility","both","","","","1607.79","1607.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (640)","30900260","CDM","310","RC","81479","HCPCS","facility","both","","","","890","890","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (640)","30900260","CDM","310","RC","81479","HCPCS","facility","both","","","","1339.8","1339.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (640)","30900260","CDM","310","RC","81479","HCPCS","facility","both","","","","1714.97","1714.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (645)","30900261","CDM","310","RC","81479","HCPCS","facility","both","","","","1350.27","1350.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (645)","30900261","CDM","310","RC","81479","HCPCS","facility","both","","","","1728.38","1728.38","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (645)","30900261","CDM","310","RC","81479","HCPCS","facility","both","","","","1245","1245","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (660)","30900262","CDM","310","RC","81479","HCPCS","facility","both","","","","1455","1455","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (660)","30900262","CDM","310","RC","81479","HCPCS","facility","both","","","","1768.57","1768.57","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (660)","30900262","CDM","310","RC","81479","HCPCS","facility","both","","","","1381.67","1381.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (670)","30900263","CDM","310","RC","81479","HCPCS","facility","both","","","","1795.37","1795.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (670)","30900263","CDM","310","RC","81479","HCPCS","facility","both","","","","1402.6","1402.6","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (680)","30900264","CDM","310","RC","81479","HCPCS","facility","both","","","","1423.54","1423.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (680)","30900264","CDM","310","RC","81479","HCPCS","facility","both","","","","1822.16","1822.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (670)","30900265","CDM","310","RC","81479","HCPCS","facility","both","","","","1190","1190","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (670)","30900265","CDM","310","RC","81479","HCPCS","facility","both","","","","1846.28","1846.28","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (670)","30900265","CDM","310","RC","81479","HCPCS","facility","both","","","","1442.38","1442.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (715)","30900266","CDM","310","RC","81479","HCPCS","facility","both","","","","1496.8","1496.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (715)","30900266","CDM","310","RC","81479","HCPCS","facility","both","","","","1915.96","1915.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (715)","30900266","CDM","310","RC","81479","HCPCS","facility","both","","","","1345","1345","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (725)","30900267","CDM","310","RC","81479","HCPCS","facility","both","","","","1942.75","1942.75","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (725)","30900267","CDM","310","RC","81479","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (725)","30900267","CDM","310","RC","81479","HCPCS","facility","both","","","","1517.74","1517.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (730)","30900268","CDM","310","RC","81479","HCPCS","facility","both","","","","795","795","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (730)","30900268","CDM","310","RC","81479","HCPCS","facility","both","","","","1956.14","1956.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (730)","30900268","CDM","310","RC","81479","HCPCS","facility","both","","","","1528.21","1528.21","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (750)","30900269","CDM","310","RC","81479","HCPCS","facility","both","","","","1570.08","1570.08","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (750)","30900269","CDM","310","RC","81479","HCPCS","facility","both","","","","2009.74","2009.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (780)","30900270","CDM","310","RC","81479","HCPCS","facility","both","","","","2090.13","2090.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (780)","30900270","CDM","310","RC","81479","HCPCS","facility","both","","","","1455","1455","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (780)","30900270","CDM","310","RC","81479","HCPCS","facility","both","","","","1632.88","1632.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (785)","30900271","CDM","310","RC","81479","HCPCS","facility","both","","","","2103.53","2103.53","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (785)","30900271","CDM","310","RC","81479","HCPCS","facility","both","","","","1643.35","1643.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (800)","30900272","CDM","310","RC","81479","HCPCS","facility","both","","","","2143.73","2143.73","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (800)","30900272","CDM","310","RC","81479","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (800)","30900272","CDM","310","RC","81479","HCPCS","facility","both","","","","1674.75","1674.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (825)","30900273","CDM","310","RC","81479","HCPCS","facility","both","","","","1727.09","1727.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (825)","30900273","CDM","310","RC","81479","HCPCS","facility","both","","","","2210.71","2210.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (825)","30900273","CDM","310","RC","81479","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (835)","30900274","CDM","310","RC","81479","HCPCS","facility","both","","","","2237.51","2237.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (835)","30900274","CDM","310","RC","81479","HCPCS","facility","both","","","","1748.02","1748.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (925)","30900275","CDM","310","RC","81479","HCPCS","facility","both","","","","1780","1780","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (925)","30900275","CDM","310","RC","81479","HCPCS","facility","both","","","","1936.43","1936.43","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (925)","30900275","CDM","310","RC","81479","HCPCS","facility","both","","","","2478.68","2478.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (955)","30900276","CDM","310","RC","81479","HCPCS","facility","both","","","","1999.24","1999.24","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (955)","30900276","CDM","310","RC","81479","HCPCS","facility","both","","","","1580","1580","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (955)","30900276","CDM","310","RC","81479","HCPCS","facility","both","","","","2559.07","2559.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1000)","30900277","CDM","310","RC","81479","HCPCS","facility","both","","","","2093.44","2093.44","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1000)","30900277","CDM","310","RC","81479","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1000)","30900277","CDM","310","RC","81479","HCPCS","facility","both","","","","2679.66","2679.66","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1030)","30900278","CDM","310","RC","81479","HCPCS","facility","both","","","","2156.24","2156.24","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1030)","30900278","CDM","310","RC","81479","HCPCS","facility","both","","","","2760.04","2760.04","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1030)","30900278","CDM","310","RC","81479","HCPCS","facility","both","","","","2190","2190","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1050)","30900279","CDM","310","RC","81479","HCPCS","facility","both","","","","2813.64","2813.64","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1050)","30900279","CDM","310","RC","81479","HCPCS","facility","both","","","","2198.11","2198.11","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1050)","30900279","CDM","310","RC","81479","HCPCS","facility","both","","","","1175","1175","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1070)","30900280","CDM","310","RC","81479","HCPCS","facility","both","","","","2867.24","2867.24","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1070)","30900280","CDM","310","RC","81479","HCPCS","facility","both","","","","1840","1840","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1070)","30900280","CDM","310","RC","81479","HCPCS","facility","both","","","","2239.98","2239.98","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1080)","30900281","CDM","310","RC","81479","HCPCS","facility","both","","","","2260.91","2260.91","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1080)","30900281","CDM","310","RC","81479","HCPCS","facility","both","","","","2894.03","2894.03","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1080)","30900281","CDM","310","RC","81479","HCPCS","facility","both","","","","2025","2025","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1100)","30900282","CDM","310","RC","81479","HCPCS","facility","both","","","","2947.62","2947.62","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1100)","30900282","CDM","310","RC","81479","HCPCS","facility","both","","","","2302.78","2302.78","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1100)","30900282","CDM","310","RC","81479","HCPCS","facility","both","","","","1870","1870","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1150)","30900283","CDM","310","RC","81479","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1150)","30900283","CDM","310","RC","81479","HCPCS","facility","both","","","","3081.6","3081.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1150)","30900283","CDM","310","RC","81479","HCPCS","facility","both","","","","2407.46","2407.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1190)","30900284","CDM","310","RC","81479","HCPCS","facility","both","","","","3188.79","3188.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1190)","30900284","CDM","310","RC","81479","HCPCS","facility","both","","","","1995","1995","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1190)","30900284","CDM","310","RC","81479","HCPCS","facility","both","","","","2491.19","2491.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1380)","30900285","CDM","310","RC","81479","HCPCS","facility","both","","","","2888.94","2888.94","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1380)","30900285","CDM","310","RC","81479","HCPCS","facility","both","","","","3697.92","3697.92","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1380)","30900285","CDM","310","RC","81479","HCPCS","facility","both","","","","2784","2784","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1380)","30900285","CDM","310","RC","81479","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1460)","30900286","CDM","310","RC","81479","HCPCS","facility","both","","","","3912.3","3912.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1460)","30900286","CDM","310","RC","81479","HCPCS","facility","both","","","","3056.42","3056.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1500)","30900287","CDM","310","RC","81479","HCPCS","facility","both","","","","2545","2545","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1500)","30900287","CDM","310","RC","81479","HCPCS","facility","both","","","","4019.48","4019.48","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1500)","30900287","CDM","310","RC","81479","HCPCS","facility","both","","","","3140.16","3140.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1540)","30900288","CDM","310","RC","81479","HCPCS","facility","both","","","","3223.89","3223.89","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1540)","30900288","CDM","310","RC","81479","HCPCS","facility","both","","","","4126.67","4126.67","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1540)","30900288","CDM","310","RC","81479","HCPCS","facility","both","","","","2700","2700","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1570)","30900289","CDM","310","RC","81479","HCPCS","facility","both","","","","3286.69","3286.69","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1570)","30900289","CDM","310","RC","81479","HCPCS","facility","both","","","","4207.06","4207.06","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1600)","30900290","CDM","310","RC","81479","HCPCS","facility","both","","","","4287.44","4287.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1600)","30900290","CDM","310","RC","81479","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1600)","30900290","CDM","310","RC","81479","HCPCS","facility","both","","","","3349.5","3349.5","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1700)","30900291","CDM","310","RC","81479","HCPCS","facility","both","","","","4555.41","4555.41","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1700)","30900291","CDM","310","RC","81479","HCPCS","facility","both","","","","3558.84","3558.84","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1770)","30900292","CDM","310","RC","81479","HCPCS","facility","both","","","","3705.39","3705.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1770)","30900292","CDM","310","RC","81479","HCPCS","facility","both","","","","4743","4743","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1770)","30900292","CDM","310","RC","81479","HCPCS","facility","both","","","","3245","3245","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1840)","30900293","CDM","310","RC","81479","HCPCS","facility","both","","","","3206","3206","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1840)","30900293","CDM","310","RC","81479","HCPCS","facility","both","","","","4930.56","4930.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1840)","30900293","CDM","310","RC","81479","HCPCS","facility","both","","","","3851.92","3851.92","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1870)","30900294","CDM","310","RC","81479","HCPCS","facility","both","","","","754","754","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1870)","30900294","CDM","310","RC","81479","HCPCS","facility","both","","","","5010.96","5010.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1870)","30900294","CDM","310","RC","81479","HCPCS","facility","both","","","","3914.72","3914.72","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1890)","30900295","CDM","310","RC","81479","HCPCS","facility","both","","","","5064.54","5064.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1890)","30900295","CDM","310","RC","81479","HCPCS","facility","both","","","","3956.59","3956.59","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1920)","30900296","CDM","310","RC","81479","HCPCS","facility","both","","","","4019.4","4019.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1920)","30900296","CDM","310","RC","81479","HCPCS","facility","both","","","","5144.94","5144.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1970)","30900297","CDM","310","RC","81479","HCPCS","facility","both","","","","5278.93","5278.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1970)","30900297","CDM","310","RC","81479","HCPCS","facility","both","","","","4124.07","4124.07","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1970)","30900297","CDM","310","RC","81479","HCPCS","facility","both","","","","4340","4340","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1980)","30900298","CDM","310","RC","81479","HCPCS","facility","both","","","","5005","5005","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (1980)","30900298","CDM","310","RC","81479","HCPCS","facility","both","","","","5305.71","5305.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1980)","30900298","CDM","310","RC","81479","HCPCS","facility","both","","","","4145","4145","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (2050)","30900299","CDM","310","RC","81479","HCPCS","facility","both","","","","4291.55","4291.55","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (2050)","30900299","CDM","310","RC","81479","HCPCS","facility","both","","","","3050","3050","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (2050)","30900299","CDM","310","RC","81479","HCPCS","facility","both","","","","5493.29","5493.29","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (2070)","30900300","CDM","310","RC","81479","HCPCS","facility","both","","","","5546.88","5546.88","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (2070)","30900300","CDM","310","RC","81479","HCPCS","facility","both","","","","4333.42","4333.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (1210)","30900301","CDM","310","RC","81479","HCPCS","facility","both","","","","3242.38","3242.38","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (1210)","30900301","CDM","310","RC","81479","HCPCS","facility","both","","","","2533.06","2533.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (2150)","30900302","CDM","310","RC","81479","HCPCS","facility","both","","","","5761.26","5761.26","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (2150)","30900302","CDM","310","RC","81479","HCPCS","facility","both","","","","4500.89","4500.89","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (2230)","30900303","CDM","310","RC","81479","HCPCS","facility","both","","","","4668.36","4668.36","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (2230)","30900303","CDM","310","RC","81479","HCPCS","facility","both","","","","5975.63","5975.63","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (2400)","30900304","CDM","310","RC","81479","HCPCS","facility","both","","","","6431.17","6431.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (2400)","30900304","CDM","310","RC","81479","HCPCS","facility","both","","","","5024.25","5024.25","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (2420)","30900305","CDM","310","RC","81479","HCPCS","facility","both","","","","4490","4490","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (2420)","30900305","CDM","310","RC","81479","HCPCS","facility","both","","","","6484.77","6484.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (2420)","30900305","CDM","310","RC","81479","HCPCS","facility","both","","","","5066.12","5066.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (2710)","30900306","CDM","310","RC","81479","HCPCS","facility","both","","","","5673.22","5673.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (2710)","30900306","CDM","310","RC","81479","HCPCS","facility","both","","","","7261.87","7261.87","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (2800)","30900307","CDM","310","RC","81479","HCPCS","facility","both","","","","5861.63","5861.63","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (2800)","30900307","CDM","310","RC","81479","HCPCS","facility","both","","","","7503.03","7503.03","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (2800)","30900307","CDM","310","RC","81479","HCPCS","facility","both","","","","5392","5392","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (4400)","30900308","CDM","310","RC","81479","HCPCS","facility","both","","","","9211.12","9211.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (4400)","30900308","CDM","310","RC","81479","HCPCS","facility","both","","","","11790.48","11790.48","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (4880)","30900309","CDM","310","RC","81479","HCPCS","facility","both","","","","10215.97","10215.97","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (4880)","30900309","CDM","310","RC","81479","HCPCS","facility","both","","","","13076.71","13076.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (4880)","30900309","CDM","310","RC","81479","HCPCS","facility","both","","","","10000","10000","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (6000)","30900310","CDM","310","RC","81479","HCPCS","facility","both","","","","11210","11210","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (6000)","30900310","CDM","310","RC","81479","HCPCS","facility","both","","","","16077.93","16077.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (6000)","30900310","CDM","310","RC","81479","HCPCS","facility","both","","","","12560.62","12560.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ONCOLOGY BREAST MRNA (24500","30900311","CDM","310","RC","81519","HCPCS","facility","both","","","","5128.92","5128.92","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ONCOLOGY BREAST MRNA (24500","30900311","CDM","310","RC","81519","HCPCS","facility","both","","","","6565.16","6565.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOLE PROC (1630)","30900312","CDM","310","RC","81479","HCPCS","facility","both","","","","4367.83","4367.83","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOLE PROC (1630)","30900312","CDM","310","RC","81479","HCPCS","facility","both","","","","3412.3","3412.3","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 1 (650)","30900313","CDM","310","RC","81400","HCPCS","facility","both","","","","1741.77","1741.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 1 (650)","30900313","CDM","310","RC","81400","HCPCS","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 1 (650)","30900313","CDM","310","RC","81400","HCPCS","facility","both","","","","1360.73","1360.73","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FETAL CHROMOSOMAL ANEUPLOIDY (990)","30900314","CDM","310","RC","81420","HCPCS","facility","both","","","","2072.5","2072.5","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FETAL CHROMOSOMAL ANEUPLOIDY (990)","30900314","CDM","310","RC","81420","HCPCS","facility","both","","","","1652","1652","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FETAL CHROMOSOMAL ANEUPLOIDY (990)","30900314","CDM","310","RC","81420","HCPCS","facility","both","","","","2652.86","2652.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS (1000)","30900315","CDM","310","RC","81455","HCPCS","facility","both","","","","2679.66","2679.66","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS (1000)","30900315","CDM","310","RC","81455","HCPCS","facility","both","","","","1673","1673","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (1000)","30900315","CDM","310","RC","81455","HCPCS","facility","both","","","","2093.44","2093.44","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS (1000)","30900315","CDM","310","RC","81455","HCPCS","facility","both","","","","5304","5304","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC  TARGETED GEN SEQ 5-50 (460)","30900316","CDM","310","RC","81445","HCPCS","facility","both","","","","962.98","962.98","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  TARGETED GEN SEQ 5-50 (460)","30900316","CDM","310","RC","81445","HCPCS","facility","both","","","","3450","3450","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC  TARGETED GEN SEQ 5-50 (460)","30900316","CDM","310","RC","81445","HCPCS","facility","both","","","","1232.64","1232.64","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GEN SEQ 5-50 (435)","30900317","CDM","310","RC","81445","HCPCS","facility","both","","","","3458","3458","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TARGETED GEN SEQ 5-50 (435)","30900317","CDM","310","RC","81445","HCPCS","facility","both","","","","910.64","910.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GEN SEQ 5-50 (435)","30900317","CDM","310","RC","81445","HCPCS","facility","both","","","","1165.65","1165.65","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOLE PROC (765)","30900318","CDM","310","RC","81479","HCPCS","facility","both","","","","1601.48","1601.48","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOLE PROC (765)","30900318","CDM","310","RC","81479","HCPCS","facility","both","","","","2049.93","2049.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOLE PROC (5150)","30900319","CDM","310","RC","81479","HCPCS","facility","both","","","","10781.2","10781.2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOLE PROC (5150)","30900319","CDM","310","RC","81479","HCPCS","facility","both","","","","13800.22","13800.22","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BCR/ABL MJR BP (275)","30900320","CDM","310","RC","81206","HCPCS","facility","both","","","","736.9","736.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BCR/ABL MJR BP (275)","30900320","CDM","310","RC","81206","HCPCS","facility","both","","","","465","465","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BCR/ABL MJR BP (275)","30900320","CDM","310","RC","81206","HCPCS","facility","both","","","","1288","1288","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BCR/ABL MJR BP (275)","30900320","CDM","310","RC","81206","HCPCS","facility","both","","","","575.7","575.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLT3 GENE (160)","30900321","CDM","310","RC","81245","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLT3 GENE (160)","30900321","CDM","310","RC","81245","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KRAS GENE (90)","30900322","CDM","310","RC","81275","HCPCS","facility","both","","","","365","365","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC KRAS GENE (90)","30900322","CDM","310","RC","81275","HCPCS","facility","both","","","","241.17","241.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KRAS GENE (90)","30900322","CDM","310","RC","81275","HCPCS","facility","both","","","","188.41","188.41","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BRAF GENE (75)","30900323","CDM","310","RC","81210","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BRAF GENE (75)","30900323","CDM","310","RC","81210","HCPCS","facility","both","","","","1039","1039","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BRAF GENE (75)","30900323","CDM","310","RC","81210","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (305)","30900324","CDM","310","RC","81403","HCPCS","facility","both","","","","638.5","638.5","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (305)","30900324","CDM","310","RC","81403","HCPCS","facility","both","","","","817.29","817.29","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHIMERISM ANAL W/CELL SELECT (210)","30900325","CDM","310","RC","81268","HCPCS","facility","both","","","","439.62","439.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHIMERISM ANAL W/CELL SELECT (210)","30900325","CDM","310","RC","81268","HCPCS","facility","both","","","","562.73","562.73","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (2200)","30900326","CDM","310","RC","81479","HCPCS","facility","both","","","","4605.56","4605.56","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (2200)","30900326","CDM","310","RC","81479","HCPCS","facility","both","","","","3720","3720","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (2200)","30900326","CDM","310","RC","81479","HCPCS","facility","both","","","","5895.24","5895.24","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC JAK2 GENE (125)","30900327","CDM","310","RC","81270","HCPCS","facility","both","","","","769","769","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC JAK2 GENE (125)","30900327","CDM","310","RC","81270","HCPCS","facility","both","","","","261.68","261.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC JAK2 GENE (125)","30900327","CDM","310","RC","81270","HCPCS","facility","both","","","","334.96","334.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC JAK2 GENE (125)","30900327","CDM","310","RC","81270","HCPCS","facility","both","","","","218.75","218.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CEBPA GENE FULL SEQ (345)","30900328","CDM","310","RC","81218","HCPCS","facility","both","","","","924.48","924.48","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CEBPA GENE FULL SEQ (345)","30900328","CDM","310","RC","81218","HCPCS","facility","both","","","","722.23","722.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CEBPA GENE FULL SEQ (345)","30900328","CDM","310","RC","81218","HCPCS","facility","both","","","","2098","2098","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NRAS GENE VAR EXON 2-3 (450)","30900329","CDM","310","RC","81311","HCPCS","facility","both","","","","1884","1884","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NRAS GENE VAR EXON 2-3 (450)","30900329","CDM","310","RC","81311","HCPCS","facility","both","","","","942.05","942.05","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NRAS GENE VAR EXON 2-3 (450)","30900329","CDM","310","RC","81311","HCPCS","facility","both","","","","1205.84","1205.84","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOLE PROC LEVEL 2 (105)","30900330","CDM","310","RC","81401","HCPCS","facility","both","","","","699","699","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOLE PROC LEVEL 2 (105)","30900330","CDM","310","RC","81401","HCPCS","facility","both","","","","165","165","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOLE PROC LEVEL 2 (105)","30900330","CDM","310","RC","81401","HCPCS","facility","both","","","","219.81","219.81","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOLE PROC LEVEL 2 (105)","30900330","CDM","310","RC","81401","HCPCS","facility","both","","","","281.36","281.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOLE PROC LEVEL 5 (450)","30900331","CDM","310","RC","81404","HCPCS","facility","both","","","","942.05","942.05","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOLE PROC LEVEL 5 (450)","30900331","CDM","310","RC","81404","HCPCS","facility","both","","","","2470","2470","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOLE PROC LEVEL 5 (450)","30900331","CDM","310","RC","81404","HCPCS","facility","both","","","","1205.84","1205.84","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KIT GENE TGT SEQ (415)","30900332","CDM","310","RC","81272","HCPCS","facility","both","","","","2098","2098","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KIT GENE TGT SEQ (415)","30900332","CDM","310","RC","81272","HCPCS","facility","both","","","","1112.06","1112.06","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KIT GENE TGT SEQ (415)","30900332","CDM","310","RC","81272","HCPCS","facility","both","","","","868.77","868.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC KRAS GENE VAR (1)","30900333","CDM","310","RC","81276","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC KRAS GENE VAR (1)","30900333","CDM","310","RC","81276","HCPCS","facility","both","","","","1257","1257","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KRAS GENE VAR (1)","30900333","CDM","310","RC","81276","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLT3 GENE (1)","30900334","CDM","310","RC","81246","HCPCS","facility","both","","","","531","531","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLT3 GENE (1)","30900334","CDM","310","RC","81246","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLT3 GENE (1)","30900334","CDM","310","RC","81246","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC KIT GENE TGTD SEQ (1)","30900335","CDM","310","RC","81272","HCPCS","facility","both","","","","2098","2098","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KIT GENE TGTD SEQ (1)","30900335","CDM","310","RC","81272","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KIT GENE TGTD SEQ (1)","30900335","CDM","310","RC","81272","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOLE PROC (1650)","30900336","CDM","310","RC","81479","HCPCS","facility","both","","","","5457","5457","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED MOLE PROC (1650)","30900336","CDM","310","RC","81479","HCPCS","facility","both","","","","3454.17","3454.17","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOLE PROC (1650)","30900336","CDM","310","RC","81479","HCPCS","facility","both","","","","3065","3065","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOLE PROC (1650)","30900336","CDM","310","RC","81479","HCPCS","facility","both","","","","4421.43","4421.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHIMERISM ANAL NO SEL (145)","30900337","CDM","310","RC","81267","HCPCS","facility","both","","","","388.56","388.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHIMERISM ANAL NO SEL (145)","30900337","CDM","310","RC","81267","HCPCS","facility","both","","","","3689","3689","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHIMERISM ANAL NO SEL (145)","30900337","CDM","310","RC","81267","HCPCS","facility","both","","","","303.55","303.55","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NPM1 GENE (345)","30900338","CDM","310","RC","81310","HCPCS","facility","both","","","","3223","3223","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NPM1 GENE (345)","30900338","CDM","310","RC","81310","HCPCS","facility","both","","","","924.48","924.48","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NPM1 GENE (345)","30900338","CDM","310","RC","81310","HCPCS","facility","both","","","","722.23","722.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PMP22 GENE ANALYSIS","30900339","CDM","310","RC","81325","HCPCS","facility","both","","","","937.88","937.88","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PMP22 GENE ANALYSIS","30900339","CDM","310","RC","81325","HCPCS","facility","both","","","","732.7","732.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PMP22 GENE ANALYSIS","30900339","CDM","310","RC","81325","HCPCS","facility","both","","","","3821","3821","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXOME SEQUENCE ANAL (3670)","30900340","CDM","310","RC","81415","HCPCS","facility","both","","","","900","900","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC EXOME SEQUENCE ANAL (3670)","30900340","CDM","310","RC","81415","HCPCS","facility","both","","","","9834.34","9834.34","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC EXOME SEQUENCE ANAL (3670)","30900340","CDM","310","RC","81415","HCPCS","facility","both","","","","12133","12133","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXOME SEQUENCE ANAL (3670)","30900340","CDM","310","RC","81415","HCPCS","facility","both","","","","7682.91","7682.91","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPARATOR EXOME (515)","30900341","CDM","310","RC","81416","HCPCS","facility","both","","","","1078.12","1078.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPARATOR EXOME (515)","30900341","CDM","310","RC","81416","HCPCS","facility","both","","","","16639","16639","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPARATOR EXOME (515)","30900341","CDM","310","RC","81416","HCPCS","facility","both","","","","1380.02","1380.02","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GBA GENE (65)","30900342","CDM","310","RC","81251","HCPCS","facility","both","","","","136.07","136.07","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GBA GENE (65)","30900342","CDM","310","RC","81251","HCPCS","facility","both","","","","174.17","174.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (340)","30900343","CDM","310","RC","81401","HCPCS","facility","both","","","","711.77","711.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (340)","30900343","CDM","310","RC","81401","HCPCS","facility","both","","","","350","350","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (340)","30900343","CDM","310","RC","81401","HCPCS","facility","both","","","","911.08","911.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PTN GENE KNOWN (505)","30900344","CDM","310","RC","81322","HCPCS","facility","both","","","","1353.22","1353.22","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PTN GENE KNOWN (505)","30900344","CDM","310","RC","81322","HCPCS","facility","both","","","","1057.19","1057.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PTN GENE KNOWN (505)","30900344","CDM","310","RC","81322","HCPCS","facility","both","","","","225","225","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTGN MARRAY COPY NO & SNP (720)","30900345","CDM","310","RC","81229","HCPCS","facility","both","","","","1929.36","1929.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTGN MARRAY COPY NO & SNP (720)","30900345","CDM","310","RC","81229","HCPCS","facility","both","","","","1507.28","1507.28","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTGN MARRAY COPY NO & SNP (720)","30900345","CDM","310","RC","81229","HCPCS","facility","both","","","","5365","5365","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTGN MARRAY COPY NO & SNP (720)","30900345","CDM","310","RC","81229","HCPCS","facility","both","","","","1263","1263","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYTGN MARRAY COPY NO & SNP (815)","30900346","CDM","310","RC","81229","HCPCS","facility","both","","","","576","576","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYTGN MARRAY COPY NO & SNP (815)","30900346","CDM","310","RC","81229","HCPCS","facility","both","","","","2183.92","2183.92","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTGN MARRAY COPY NO & SNP (815)","30900346","CDM","310","RC","81229","HCPCS","facility","both","","","","1706.15","1706.15","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTGN MARRAY COPY NO & SNP (815)","30900346","CDM","310","RC","81229","HCPCS","facility","both","","","","6045","6045","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UNLISTED MOL PATH (610)","30900347","CDM","310","RC","81479","HCPCS","facility","both","","","","985","985","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOL PATH (610)","30900347","CDM","310","RC","81479","HCPCS","facility","both","","","","1634.59","1634.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (610)","30900347","CDM","310","RC","81479","HCPCS","facility","both","","","","4096","4096","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UNLISTED MOL PATH (610)","30900347","CDM","310","RC","81479","HCPCS","facility","both","","","","1276.99","1276.99","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MPATH PROCEDUR LEVEL 5 (2460)","30900348","CDM","310","RC","81404","HCPCS","facility","both","","","","6591.95","6591.95","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MPATH PROCEDUR LEVEL 5 (2460)","30900348","CDM","310","RC","81404","HCPCS","facility","both","","","","5149.86","5149.86","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MPATH PROCEDUR LEVEL 5 (2460)","30900348","CDM","310","RC","81404","HCPCS","facility","both","","","","17829","17829","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA II TYPING  1 LOC LR (120)","30900349","CDM","310","RC","81376","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA II TYPING  1 LOC LR (120)","30900349","CDM","310","RC","81376","HCPCS","facility","both","","","","1152","1152","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA II TYPING  1 LOC LR (120)","30900349","CDM","310","RC","81376","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA II TYPING  1 LOC HR (290)","30900350","CDM","310","RC","81382","HCPCS","facility","both","","","","777.1","777.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA II TYPING  1 LOC HR (290)","30900350","CDM","310","RC","81382","HCPCS","facility","both","","","","2787","2787","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA II TYPING  1 LOC HR (290)","30900350","CDM","310","RC","81382","HCPCS","facility","both","","","","607.1","607.1","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA CLASS I PHENOTYPE QUAL","30900351","CDM","302","RC","86830","HCPCS","facility","both","","","","644","644","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA CLASS I PHENOTYPE QUAL","30900351","CDM","302","RC","86830","HCPCS","facility","both","","","","293.09","293.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA CLASS I PHENOTYPE QUAL","30900351","CDM","302","RC","86830","HCPCS","facility","both","","","","375.15","375.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA CLASS II PHENOTYPE QUAL","30900352","CDM","302","RC","86831","HCPCS","facility","both","","","","293.09","293.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA CLASS II PHENOTYPE QUAL","30900352","CDM","302","RC","86831","HCPCS","facility","both","","","","846","846","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA CLASS II PHENOTYPE QUAL","30900352","CDM","302","RC","86831","HCPCS","facility","both","","","","375.15","375.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA I TYPING 1 LOCUS LR (55)","30900353","CDM","310","RC","81373","HCPCS","facility","both","","","","115.14","115.14","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA I TYPING 1 LOCUS LR (55)","30900353","CDM","310","RC","81373","HCPCS","facility","both","","","","918","918","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA I TYPING 1 LOCUS LR (55)","30900353","CDM","310","RC","81373","HCPCS","facility","both","","","","147.37","147.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA CLASS I&II ANTIBODY QUAL","30900354","CDM","302","RC","86828","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA CLASS I&II ANTIBODY QUAL","30900354","CDM","302","RC","86828","HCPCS","facility","both","","","","217","217","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA CLASS I&II ANTIBODY QUAL","30900354","CDM","302","RC","86828","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PMP22 GENE DUP/DELET (505)","30900355","CDM","310","RC","81324","HCPCS","facility","both","","","","525","525","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PMP22 GENE DUP/DELET (505)","30900355","CDM","310","RC","81324","HCPCS","facility","both","","","","1353.22","1353.22","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PMP22 GENE DUP/DELET (505)","30900355","CDM","310","RC","81324","HCPCS","facility","both","","","","1057.19","1057.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PMPP22 GENE DUP/DELET (850)","30900356","CDM","310","RC","81324","HCPCS","facility","both","","","","1779.42","1779.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PMPP22 GENE DUP/DELET (850)","30900356","CDM","310","RC","81324","HCPCS","facility","both","","","","2277.7","2277.7","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 2 (595)","30900357","CDM","310","RC","81401","HCPCS","facility","both","","","","1245.6","1245.6","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 2 (595)","30900357","CDM","310","RC","81401","HCPCS","facility","both","","","","1594.4","1594.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 5 (870)","30900358","CDM","310","RC","81404","HCPCS","facility","both","","","","2331.3","2331.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 5 (870)","30900358","CDM","310","RC","81404","HCPCS","facility","both","","","","1821.29","1821.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 5 (870)","30900358","CDM","310","RC","81404","HCPCS","facility","both","","","","740","740","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 5 (1580)","30900359","CDM","310","RC","81404","HCPCS","facility","both","","","","3440","3440","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 5 (1580)","30900359","CDM","310","RC","81404","HCPCS","facility","both","","","","4233.85","4233.85","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 5 (1580)","30900359","CDM","310","RC","81404","HCPCS","facility","both","","","","3307.63","3307.63","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 6 (3030)","30900360","CDM","310","RC","81405","HCPCS","facility","both","","","","6343.11","6343.11","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 6 (3030)","30900360","CDM","310","RC","81405","HCPCS","facility","both","","","","8119.34","8119.34","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 7  (870)","30900361","CDM","310","RC","81406","HCPCS","facility","both","","","","1821.29","1821.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 7  (870)","30900361","CDM","310","RC","81406","HCPCS","facility","both","","","","2331.3","2331.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASPA GENE (185)","30900362","CDM","310","RC","81200","HCPCS","facility","both","","","","495.74","495.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASPA GENE (185)","30900362","CDM","310","RC","81200","HCPCS","facility","both","","","","387.29","387.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GJB2 GENE FULL SEQ (220)","30900363","CDM","310","RC","81252","HCPCS","facility","both","","","","460.55","460.55","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GJB2 GENE FULL SEQ (220)","30900363","CDM","310","RC","81252","HCPCS","facility","both","","","","369","369","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GJB2 GENE FULL SEQ (220)","30900363","CDM","310","RC","81252","HCPCS","facility","both","","","","589.53","589.53","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GJB6 GENE COM VAR (1)","30900364","CDM","310","RC","81254","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GJB6 GENE COM VAR (1)","30900364","CDM","310","RC","81254","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DMD DUP/DELET ANALYSIS (1340)","30900365","CDM","310","RC","81161","HCPCS","facility","both","","","","8120","8120","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DMD DUP/DELET ANALYSIS (1340)","30900365","CDM","310","RC","81161","HCPCS","facility","both","","","","2805.21","2805.21","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DMD DUP/DELET ANALYSIS (1340)","30900365","CDM","310","RC","81161","HCPCS","facility","both","","","","3590.73","3590.73","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MO PATH PROCEDUR LEVEL 1  (320)","30900366","CDM","310","RC","81400","HCPCS","facility","both","","","","545","545","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MO PATH PROCEDUR LEVEL 1  (320)","30900366","CDM","310","RC","81400","HCPCS","facility","both","","","","857.5","857.5","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MO PATH PROCEDUR LEVEL 1  (320)","30900366","CDM","310","RC","81400","HCPCS","facility","both","","","","1939","1939","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MO PATH PROCEDUR LEVEL 1  (320)","30900366","CDM","310","RC","81400","HCPCS","facility","both","","","","669.9","669.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MO PATH PROCEDUR LEVEL 6  (320)","30900367","CDM","310","RC","81405","HCPCS","facility","both","","","","857.5","857.5","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MO PATH PROCEDUR LEVEL 6  (320)","30900367","CDM","310","RC","81405","HCPCS","facility","both","","","","1939","1939","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MO PATH PROCEDUR LEVEL 6  (320)","30900367","CDM","310","RC","81405","HCPCS","facility","both","","","","669.9","669.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MO PATH PROCEDUR LEVEL 6  (320)","30900367","CDM","310","RC","81405","HCPCS","facility","both","","","","950","950","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYS (560)","30900368","CDM","310","RC","81450","HCPCS","facility","both","","","","1500.61","1500.61","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYS (560)","30900368","CDM","310","RC","81450","HCPCS","facility","both","","","","1172.32","1172.32","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BCR/ABL1 GENE MINOR BP (235)","30900369","CDM","310","RC","81207","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BCR/ABL1 GENE MINOR BP (235)","30900369","CDM","310","RC","81207","HCPCS","facility","both","","","","558","558","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BCR/ABL1 GENE MINOR BP (235)","30900369","CDM","310","RC","81207","HCPCS","facility","both","","","","491.96","491.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BCR/ABL1 GENE MINOR BP (235)","30900369","CDM","310","RC","81207","HCPCS","facility","both","","","","629.72","629.72","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BCR/ABL1 GENE MINOR BP (235)","30900369","CDM","310","RC","81207","HCPCS","facility","both","","","","558","558","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOGEN M ARRAY COPY NO&SNP (1115)","30900370","CDM","310","RC","81229","HCPCS","facility","both","","","","1950","1950","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYTOGEN M ARRAY COPY NO&SNP (1115)","30900370","CDM","310","RC","81229","HCPCS","facility","both","","","","2987.81","2987.81","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOGEN M ARRAY COPY NO&SNP (1115)","30900370","CDM","310","RC","81229","HCPCS","facility","both","","","","2334.18","2334.18","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOGEN M ARRAY COPY NO&SNP (1115)","30900370","CDM","310","RC","81229","HCPCS","facility","both","","","","4502","4502","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BCR/ABL1 GENE MAJOR BP (280)","30900371","CDM","310","RC","81206","HCPCS","facility","both","","","","750.3","750.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BCR/ABL1 GENE MAJOR BP (280)","30900371","CDM","310","RC","81206","HCPCS","facility","both","","","","586.16","586.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BCR/ABL1 GENE MAJOR BP (280)","30900371","CDM","310","RC","81206","HCPCS","facility","both","","","","1132","1132","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BCR/ABL1 GENE MAJOR BP (320)","30900372","CDM","310","RC","81206","HCPCS","facility","both","","","","1292","1292","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BCR/ABL1 GENE MAJOR BP (320)","30900372","CDM","310","RC","81206","HCPCS","facility","both","","","","669.9","669.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BCR/ABL1 GENE MAJOR BP (320)","30900372","CDM","310","RC","81206","HCPCS","facility","both","","","","857.5","857.5","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BRAF GENE (205)","30900373","CDM","310","RC","81210","HCPCS","facility","both","","","","549.33","549.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BRAF GENE (205)","30900373","CDM","310","RC","81210","HCPCS","facility","both","","","","341","341","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BRAF GENE (205)","30900373","CDM","310","RC","81210","HCPCS","facility","both","","","","429.16","429.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BRAF GENE (205)","30900373","CDM","310","RC","81210","HCPCS","facility","both","","","","828","828","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CEBPA GENE FULL SEQUENCE (400)","30900374","CDM","310","RC","81218","HCPCS","facility","both","","","","1616","1616","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CEBPA GENE FULL SEQUENCE (400)","30900374","CDM","310","RC","81218","HCPCS","facility","both","","","","837.38","837.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CEBPA GENE FULL SEQUENCE (400)","30900374","CDM","310","RC","81218","HCPCS","facility","both","","","","659","659","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CEBPA GENE FULL SEQUENCE (400)","30900374","CDM","310","RC","81218","HCPCS","facility","both","","","","1071.86","1071.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC EGFR GENE COM VARIANTS (390)","30900375","CDM","310","RC","81235","HCPCS","facility","both","","","","816.44","816.44","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC EGFR GENE COM VARIANTS (390)","30900375","CDM","310","RC","81235","HCPCS","facility","both","","","","1576","1576","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EGFR GENE COM VARIANTS (390)","30900375","CDM","310","RC","81235","HCPCS","facility","both","","","","760","760","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC EGFR GENE COM VARIANTS (390)","30900375","CDM","310","RC","81235","HCPCS","facility","both","","","","1045.06","1045.06","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLT3 GENE (190)","30900376","CDM","310","RC","81245","HCPCS","facility","both","","","","769","769","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLT3 GENE (190)","30900376","CDM","310","RC","81245","HCPCS","facility","both","","","","397.75","397.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLT3 GENE (190)","30900376","CDM","310","RC","81245","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FLT3 GENE (190)","30900376","CDM","310","RC","81245","HCPCS","facility","both","","","","509.13","509.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IGH GENE REARRANGE AMP METH (180)","30900377","CDM","310","RC","81261","HCPCS","facility","both","","","","269","269","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IGH GENE REARRANGE AMP METH (180)","30900377","CDM","310","RC","81261","HCPCS","facility","both","","","","482.33","482.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IGH GENE REARRANGE AMP METH (180)","30900377","CDM","310","RC","81261","HCPCS","facility","both","","","","376.81","376.81","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IGH GENE REARRANGE AMP METH (180)","30900377","CDM","310","RC","81261","HCPCS","facility","both","","","","728","728","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STR MARKERS SPECIMEN ANAL (260)","30900378","CDM","310","RC","81265","HCPCS","facility","both","","","","1049","1049","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STR MARKERS SPECIMEN ANAL (260)","30900378","CDM","310","RC","81265","HCPCS","facility","both","","","","544.29","544.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STR MARKERS SPECIMEN ANAL (260)","30900378","CDM","310","RC","81265","HCPCS","facility","both","","","","440","440","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC STR MARKERS SPECIMEN ANAL (260)","30900378","CDM","310","RC","81265","HCPCS","facility","both","","","","696.71","696.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STR MARKERS SPECIMEN ANAL (320)","30900379","CDM","310","RC","81265","HCPCS","facility","both","","","","1292","1292","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STR MARKERS SPECIMEN ANAL (320)","30900379","CDM","310","RC","81265","HCPCS","facility","both","","","","857.5","857.5","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STR MARKERS SPECIMEN ANAL (320)","30900379","CDM","310","RC","81265","HCPCS","facility","both","","","","669.9","669.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STR MARKERS SPECIMEN ANAL (320)","30900379","CDM","310","RC","81265","HCPCS","facility","both","","","","604","604","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHIMERISM ANAL NO CELL SELEC (170)","30900380","CDM","310","RC","81267","HCPCS","facility","both","","","","355.88","355.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHIMERISM ANAL NO CELL SELEC (170)","30900380","CDM","310","RC","81267","HCPCS","facility","both","","","","687","687","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHIMERISM ANAL NO CELL SELEC (170)","30900380","CDM","310","RC","81267","HCPCS","facility","both","","","","455.54","455.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHIMERISM ANAL NO CELL SELEC (170)","30900380","CDM","310","RC","81267","HCPCS","facility","both","","","","281","281","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHIMERISM ANAL NO CELL SELEC (300)","30900381","CDM","310","RC","81267","HCPCS","facility","both","","","","803.9","803.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHIMERISM ANAL NO CELL SELEC (300)","30900381","CDM","310","RC","81267","HCPCS","facility","both","","","","628.03","628.03","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHIMERISM ANAL NO CELL SELEC (300)","30900381","CDM","310","RC","81267","HCPCS","facility","both","","","","1212","1212","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHIMERISM ANAL NO CELL SELEC (300)","30900381","CDM","310","RC","81267","HCPCS","facility","both","","","","498","498","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHIMERISM ANAL WI/CELL SELECT (245)","30900382","CDM","310","RC","81268","HCPCS","facility","both","","","","512.89","512.89","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHIMERISM ANAL WI/CELL SELECT (245)","30900382","CDM","310","RC","81268","HCPCS","facility","both","","","","909","909","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHIMERISM ANAL WI/CELL SELECT (245)","30900382","CDM","310","RC","81268","HCPCS","facility","both","","","","656.51","656.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHIMERISM ANAL WI/CELL SELECT (245)","30900382","CDM","310","RC","81268","HCPCS","facility","both","","","","401","401","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC KIT GENE TARGETED SEQ ANALYS (440)","30900383","CDM","310","RC","81272","HCPCS","facility","both","","","","921.12","921.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC KIT GENE TARGETED SEQ ANALYS (440)","30900383","CDM","310","RC","81272","HCPCS","facility","both","","","","642","642","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC KIT GENE TARGETED SEQ ANALYS (440)","30900383","CDM","310","RC","81272","HCPCS","facility","both","","","","1179.04","1179.04","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KIT GENE TARGETED SEQ ANALYS (440)","30900383","CDM","310","RC","81272","HCPCS","facility","both","","","","1778","1778","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MICROSATELLITE INSTABILITY (275)","30900384","CDM","310","RC","81301","HCPCS","facility","both","","","","1112","1112","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MICROSATELLITE INSTABILITY (275)","30900384","CDM","310","RC","81301","HCPCS","facility","both","","","","300","300","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MICROSATELLITE INSTABILITY (275)","30900384","CDM","310","RC","81301","HCPCS","facility","both","","","","736.9","736.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MICROSATELLITE INSTABILITY (275)","30900384","CDM","310","RC","81301","HCPCS","facility","both","","","","575.7","575.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NPM1 GENE (400)","30900385","CDM","310","RC","81310","HCPCS","facility","both","","","","1071.86","1071.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NPM1 GENE (400)","30900385","CDM","310","RC","81310","HCPCS","facility","both","","","","837.38","837.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NPM1 GENE (400)","30900385","CDM","310","RC","81310","HCPCS","facility","both","","","","648","648","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC NPM1 GENE (400)","30900385","CDM","310","RC","81310","HCPCS","facility","both","","","","1616","1616","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NRAS GENE VARIANTS EXON 2&3 (475)","30900386","CDM","310","RC","81311","HCPCS","facility","both","","","","1920","1920","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NRAS GENE VARIANTS EXON 2&3 (475)","30900386","CDM","310","RC","81311","HCPCS","facility","both","","","","1272.84","1272.84","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NRAS GENE VARIANTS EXON 2&3 (475)","30900386","CDM","310","RC","81311","HCPCS","facility","both","","","","994.38","994.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PML/RARALPHA COM  BREAKPOINTS (320)","30900387","CDM","310","RC","81315","HCPCS","facility","both","","","","857.5","857.5","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PML/RARALPHA COM  BREAKPOINTS (320)","30900387","CDM","310","RC","81315","HCPCS","facility","both","","","","1252","1252","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PML/RARALPHA COM  BREAKPOINTS (320)","30900387","CDM","310","RC","81315","HCPCS","facility","both","","","","530","530","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PML/RARALPHA COM  BREAKPOINTS (320)","30900387","CDM","310","RC","81315","HCPCS","facility","both","","","","669.9","669.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TRG GENE REARRANGEMENT ANAL (230)","30900388","CDM","310","RC","81342","HCPCS","facility","both","","","","481.49","481.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TRG GENE REARRANGEMENT ANAL (230)","30900388","CDM","310","RC","81342","HCPCS","facility","both","","","","616.32","616.32","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRG GENE REARRANGEMENT ANAL (230)","30900388","CDM","310","RC","81342","HCPCS","facility","both","","","","929","929","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRG GENE REARRANGEMENT ANAL (230)","30900388","CDM","310","RC","81342","HCPCS","facility","both","","","","382","382","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 2 (105)","30900389","CDM","310","RC","81401","HCPCS","facility","both","","","","281.36","281.36","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 2 (105)","30900389","CDM","310","RC","81401","HCPCS","facility","both","","","","219.81","219.81","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 2 (105)","30900389","CDM","310","RC","81401","HCPCS","facility","both","","","","424","424","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 4 (230)","30900390","CDM","310","RC","81403","HCPCS","facility","both","","","","929","929","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 4 (230)","30900390","CDM","310","RC","81403","HCPCS","facility","both","","","","481.49","481.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 4 (230)","30900390","CDM","310","RC","81403","HCPCS","facility","both","","","","616.32","616.32","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 7 (350)","30900391","CDM","310","RC","81406","HCPCS","facility","both","","","","732.7","732.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 7 (350)","30900391","CDM","310","RC","81406","HCPCS","facility","both","","","","1413","1413","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 7 (350)","30900391","CDM","310","RC","81406","HCPCS","facility","both","","","","937.88","937.88","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYS (480)","30900392","CDM","310","RC","81445","HCPCS","facility","both","","","","1004.85","1004.85","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYS (480)","30900392","CDM","310","RC","81445","HCPCS","facility","both","","","","1939","1939","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYS (480)","30900392","CDM","310","RC","81445","HCPCS","facility","both","","","","1286.23","1286.23","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYS (530)","30900393","CDM","310","RC","81445","HCPCS","facility","both","","","","2141","2141","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYS (530)","30900393","CDM","310","RC","81445","HCPCS","facility","both","","","","1109.52","1109.52","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYS (530)","30900393","CDM","310","RC","81445","HCPCS","facility","both","","","","1420.21","1420.21","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CAR ION CHNNLPATH INC 10 GNS ADDON","30900394","CDM","310","RC","81413","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CAR ION CHNNLPATH INC 10 GNS ADDON","30900394","CDM","310","RC","81413","HCPCS","facility","both","","","","3085","3085","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CAR ION CHNNLPATH INC 10 GNS ADDON","30900394","CDM","310","RC","81413","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CAR ION CHNNLPATH INC 10 GNS ADDON","30900394","CDM","310","RC","81413","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CAR ION CHNNLPATH INC 2 GN (2675)","30900395","CDM","310","RC","81414","HCPCS","facility","both","","","","7168.07","7168.07","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CAR ION CHNNLPATH INC 2 GN (2675)","30900395","CDM","310","RC","81414","HCPCS","facility","both","","","","5599.94","5599.94","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLT3 GENE (100)","30900396","CDM","310","RC","81245","HCPCS","facility","both","","","","178.75","178.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FLT3 GENE (100)","30900396","CDM","310","RC","81245","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLT3 GENE (100)","30900396","CDM","310","RC","81245","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLT3 GENE (100)","30900396","CDM","310","RC","81245","HCPCS","facility","both","","","","676","676","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLT3 GENE ANALSYS (455)","30900397","CDM","310","RC","81246","HCPCS","facility","both","","","","793.75","793.75","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FLT3 GENE ANALSYS (455)","30900397","CDM","310","RC","81246","HCPCS","facility","both","","","","1838","1838","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLT3 GENE ANALSYS (455)","30900397","CDM","310","RC","81246","HCPCS","facility","both","","","","1219.24","1219.24","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLT3 GENE ANALSYS (455)","30900397","CDM","310","RC","81246","HCPCS","facility","both","","","","952.51","952.51","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA I & II TYPING LR (320)","30900398","CDM","310","RC","81370","HCPCS","facility","both","","","","857.5","857.5","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA I & II TYPING LR (320)","30900398","CDM","310","RC","81370","HCPCS","facility","both","","","","669.9","669.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA CLASS I HIGH DEFIN QUAL","30900399","CDM","302","RC","86832","HCPCS","facility","both","","","","293.09","293.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA CLASS I HIGH DEFIN QUAL","30900399","CDM","302","RC","86832","HCPCS","facility","both","","","","734","734","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA CLASS I HIGH DEFIN QUAL","30900399","CDM","302","RC","86832","HCPCS","facility","both","","","","375.15","375.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA CLAS II HIGH DEFIN QUAL","30900400","CDM","302","RC","86833","HCPCS","facility","both","","","","293.09","293.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA CLAS II HIGH DEFIN QUAL","30900400","CDM","302","RC","86833","HCPCS","facility","both","","","","702","702","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HLA CLAS II HIGH DEFIN QUAL","30900400","CDM","302","RC","86833","HCPCS","facility","both","","","","375.15","375.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA I & II TYPING HR (580)","30900401","CDM","310","RC","81378","HCPCS","facility","both","","","","1214.19","1214.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA I & II TYPING HR (580)","30900401","CDM","310","RC","81378","HCPCS","facility","both","","","","1554.2","1554.2","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA X-MATCH NON-CYT ADD-ON","30900402","CDM","310","RC","86826","HCPCS","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA X-MATCH NON-CYT ADD-ON","30900402","CDM","310","RC","86826","HCPCS","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA I TYPING 1 LOCUS HR (165)","30900403","CDM","310","RC","81380","HCPCS","facility","both","","","","345.42","345.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA I TYPING 1 LOCUS HR (165)","30900403","CDM","310","RC","81380","HCPCS","facility","both","","","","442.14","442.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA I & II TYPE VERIFY LR (150)","30900404","CDM","310","RC","81371","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HLA I & II TYPE VERIFY LR (150)","30900404","CDM","310","RC","81371","HCPCS","facility","both","","","","1262","1262","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HLA I & II TYPE VERIFY LR (150)","30900404","CDM","310","RC","81371","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA TYPING 1 LOCUS LR (120)","30900405","CDM","310","RC","81373","HCPCS","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HLA TYPING 1 LOCUS LR (120)","30900405","CDM","310","RC","81373","HCPCS","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 7 (505)","30900406","CDM","310","RC","81406","HCPCS","facility","both","","","","824","824","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 7 (505)","30900406","CDM","310","RC","81406","HCPCS","facility","both","","","","1353.22","1353.22","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 7 (505)","30900406","CDM","310","RC","81406","HCPCS","facility","both","","","","1057.19","1057.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH PROC (1270)","30900407","CDM","310","RC","81479","HCPCS","facility","both","","","","2658.66","2658.66","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH PROC (1270)","30900407","CDM","310","RC","81479","HCPCS","facility","both","","","","3403.17","3403.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH PROC (1270)","30900407","CDM","310","RC","81479","HCPCS","facility","both","","","","2145","2145","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC EXOME SEQUENCE ANAL (2800)","30900408","CDM","310","RC","81415","HCPCS","facility","both","","","","4900","4900","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC EXOME SEQUENCE ANAL (2800)","30900408","CDM","310","RC","81415","HCPCS","facility","both","","","","7503.03","7503.03","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC EXOME SEQUENCE ANAL (2800)","30900408","CDM","310","RC","81415","HCPCS","facility","both","","","","5861.63","5861.63","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPARATOR EXOME (375)","30900409","CDM","310","RC","81416","HCPCS","facility","both","","","","785.04","785.04","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPARATOR EXOME (375)","30900409","CDM","310","RC","81416","HCPCS","facility","both","","","","600","600","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPARATOR EXOME (375)","30900409","CDM","310","RC","81416","HCPCS","facility","both","","","","17828","17828","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPARATOR EXOME (375)","30900409","CDM","310","RC","81416","HCPCS","facility","both","","","","1004.87","1004.87","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOLE PROC (900)","30900410","CDM","310","RC","81479","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED MOLE PROC (900)","30900410","CDM","310","RC","81479","HCPCS","facility","both","","","","1884.09","1884.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOLE PROC (900)","30900410","CDM","310","RC","81479","HCPCS","facility","both","","","","2411.69","2411.69","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOLE PROC (900)","30900410","CDM","310","RC","81479","HCPCS","facility","both","","","","1640","1640","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOLE PROC (305)","30900411","CDM","310","RC","81479","HCPCS","facility","both","","","","638.5","638.5","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOLE PROC (305)","30900411","CDM","310","RC","81479","HCPCS","facility","both","","","","817.29","817.29","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CFTR GENE FULL SEQUENCE (1460)","30900412","CDM","310","RC","81223","HCPCS","facility","both","","","","3912.3","3912.3","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CFTR GENE FULL SEQUENCE (1460)","30900412","CDM","310","RC","81223","HCPCS","facility","both","","","","3056.42","3056.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOLE PROC (275)","30900413","CDM","310","RC","81479","HCPCS","facility","both","","","","736.9","736.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOLE PROC (275)","30900413","CDM","310","RC","81479","HCPCS","facility","both","","","","575.7","575.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 9 (1630)","30900414","CDM","310","RC","81408","HCPCS","facility","both","","","","4367.83","4367.83","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 9 (1630)","30900414","CDM","310","RC","81408","HCPCS","facility","both","","","","3412.3","3412.3","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOLE PROC (555)","30900415","CDM","310","RC","81479","HCPCS","facility","both","","","","1161.86","1161.86","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOLE PROC (555)","30900415","CDM","310","RC","81479","HCPCS","facility","both","","","","1487.2","1487.2","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOLE PROC (270)","30900416","CDM","310","RC","81479","HCPCS","facility","both","","","","723.51","723.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOLE PROC (270)","30900416","CDM","310","RC","81479","HCPCS","facility","both","","","","565.23","565.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RBC DNA HEA 35 AG 11 BLD GRP","30900417","CDM","310","RC","","","facility","both","","","","701.3","701.3","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RBC DNA HEA 35 AG 11 BLD GRP","30900417","CDM","310","RC","","","facility","both","","","","658","658","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC DNA HEA 35 AG 11 BLD GRP","30900417","CDM","310","RC","","","facility","both","","","","897.69","897.69","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 4 (270)","30900418","CDM","310","RC","81403","HCPCS","facility","both","","","","565.23","565.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 4 (270)","30900418","CDM","310","RC","81403","HCPCS","facility","both","","","","723.51","723.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (340)","30900419","CDM","310","RC","81404","HCPCS","facility","both","","","","711.77","711.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (340)","30900419","CDM","310","RC","81404","HCPCS","facility","both","","","","911.08","911.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (415)","30900420","CDM","310","RC","81404","HCPCS","facility","both","","","","868.77","868.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 5 (415)","30900420","CDM","310","RC","81404","HCPCS","facility","both","","","","1112.06","1112.06","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (565)","30900421","CDM","310","RC","81479","HCPCS","facility","both","","","","1514","1514","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (565)","30900421","CDM","310","RC","81479","HCPCS","facility","both","","","","1182.79","1182.79","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (190)","30900422","CDM","310","RC","81479","HCPCS","facility","both","","","","397.75","397.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (190)","30900422","CDM","310","RC","81479","HCPCS","facility","both","","","","509.13","509.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (415)","30900423","CDM","310","RC","81479","HCPCS","facility","both","","","","868.77","868.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (415)","30900423","CDM","310","RC","81479","HCPCS","facility","both","","","","1112.06","1112.06","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (265)","30900424","CDM","310","RC","81404","HCPCS","facility","both","","","","710.1","710.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 5 (265)","30900424","CDM","310","RC","81404","HCPCS","facility","both","","","","554.76","554.76","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 6 (590)","30900425","CDM","310","RC","81405","HCPCS","facility","both","","","","1581","1581","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 6 (590)","30900425","CDM","310","RC","81405","HCPCS","facility","both","","","","1235.13","1235.13","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (625)","30900426","CDM","310","RC","81479","HCPCS","facility","both","","","","1308.4","1308.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (625)","30900426","CDM","310","RC","81479","HCPCS","facility","both","","","","1674.79","1674.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (80)","30900427","CDM","310","RC","81479","HCPCS","facility","both","","","","214.37","214.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (80)","30900427","CDM","310","RC","81479","HCPCS","facility","both","","","","167.48","167.48","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (75)","30900428","CDM","310","RC","81479","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (75)","30900428","CDM","310","RC","81479","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOL PATH (490)","30900429","CDM","310","RC","81479","HCPCS","facility","both","","","","1025.79","1025.79","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (490)","30900429","CDM","310","RC","81479","HCPCS","facility","both","","","","1313.03","1313.03","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS","30900430","CDM","310","RC","81445","HCPCS","facility","both","","","","881","881","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS","30900430","CDM","310","RC","81445","HCPCS","facility","both","","","","1031.67","1031.67","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS","30900430","CDM","310","RC","81445","HCPCS","facility","both","","","","805.97","805.97","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS","30900430","CDM","310","RC","81445","HCPCS","facility","both","","","","2306","2306","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALR GENE COM VARIANTS (240)","30900431","CDM","310","RC","81219","HCPCS","facility","both","","","","1453","1453","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CALR GENE COM VARIANTS (240)","30900431","CDM","310","RC","81219","HCPCS","facility","both","","","","502.42","502.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CALR GENE COM VARIANTS (240)","30900431","CDM","310","RC","81219","HCPCS","facility","both","","","","1453","1453","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALR GENE COM VARIANTS (240)","30900431","CDM","310","RC","81219","HCPCS","facility","both","","","","643.12","643.12","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MTHFR GENE (85)","30900432","CDM","310","RC","81291","HCPCS","facility","both","","","","508","508","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MTHFR GENE (85)","30900432","CDM","310","RC","81291","HCPCS","facility","both","","","","227.77","227.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MTHFR GENE (85)","30900432","CDM","310","RC","81291","HCPCS","facility","both","","","","508","508","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MTHFR GENE (85)","30900432","CDM","310","RC","81291","HCPCS","facility","both","","","","177.94","177.94","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS (795)","30900433","CDM","310","RC","81450","HCPCS","facility","both","","","","2130.33","2130.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS (795)","30900433","CDM","310","RC","81450","HCPCS","facility","both","","","","1355","1355","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (795)","30900433","CDM","310","RC","81450","HCPCS","facility","both","","","","3055","3055","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (795)","30900433","CDM","310","RC","81450","HCPCS","facility","both","","","","3055","3055","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (795)","30900433","CDM","310","RC","81450","HCPCS","facility","both","","","","1664.28","1664.28","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS 51+ (795)","30900434","CDM","310","RC","81455","HCPCS","facility","both","","","","4049","4049","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS 51+ (795)","30900434","CDM","310","RC","81455","HCPCS","facility","both","","","","1355","1355","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS 51+ (795)","30900434","CDM","310","RC","81455","HCPCS","facility","both","","","","1664.28","1664.28","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS 51+ (795)","30900434","CDM","310","RC","81455","HCPCS","facility","both","","","","4049","4049","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS 51+ (795)","30900434","CDM","310","RC","81455","HCPCS","facility","both","","","","2130.33","2130.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 1 (265)","30900435","CDM","310","RC","81400","HCPCS","facility","both","","","","710.1","710.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 1 (265)","30900435","CDM","310","RC","81400","HCPCS","facility","both","","","","554.76","554.76","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CFTR GENE COM VARIANTS (70)","30900436","CDM","310","RC","81220","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CFTR GENE COM VARIANTS (70)","30900436","CDM","310","RC","81220","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CFTR GENE COM VARIANTS (70)","30900436","CDM","310","RC","81220","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CFTR GENE COM VARIANTS (70)","30900436","CDM","310","RC","81220","HCPCS","facility","both","","","","772","772","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CFTR GENE COM VARIANTS (70)","30900436","CDM","310","RC","81220","HCPCS","facility","both","","","","772","772","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ABL1  GENE (200)","30900439","CDM","310","RC","81170","HCPCS","facility","both","","","","535.93","535.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ABL1  GENE (200)","30900439","CDM","310","RC","81170","HCPCS","facility","both","","","","1276","1276","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABL1  GENE (200)","30900439","CDM","310","RC","81170","HCPCS","facility","both","","","","418.68","418.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ABL1  GENE (200)","30900439","CDM","310","RC","81170","HCPCS","facility","both","","","","340","340","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GJB2 GENE FULL SEQUENCE (470)","30900440","CDM","310","RC","81252","HCPCS","facility","both","","","","2863","2863","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GJB2 GENE FULL SEQUENCE (470)","30900440","CDM","310","RC","81252","HCPCS","facility","both","","","","983.92","983.92","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GJB2 GENE FULL SEQUENCE (470)","30900440","CDM","310","RC","81252","HCPCS","facility","both","","","","1259.44","1259.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENE TARGETED SEQUENCE ANALYSIS  (160)","30900441","CDM","310","RC","81272","HCPCS","facility","both","","","","272.36","272.36","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GENE TARGETED SEQUENCE ANALYSIS  (160)","30900441","CDM","310","RC","81272","HCPCS","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENE TARGETED SEQUENCE ANALYSIS  (160)","30900441","CDM","310","RC","81272","HCPCS","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GENE TARGETED SEQUENCE ANALYSIS  (160)","30900441","CDM","310","RC","81272","HCPCS","facility","both","","","","1276","1276","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 2 (555)","30900442","CDM","310","RC","81401","HCPCS","facility","both","","","","1487.2","1487.2","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 2 (555)","30900442","CDM","310","RC","81401","HCPCS","facility","both","","","","1161.86","1161.86","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 2 (555)","30900442","CDM","310","RC","81401","HCPCS","facility","both","","","","902","902","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 2 (555)","30900442","CDM","310","RC","81401","HCPCS","facility","both","","","","3389","3389","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IDH1  COMMON VARIANTS (230)","30900443","CDM","310","RC","81120","HCPCS","facility","both","","","","929","929","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IDH1  COMMON VARIANTS (230)","30900443","CDM","310","RC","81120","HCPCS","facility","both","","","","616.32","616.32","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IDH1  COMMON VARIANTS (230)","30900443","CDM","310","RC","81120","HCPCS","facility","both","","","","360","360","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IDH1  COMMON VARIANTS (230)","30900443","CDM","310","RC","81120","HCPCS","facility","both","","","","481.49","481.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IDH2  COMMON VARIANTS (230)","30900444","CDM","310","RC","81121","HCPCS","facility","both","","","","929","929","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IDH2  COMMON VARIANTS (230)","30900444","CDM","310","RC","81121","HCPCS","facility","both","","","","360","360","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IDH2  COMMON VARIANTS (230)","30900444","CDM","310","RC","81121","HCPCS","facility","both","","","","481.49","481.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IDH2  COMMON VARIANTS (230)","30900444","CDM","310","RC","81121","HCPCS","facility","both","","","","616.32","616.32","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IFNL3 GENE (70)","30900445","CDM","310","RC","81283","HCPCS","facility","both","","","","654","654","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IFNL3 GENE (70)","30900445","CDM","310","RC","81283","HCPCS","facility","both","","","","128","128","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IFNL3 GENE (70)","30900445","CDM","310","RC","81283","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IFNL3 GENE (70)","30900445","CDM","310","RC","81283","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TPMT  GENE COM VARIANTS","30900446","CDM","310","RC","81335","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TPMT  GENE COM VARIANTS","30900446","CDM","310","RC","81335","HCPCS","facility","both","","","","699","699","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TPMT  GENE COM VARIANTS","30900446","CDM","310","RC","81335","HCPCS","facility","both","","","","240.74","240.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TPMT  GENE COM VARIANTS","30900446","CDM","310","RC","81335","HCPCS","facility","both","","","","308.16","308.16","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HPA-1  GENOTYPING (35)","30900447","CDM","310","RC","81105","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HPA-1  GENOTYPING (35)","30900447","CDM","310","RC","81105","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HPA-2  GENOTYPING (35)","30900448","CDM","310","RC","81106","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HPA-2  GENOTYPING (35)","30900448","CDM","310","RC","81106","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HPA-3  GENOTYPING (35)","30900449","CDM","310","RC","81107","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HPA-3  GENOTYPING (35)","30900449","CDM","310","RC","81107","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HPA-4  GENOTYPING (35)","30900450","CDM","310","RC","81108","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HPA-4  GENOTYPING (35)","30900450","CDM","310","RC","81108","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HPA-5  GENOTYPING (35)","30900451","CDM","310","RC","81109","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HPA-5  GENOTYPING (35)","30900451","CDM","310","RC","81109","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HPA-6  GENOTYPING (35)","30900452","CDM","310","RC","81110","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HPA-6  GENOTYPING (35)","30900452","CDM","310","RC","81110","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HPA-9  GENOTYPING (35)","30900453","CDM","310","RC","81111","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HPA-9  GENOTYPING (35)","30900453","CDM","310","RC","81111","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HPA-15  GENOTYPING (35)","30900454","CDM","310","RC","81112","HCPCS","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HPA-15  GENOTYPING (35)","30900454","CDM","310","RC","81112","HCPCS","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (260)","30900455","CDM","310","RC","81401","HCPCS","facility","both","","","","696.71","696.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDUR LEVEL 2 (260)","30900455","CDM","310","RC","81401","HCPCS","facility","both","","","","432","432","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDUR LEVEL 2 (260)","30900455","CDM","310","RC","81401","HCPCS","facility","both","","","","544.29","544.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDUR LEVEL 2 (260)","30900455","CDM","310","RC","81401","HCPCS","facility","both","","","","1561","1561","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED MOL PATH (545)","30900456","CDM","310","RC","81479","HCPCS","facility","both","","","","1140.92","1140.92","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOL PATH (545)","30900456","CDM","310","RC","81479","HCPCS","facility","both","","","","1460.41","1460.41","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC F2 GENE (40)","30900457","CDM","310","RC","81240","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC F2 GENE (40)","30900457","CDM","310","RC","81240","HCPCS","facility","both","","","","90.5","90.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC F2 GENE (40)","30900457","CDM","310","RC","81240","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC F2 GENE (40)","30900457","CDM","310","RC","81240","HCPCS","facility","both","","","","251","251","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC F5 GENE (40)","30900458","CDM","310","RC","81241","HCPCS","facility","both","","","","291","291","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC F5 GENE (40)","30900458","CDM","310","RC","81241","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC F5 GENE (40)","30900458","CDM","310","RC","81241","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC F5 GENE (40)","30900458","CDM","310","RC","81241","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 2 (210)","30900459","CDM","310","RC","81401","HCPCS","facility","both","","","","439.62","439.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 2 (210)","30900459","CDM","310","RC","81401","HCPCS","facility","both","","","","395.95","395.95","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 2 (210)","30900459","CDM","310","RC","81401","HCPCS","facility","both","","","","1445","1445","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 2 (210)","30900459","CDM","310","RC","81401","HCPCS","facility","both","","","","562.73","562.73","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 7 (1490)","30900460","CDM","310","RC","81406","HCPCS","facility","both","","","","3119.23","3119.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 7 (1490)","30900460","CDM","310","RC","81406","HCPCS","facility","both","","","","3992.69","3992.69","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 7 (1490)","30900460","CDM","310","RC","81406","HCPCS","facility","both","","","","2870","2870","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 7 (1490)","30900460","CDM","310","RC","81406","HCPCS","facility","both","","","","10431","10431","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MECP2 GENE FULL SEQ (340)","30900461","CDM","310","RC","81302","HCPCS","facility","both","","","","2233","2233","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MECP2 GENE FULL SEQ (340)","30900461","CDM","310","RC","81302","HCPCS","facility","both","","","","631","631","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MECP2 GENE FULL SEQ (340)","30900461","CDM","310","RC","81302","HCPCS","facility","both","","","","911.08","911.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MECP2 GENE FULL SEQ (340)","30900461","CDM","310","RC","81302","HCPCS","facility","both","","","","711.77","711.77","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASHKENAZI JEWISH ASSOC DIS (730)","30900462","CDM","310","RC","81412","HCPCS","facility","both","","","","1956.14","1956.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ASHKENAZI JEWISH ASSOC DIS (730)","30900462","CDM","310","RC","81412","HCPCS","facility","both","","","","1528.21","1528.21","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ASHKENAZI JEWISH ASSOC DIS (730)","30900462","CDM","310","RC","81412","HCPCS","facility","both","","","","8960","8960","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASHKENAZI JEWISH ASSOC DIS (730)","30900462","CDM","310","RC","81412","HCPCS","facility","both","","","","537","537","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC BCR/ABL1 GENE MAJOR BP QUAN","30900463","CDM","310","RC","","","facility","both","","","","840","840","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BCR/ABL1 GENE MAJOR BP QUAN","30900463","CDM","310","RC","","","facility","both","","","","575.7","575.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BCR/ABL1 GENE MAJOR BP QUAN","30900463","CDM","310","RC","","","facility","both","","","","736.9","736.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HTT GENE DETC ABNOR ALLELES (225)","30900464","CDM","310","RC","81271","HCPCS","facility","both","","","","471.02","471.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HTT GENE DETC ABNOR ALLELES (225)","30900464","CDM","310","RC","81271","HCPCS","facility","both","","","","602.93","602.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TERT GENE TARGETED SEQ ALYS (2230)","30900465","CDM","310","RC","81345","HCPCS","facility","both","","","","4668.36","4668.36","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TERT GENE TARGETED SEQ ALYS (2230)","30900465","CDM","310","RC","81345","HCPCS","facility","both","","","","5975.63","5975.63","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KRAS GENE (210)","30900466","CDM","310","RC","81275","HCPCS","facility","both","","","","439.62","439.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC KRAS GENE (210)","30900466","CDM","310","RC","81275","HCPCS","facility","both","","","","419","419","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC KRAS GENE (210)","30900466","CDM","310","RC","81275","HCPCS","facility","both","","","","562.73","562.73","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC KRAS GENE VAR (250)","30900467","CDM","310","RC","81276","HCPCS","facility","both","","","","523.36","523.36","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC KRAS GENE VAR (250)","30900467","CDM","310","RC","81276","HCPCS","facility","both","","","","669.91","669.91","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MGMT GENE PMTR MTHYLTN ALYS (355)","30900468","CDM","310","RC","81287","HCPCS","facility","both","","","","951.27","951.27","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MGMT GENE PMTR MTHYLTN ALYS (355)","30900468","CDM","310","RC","81287","HCPCS","facility","both","","","","652","652","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MGMT GENE PMTR MTHYLTN ALYS (355)","30900468","CDM","310","RC","81287","HCPCS","facility","both","","","","658","658","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MGMT GENE PMTR MTHYLTN ALYS (355)","30900468","CDM","310","RC","81287","HCPCS","facility","both","","","","743.17","743.17","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOGENOMIC NEO MICRORA ALYS (350)","30900469","CDM","310","RC","81277","HCPCS","facility","both","","","","1609","1609","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOGENOMIC NEO MICRORA ALYS (350)","30900469","CDM","310","RC","81277","HCPCS","facility","both","","","","732.7","732.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOGENOMIC NEO MICRORA ALYS (350)","30900469","CDM","310","RC","81277","HCPCS","facility","both","","","","548","548","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYTOGENOMIC NEO MICRORA ALYS (350)","30900469","CDM","310","RC","81277","HCPCS","facility","both","","","","937.88","937.88","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 7 (966)","30900470","CDM","310","RC","81406","HCPCS","facility","both","","","","2022.26","2022.26","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 7 (966)","30900470","CDM","310","RC","81406","HCPCS","facility","both","","","","1760","1760","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 7 (966)","30900470","CDM","310","RC","81406","HCPCS","facility","both","","","","2588.55","2588.55","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 7 (966)","30900470","CDM","310","RC","81406","HCPCS","facility","both","","","","985","985","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (1426)","30900471","CDM","310","RC","81455","HCPCS","facility","both","","","","3821.18","3821.18","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS (1426)","30900471","CDM","310","RC","81455","HCPCS","facility","both","","","","2985.24","2985.24","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS (1426)","30900471","CDM","310","RC","81455","HCPCS","facility","both","","","","7631","7631","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOGEN M ARRAY COPY NO & SNP (417)","30900472","CDM","310","RC","81229","HCPCS","facility","both","","","","2091","2091","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOGEN M ARRAY COPY NO & SNP (417)","30900472","CDM","310","RC","81229","HCPCS","facility","both","","","","872.96","872.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOGEN M ARRAY COPY NO & SNP (417)","30900472","CDM","310","RC","81229","HCPCS","facility","both","","","","1117.42","1117.42","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS (202)","30900473","CDM","310","RC","81455","HCPCS","facility","both","","","","541.29","541.29","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS (202)","30900473","CDM","310","RC","81455","HCPCS","facility","both","","","","7843","7843","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (202)","30900473","CDM","310","RC","81455","HCPCS","facility","both","","","","385","385","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (202)","30900473","CDM","310","RC","81455","HCPCS","facility","both","","","","422.87","422.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS (328)","30900474","CDM","310","RC","81455","HCPCS","facility","both","","","","686.65","686.65","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS (328)","30900474","CDM","310","RC","81455","HCPCS","facility","both","","","","585","585","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (328)","30900474","CDM","310","RC","81455","HCPCS","facility","both","","","","7843","7843","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (328)","30900474","CDM","310","RC","81455","HCPCS","facility","both","","","","878.92","878.92","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS (467)","30900475","CDM","310","RC","81455","HCPCS","facility","both","","","","1251.39","1251.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS (467)","30900475","CDM","310","RC","81455","HCPCS","facility","both","","","","785","785","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (467)","30900475","CDM","310","RC","81455","HCPCS","facility","both","","","","977.64","977.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS (467)","30900475","CDM","310","RC","81455","HCPCS","facility","both","","","","7843","7843","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IGK GENE PART OF PANEL (154)","30900476","CDM","310","RC","81264","HCPCS","facility","both","","","","558","558","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IGK GENE PART OF PANEL (154)","30900476","CDM","310","RC","81264","HCPCS","facility","both","","","","322.39","322.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IGK GENE PART OF PANEL (154)","30900476","CDM","310","RC","81264","HCPCS","facility","both","","","","412.67","412.67","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOLECULAR PATHOLOGY (1357)","30900477","CDM","310","RC","81479","HCPCS","facility","both","","","","2580","2580","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC UNLISTED MOLECULAR PATHOLOGY (1357)","30900477","CDM","310","RC","81479","HCPCS","facility","both","","","","2840.79","2840.79","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOLECULAR PATHOLOGY (1357)","30900477","CDM","310","RC","81479","HCPCS","facility","both","","","","3636.29","3636.29","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 4 (108)","30900478","CDM","310","RC","81403","HCPCS","facility","both","","","","226.09","226.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 4 (108)","30900478","CDM","310","RC","81403","HCPCS","facility","both","","","","289.41","289.41","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS (170)","30900479","CDM","310","RC","81455","HCPCS","facility","both","","","","5304","5304","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (170)","30900479","CDM","310","RC","81455","HCPCS","facility","both","","","","455.54","455.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS (170)","30900479","CDM","310","RC","81455","HCPCS","facility","both","","","","340","340","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (170)","30900479","CDM","310","RC","81455","HCPCS","facility","both","","","","355.88","355.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROC LEVEL 8 (608)","30900480","CDM","310","RC","81407","HCPCS","facility","both","","","","4233","4233","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROC LEVEL 8 (608)","30900480","CDM","310","RC","81407","HCPCS","facility","both","","","","1629.23","1629.23","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROC LEVEL 8 (608)","30900480","CDM","310","RC","81407","HCPCS","facility","both","","","","1272.81","1272.81","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROC LEVEL 9 (778)","30900481","CDM","310","RC","81408","HCPCS","facility","both","","","","2084.77","2084.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROC LEVEL 9 (778)","30900481","CDM","310","RC","81408","HCPCS","facility","both","","","","7851","7851","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROC LEVEL 9 (778)","30900481","CDM","310","RC","81408","HCPCS","facility","both","","","","1628.7","1628.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC STR MARKERS SPECIMEN ANAL (109)","30900482","CDM","310","RC","81265","HCPCS","facility","both","","","","292.08","292.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC STR MARKERS SPECIMEN ANAL (109)","30900482","CDM","310","RC","81265","HCPCS","facility","both","","","","228.19","228.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS (342)","30900483","CDM","310","RC","81445","HCPCS","facility","both","","","","715.96","715.96","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS (342)","30900483","CDM","310","RC","81445","HCPCS","facility","both","","","","916.44","916.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS (342)","30900483","CDM","310","RC","81445","HCPCS","facility","both","","","","2377","2377","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IADNA CNS PTHGN NEXT GEN SEQ(780)","30900484","CDM","310","RC","","","facility","both","","","","3083","3083","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IADNA CNS PTHGN NEXT GEN SEQ(780)","30900484","CDM","310","RC","","","facility","both","","","","1632.88","1632.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IADNA CNS PTHGN NEXT GEN SEQ(780)","30900484","CDM","310","RC","","","facility","both","","","","2090.13","2090.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"DEAC 12/31/2023 HC LIVER DISEASE ALYS 3 BMRK SRM ALG (171)","30900485","CDM","309","RC","","","facility","both","","","","530","530","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 12/31/2023 HC LIVER DISEASE ALYS 3 BMRK SRM ALG (171)","30900485","CDM","309","RC","","","facility","both","","","","357.97","357.97","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 12/31/2023 HC LIVER DISEASE ALYS 3 BMRK SRM ALG (171)","30900485","CDM","309","RC","","","facility","both","","","","458.22","458.22","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOPATH FL NONGYN SMEARS","31000001","CDM","311","RC","88104","HCPCS","facility","both","","","","333","333","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOPATH FL NONGYN SMEARS","31000001","CDM","311","RC","88104","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOPATH FL NONGYN SMEARS","31000001","CDM","311","RC","88104","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CP SMR OTHR; SCRN & INT","31000002","CDM","311","RC","88160","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CP SMR OTHR; SCRN & INT","31000002","CDM","311","RC","88160","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CP SMR OTHR; SCRN & INT","31000002","CDM","311","RC","88160","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FLOW CYTOMETRY EA ADDTL MARKER","31000003","CDM","311","RC","88185","HCPCS","facility","both","","","","81","81","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FLOW CYTOMETRY EA ADDTL MARKER","31000003","CDM","311","RC","88185","HCPCS","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FLOW CYTOMETRY EA ADDTL MARKER","31000003","CDM","311","RC","88185","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLOW CYTOMETRY EA ADDTL MARKER","31000003","CDM","311","RC","88185","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLOW CYTOMETRY EA ADDTL MARKER","31000003","CDM","311","RC","88185","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC TISSUE CULTURE; BM BLD CELLS","31000004","CDM","310","RC","88237","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISSUE CULTURE; BM BLD CELLS","31000004","CDM","310","RC","88237","HCPCS","facility","both","","","","856","856","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TISSUE CULTURE; BM BLD CELLS","31000004","CDM","310","RC","88237","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TISSUE CULTURE; BM BLD CELLS","31000004","CDM","310","RC","88237","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TISSUE CULTURE; OTHER TISSUE","31000005","CDM","319","RC","88239","HCPCS","facility","both","","","","669.91","669.91","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TISSUE CULTURE; OTHER TISSUE","31000005","CDM","319","RC","88239","HCPCS","facility","both","","","","523.36","523.36","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISSUE CULTURE; OTHER TISSUE","31000005","CDM","319","RC","88239","HCPCS","facility","both","","","","2188","2188","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TISSUE CULTURE; OTHER TISSUE","31000005","CDM","319","RC","88239","HCPCS","facility","both","","","","604","604","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHROM ANALY; 45 CELLS","31000006","CDM","319","RC","88263","HCPCS","facility","both","","","","2228","2228","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROM ANALY; 45 CELLS","31000006","CDM","319","RC","88263","HCPCS","facility","both","","","","1321","1321","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROM ANALY; 45 CELLS","31000006","CDM","319","RC","88263","HCPCS","facility","both","","","","837.38","837.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROM ANALY; 45 CELLS","31000006","CDM","319","RC","88263","HCPCS","facility","both","","","","1071.86","1071.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MCG; SITU HYBRID 3-5 CELLS","31000007","CDM","310","RC","88272","HCPCS","facility","both","","","","397","397","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MCG; SITU HYBRID 10-30 CELLS","31000008","CDM","310","RC","88273","HCPCS","facility","both","","","","468.94","468.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MCG; SITU HYBRID 10-30 CELLS","31000008","CDM","310","RC","88273","HCPCS","facility","both","","","","130","130","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MCG; SITU HYBRID 10-30 CELLS","31000008","CDM","310","RC","88273","HCPCS","facility","both","","","","477","477","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MCG; SITU HYBRID 10-30 CELLS","31000008","CDM","310","RC","88273","HCPCS","facility","both","","","","366.35","366.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MCG; IP SITU 25-99 CELLS","31000009","CDM","310","RC","88274","HCPCS","facility","both","","","","142","142","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MCG; IP SITU 25-99 CELLS","31000009","CDM","310","RC","88274","HCPCS","facility","both","","","","517","517","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MCG; IP SITU 25-99 CELLS","31000009","CDM","310","RC","88274","HCPCS","facility","both","","","","535.93","535.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MCG; IP SITU 25-99 CELLS","31000009","CDM","310","RC","88274","HCPCS","facility","both","","","","418.68","418.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROM ANALY; ADDTL BANDING","31000010","CDM","319","RC","88283","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHROM ANALY; ADDTL BANDING","31000010","CDM","319","RC","88283","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROM ANALY; ADDTL BANDING","31000010","CDM","319","RC","88283","HCPCS","facility","both","","","","1018","1018","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROM ANALY; ADDTL CELL COUNTS","31000011","CDM","310","RC","88285","HCPCS","facility","both","","","","78","78","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHROM ANALY; ADDTL CELL COUNTS","31000011","CDM","310","RC","88285","HCPCS","facility","both","","","","282","282","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROM ANALY; ADDTL CELL COUNTS","31000011","CDM","310","RC","88285","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHROM ANALY; ADDTL CELL COUNTS","31000011","CDM","310","RC","88285","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISSUE EXAM BY PATHOLOGIST LVL 4","31000012","CDM","310","RC","88305","HCPCS","facility","both","","","","550","550","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TISSUE EXAM BY PATHOLOGIST LVL 4","31000012","CDM","310","RC","88305","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISSUE EXAM BY PATHOLOGIST LVL 4","31000012","CDM","310","RC","88305","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ENZYME HISTOCHEMISTRY","31000013","CDM","310","RC","88319","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ENZYME HISTOCHEMISTRY","31000013","CDM","310","RC","88319","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ENZYME HISTOCHEMISTRY","31000013","CDM","310","RC","88319","HCPCS","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC ENZYME HISTOCHEMISTRY","31000013","CDM","310","RC","88319","HCPCS","facility","both","","","","2386","2386","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PATH CONSULT DURING SURGERY","31000014","CDM","310","RC","88329","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PATH CONSULT DURING SURGERY","31000014","CDM","310","RC","88329","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PATH CONSULT DURING SURGERY","31000014","CDM","310","RC","88329","HCPCS","facility","both","","","","214","214","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INTRAOP CYTO PATH CONSULT 1","31000015","CDM","311","RC","88333","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INTRAOP CYTO PATH CONSULT 1","31000015","CDM","311","RC","88333","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INTRAOP CYTO PATH CONSULT 1","31000015","CDM","311","RC","88333","HCPCS","facility","both","","","","1057","1057","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INTRAOP CYTO PATH CONSULT 2","31000016","CDM","311","RC","88334","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INTRAOP CYTO PATH CONSULT 2","31000016","CDM","311","RC","88334","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INTRAOP CYTO PATH CONSULT 2","31000016","CDM","311","RC","88334","HCPCS","facility","both","","","","133","133","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRAOP CYTO PATH CONSULT 2","31000016","CDM","311","RC","88334","HCPCS","facility","both","","","","214","214","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IHC EACH ANTIBODY","31000017","CDM","310","RC","88342","HCPCS","facility","both","","","","654","654","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IHC EACH ANTIBODY","31000017","CDM","310","RC","88342","HCPCS","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IHC EACH ANTIBODY","31000017","CDM","310","RC","88342","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IHC EACH ANTIBODY","31000017","CDM","310","RC","88342","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IHC EACH ANTIBODY","31000017","CDM","310","RC","88342","HCPCS","facility","both","","","","643","643","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IF STAIN , INITIAL","31000018","CDM","310","RC","88346","HCPCS","facility","both","","","","1312","1312","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IF STAIN , INITIAL","31000018","CDM","310","RC","88346","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IF STAIN , INITIAL","31000018","CDM","310","RC","88346","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IF EA AB; INDIRECT","31000019","CDM","310","RC","88347","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IF EA AB; INDIRECT","31000019","CDM","310","RC","88347","HCPCS","facility","both","","","","222.41","222.41","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC IF EA AB; INDIRECT","31000019","CDM","310","RC","88347","HCPCS","facility","both","","","","183.87","183.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IF EA AB; INDIRECT","31000019","CDM","310","RC","88347","HCPCS","facility","both","","","","101","101","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MORPHOMETRICS; NERVE","31000020","CDM","310","RC","88356","HCPCS","facility","both","","","","777.1","777.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MORPHOMETRICS; NERVE","31000020","CDM","310","RC","88356","HCPCS","facility","both","","","","607.1","607.1","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MORPHOMETRICS; NERVE","31000020","CDM","310","RC","88356","HCPCS","facility","both","","","","819","819","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MANUAL TUMOR IM HISTOCHEM EA AB","31000021","CDM","310","RC","88360","HCPCS","facility","both","","","","487","487","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MANUAL TUMOR IM HISTOCHEM EA AB","31000021","CDM","310","RC","88360","HCPCS","facility","both","","","","200.97","200.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MANUAL TUMOR IM HISTOCHEM EA AB","31000021","CDM","310","RC","88360","HCPCS","facility","both","","","","157.01","157.01","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPUTER MORPHOMETRIC ANALYSIS EA AB","31000022","CDM","310","RC","88361","HCPCS","facility","both","","","","444","444","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TISSUE IDENTITY TYPING","31000023","CDM","310","RC","88380","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISSUE IDENTITY TYPING","31000023","CDM","310","RC","88380","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TISSUE IDENTITY TYPING","31000023","CDM","310","RC","88380","HCPCS","facility","both","","","","393","393","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MICRODISSECTION MANUAL","31000025","CDM","310","RC","88381","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MICRODISSECTION MANUAL","31000025","CDM","310","RC","88381","HCPCS","facility","both","","","","711","711","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MICRODISSECTION MANUAL","31000025","CDM","310","RC","88381","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TISS EXAM MOLECULAR STUDY","31000038","CDM","310","RC","88387","HCPCS","facility","both","","","","1222","1222","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"DEAC 01/01/2025 HC TISS EX MOLECUL STUDY ADD-ON","31000039","CDM","310","RC","88388","HCPCS","facility","both","","","","1222","1222","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UNLISTED SURG PATH","31000040","CDM","310","RC","88399","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CELL COUNT NOT BLOOD","31000041","CDM","300","RC","89050","HCPCS","facility","both","","","","71","71","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CELL COUNT NOT BLOOD","31000041","CDM","300","RC","89050","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CELL COUNT NOT BLOOD","31000041","CDM","300","RC","89050","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CELL COUNT NOT BLOOD","31000041","CDM","300","RC","89050","HCPCS","facility","both","","","","24","24","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CELL COUNT NOT BLOOD","31000041","CDM","300","RC","89050","HCPCS","facility","both","","","","12","12","","","","","","","","","","","","","Gross Charge Type: JHH PATHOLOGY ADMIN ONLY RSH FEE SCHEDULE"
"HC CELL COUNT NOT BLOOD","31000041","CDM","300","RC","89050","HCPCS","facility","both","","","","4.72","4.72","","","","","","","","","","","","","Gross Charge Type: FMCMC22 FRESENIUS MEDICAL CARE"
"HC MORPHOMETRIC ANAL,BONE","31000042","CDM","310","RC","88399","HCPCS","facility","both","","","","837.38","837.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MORPHOMETRIC ANAL,BONE","31000042","CDM","310","RC","88399","HCPCS","facility","both","","","","1071.86","1071.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MORPHOMETRIC ANAL,BONE","31000042","CDM","310","RC","88399","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IMMUNOFLUOR STN, ADD","31000043","CDM","310","RC","88350","HCPCS","facility","both","","","","1375","1375","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNOFLUOR STN, ADD","31000043","CDM","310","RC","88350","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IMMUNOFLUOR STN, ADD","31000043","CDM","310","RC","88350","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"DEAC 2/8/2017 HC CYTP URNE 3-5 PROBES EA SPEC","31000100","CDM","311","RC","88120","HCPCS","facility","both","","","","279.74","279.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"DEAC 2/8/2017 HC CYTP URNE 3-5 PROBES EA SPEC","31000100","CDM","311","RC","88120","HCPCS","facility","both","","","","436","436","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"DEAC 2/8/2017 HC CYTP URNE 3-5 PROBES EA SPEC","31000100","CDM","311","RC","88120","HCPCS","facility","both","","","","900.9","900.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC REF CONSULT PREP ELSEWHERE","31000101","CDM","310","RC","88321","HCPCS","facility","both","","","","820","820","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC REF CONSULT W SLIDE PREP","31000102","CDM","310","RC","88323","HCPCS","facility","both","","","","631","631","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPREHENSIVE CONSULT","31000103","CDM","310","RC","88325","HCPCS","facility","both","","","","1098","1098","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC XM ARCHIVE TISSUE MOLEC ANAL","31000104","CDM","310","RC","88363","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PROSTATE BIOPSY ANY METHOD","31000106","CDM","310","RC","","","facility","both","","","","2377","2377","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SAT BIOPSY PROSTATE 21-40","31000107","CDM","310","RC","","","facility","both","","","","1658","1658","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MORPHOMETRICS; TUMOR","31000111","CDM","310","RC","88358","HCPCS","facility","both","","","","1866","1866","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NERVE TEASING PREP","31000112","CDM","310","RC","88362","HCPCS","facility","both","","","","2386","2386","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC NERVE TEASING PREP","31000112","CDM","310","RC","88362","HCPCS","facility","both","","","","1415","1415","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PATHOLOGY LAB PROCEDURE","31000113","CDM","310","RC","89240","HCPCS","facility","both","","","","221","221","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC  IHC ADD SINGLE AB STN,EACH","31000114","CDM","310","RC","88341","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  IHC ADD SINGLE AB STN,EACH","31000114","CDM","310","RC","88341","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  IHC ADD SINGLE AB STN,EACH","31000114","CDM","310","RC","88341","HCPCS","facility","both","","","","643","643","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MULTIPLEX AB STN EACH","31000115","CDM","310","RC","88344","HCPCS","facility","both","","","","177.94","177.94","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MULTIPLEX AB STN EACH","31000115","CDM","310","RC","88344","HCPCS","facility","both","","","","643","643","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MULTIPLEX AB STN EACH","31000115","CDM","310","RC","88344","HCPCS","facility","both","","","","227.77","227.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOPATH, ISH, URIN C MORPHOM (140)","31000116","CDM","310","RC","88120","HCPCS","facility","both","","","","876","876","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOPATH, ISH, URIN C MORPHOM (140)","31000116","CDM","310","RC","88120","HCPCS","facility","both","","","","375.15","375.15","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOPATH, ISH, URIN C MORPHOM (140)","31000116","CDM","310","RC","88120","HCPCS","facility","both","","","","570","570","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYTOPATH, ISH, URIN C MORPHOM (140)","31000116","CDM","310","RC","88120","HCPCS","facility","both","","","","293.09","293.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC WASH HARVEST STEM CELLS","31000117","CDM","310","RC","38209","HCPCS","facility","both","","","","2195","2195","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC WASH HARVEST STEM CELLS","31000117","CDM","310","RC","38209","HCPCS","facility","both","","","","3096.73","3096.73","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC T-CELL DEPLETION OF HARVEST","31000118","CDM","310","RC","38210","HCPCS","facility","both","","","","27354.06","27354.06","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC M/PHMTRC ALYS ISH QUANT/SEMIQ (50)","31000119","CDM","310","RC","88377","HCPCS","facility","both","","","","523","523","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC M/PHMTRC ALYS ISH QUANT/SEMIQ (50)","31000119","CDM","310","RC","88377","HCPCS","facility","both","","","","523","523","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC M/PHMTRC ALYS ISH QUANT/SEMIQ (50)","31000119","CDM","310","RC","88377","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC M/PHMTRC ALYS ISH QUANT/SEMIQ (50)","31000119","CDM","310","RC","88377","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC M/PHMTRC ALYS ISH QUANT/SEMIQ (50)","31000119","CDM","310","RC","88377","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC EXOME RE-EVALUATION","31000120","CDM","310","RC","81417","HCPCS","facility","both","","","","2840.79","2840.79","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC EXOME RE-EVALUATION","31000120","CDM","310","RC","81417","HCPCS","facility","both","","","","3636.29","3636.29","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SMN1   GENE DOS/DELETION ALYS (395)","31000121","CDM","310","RC","81329","HCPCS","facility","both","","","","693","693","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SMN1   GENE DOS/DELETION ALYS (395)","31000121","CDM","310","RC","81329","HCPCS","facility","both","","","","826.9","826.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SMN1   GENE DOS/DELETION ALYS (395)","31000121","CDM","310","RC","81329","HCPCS","facility","both","","","","1058.47","1058.47","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTP URINE 3-5 PROBES CMPTR (122)","31000122","CDM","310","RC","88121","HCPCS","facility","both","","","","990","990","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTP URINE 3-5 PROBES CMPTR (122)","31000122","CDM","310","RC","88121","HCPCS","facility","both","","","","326.92","326.92","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTP URINE 3-5 PROBES CMPTR (122)","31000122","CDM","310","RC","88121","HCPCS","facility","both","","","","255.4","255.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC EXOME RE-EVALUATION (1840)","31000123","CDM","310","RC","81417","HCPCS","facility","both","","","","1116","1116","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXOME RE-EVALUATION (1840)","31000123","CDM","310","RC","81417","HCPCS","facility","both","","","","3851.92","3851.92","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC EXOME RE-EVALUATION (1840)","31000123","CDM","310","RC","81417","HCPCS","facility","both","","","","4930.56","4930.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MYD88 GENE P. LEU265PRO VRNT (300)","31000125","CDM","310","RC","81305","HCPCS","facility","both","","","","628.03","628.03","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MYD88 GENE P. LEU265PRO VRNT (300)","31000125","CDM","310","RC","81305","HCPCS","facility","both","","","","803.9","803.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MYD88 GENE P. LEU265PRO VRNT (300)","31000125","CDM","310","RC","81305","HCPCS","facility","both","","","","695","695","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEM VW DS VW FACTOR & COLLAGEN III BINDING ELISA","31000128","CDM","310","RC","","","facility","both","","","","514.49","514.49","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEM VW DS VW FACTOR & COLLAGEN III BINDING ELISA","31000128","CDM","310","RC","","","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYP2C9, GENE ANALYSIS, COMMON VARIANTS(30)","31000131","CDM","310","RC","81227","HCPCS","facility","both","","","","646","646","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYP2C9, GENE ANALYSIS, COMMON VARIANTS(30)","31000131","CDM","310","RC","81227","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYP2C9, GENE ANALYSIS, COMMON VARIANTS(30)","31000131","CDM","310","RC","81227","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYP2D6, GENE ANALYSIS, COMMON VARIANTS(30)","31000132","CDM","310","RC","81226","HCPCS","facility","both","","","","1519","1519","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYP2D6, GENE ANALYSIS, COMMON VARIANTS(30)","31000132","CDM","310","RC","81226","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYP2D6, GENE ANALYSIS, COMMON VARIANTS(30)","31000132","CDM","310","RC","81226","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYP3A4, GENE ANALYSIS, COMMON VARIANTS(30)","31000133","CDM","310","RC","81230","HCPCS","facility","both","","","","646","646","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYP3A4, GENE ANALYSIS, COMMON VARIANTS(30)","31000133","CDM","310","RC","81230","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYP3A4, GENE ANALYSIS, COMMON VARIANTS(30)","31000133","CDM","310","RC","81230","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYP3A5, GENE ANALYSIS, COMMON VARIANTS(30)","31000134","CDM","310","RC","81231","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYP3A5, GENE ANALYSIS, COMMON VARIANTS(30)","31000134","CDM","310","RC","81231","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYP3A5, GENE ANALYSIS, COMMON VARIANTS(30)","31000134","CDM","310","RC","81231","HCPCS","facility","both","","","","646","646","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DPYD, GENE ANALYSIS, COMMON VARIANTS(30)","31000135","CDM","310","RC","81232","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DPYD, GENE ANALYSIS, COMMON VARIANTS(30)","31000135","CDM","310","RC","81232","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DPYD, GENE ANALYSIS, COMMON VARIANTS(30)","31000135","CDM","310","RC","81232","HCPCS","facility","both","","","","646","646","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUDT15, GENE ANALYSIS, COMMON VARIANTS(30)","31000136","CDM","310","RC","81306","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NUDT15, GENE ANALYSIS, COMMON VARIANTS(30)","31000136","CDM","310","RC","81306","HCPCS","facility","both","","","","1015","1015","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NUDT15, GENE ANALYSIS, COMMON VARIANTS(30)","31000136","CDM","310","RC","81306","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SLCO1BI, GENE ANALYSIS, COMMON VARIANTS(30)","31000137","CDM","310","RC","81328","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SLCO1BI, GENE ANALYSIS, COMMON VARIANTS(30)","31000137","CDM","310","RC","81328","HCPCS","facility","both","","","","646","646","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SLCO1BI, GENE ANALYSIS, COMMON VARIANTS(30)","31000137","CDM","310","RC","81328","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"DEAC 4/1/2023 HC TPMT, GENE ANALYSIS, COMMON VARIANTS(30)","31000138","CDM","310","RC","81355","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 4/1/2023 HC TPMT, GENE ANALYSIS, COMMON VARIANTS(30)","31000138","CDM","310","RC","81355","HCPCS","facility","both","","","","282.72","282.72","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 4/1/2023 HC TPMT, GENE ANALYSIS, COMMON VARIANTS(30)","31000138","CDM","310","RC","81355","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FETAL CONGENTIAL ABNORML ASSAY TWO PROTEINS (PAPP-A, HCG) (25)","31000140","CDM","310","RC","81508","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FETAL CONGENTIAL ABNORML ASSAY TWO PROTEINS (PAPP-A, HCG) (25)","31000140","CDM","310","RC","81508","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FETAL CONGENTIAL ABNORML ASSAY TWO PROTEINS (PAPP-A, HCG) (25)","31000140","CDM","310","RC","81508","HCPCS","facility","both","","","","78","78","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TARGETED GENOMIC SEQ ANALYSIS (263)","31000141","CDM","310","RC","81455","HCPCS","facility","both","","","","550.57","550.57","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS (263)","31000141","CDM","310","RC","81455","HCPCS","facility","both","","","","704.75","704.75","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS (263)","31000141","CDM","310","RC","81455","HCPCS","facility","both","","","","4653","4653","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TARGETED GENOMIC ANALYSIS(170)","31000142","CDM","310","RC","81456","HCPCS","facility","both","","","","355.88","355.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC ANALYSIS(170)","31000142","CDM","310","RC","81456","HCPCS","facility","both","","","","455.54","455.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC ANALYSIS(170)","31000142","CDM","310","RC","81456","HCPCS","facility","both","","","","7711","7711","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VERSITI HEPARININDUCED THROMBOCYTOPENIA EVALUATION  PEA(170)","31000143","CDM","310","RC","","","facility","both","","","","355.88","355.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC VERSITI HEPARININDUCED THROMBOCYTOPENIA EVALUATION  PEA(170)","31000143","CDM","310","RC","","","facility","both","","","","455.54","455.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UGT1A1, GENE ANALYSIS, COMMON VARIANTS(85)","31000144","CDM","310","RC","81350","HCPCS","facility","both","","","","227.77","227.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UGT1A1, GENE ANALYSIS, COMMON VARIANTS(85)","31000144","CDM","310","RC","81350","HCPCS","facility","both","","","","177.94","177.94","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UGT1A1, GENE ANALYSIS, COMMON VARIANTS(85)","31000144","CDM","310","RC","81350","HCPCS","facility","both","","","","773","773","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TPMT, GENE ANALYSIS, COMMON VARIANTS(30)","31000147","CDM","310","RC","81335","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TPMT, GENE ANALYSIS, COMMON VARIANTS(30)","31000147","CDM","310","RC","81335","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TPMT, GENE ANALYSIS, COMMON VARIANTS(30)","31000147","CDM","310","RC","81335","HCPCS","facility","both","","","","328","328","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","31000150","CDM","310","RC","","","facility","both","","","","376.2","376.2","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC INFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","31000150","CDM","310","RC","","","facility","both","","","","482.22","482.22","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC INFCT DS BCT/VIR RESPIR DNA/RNA 22 TRGT SARSCOV2","31000150","CDM","310","RC","","","facility","both","","","","1180","1180","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLT3 GENE (795)","31000152","CDM","310","RC","81245","HCPCS","facility","both","","","","2748","2748","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLT3 GENE (795)","31000152","CDM","310","RC","81245","HCPCS","facility","both","","","","1664.28","1664.28","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLT3 GENE (795)","31000152","CDM","310","RC","81245","HCPCS","facility","both","","","","2130.33","2130.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CARDIOMYOPATHY  PANEL (296)","31000153","CDM","310","RC","81439","HCPCS","facility","both","","","","661","661","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDIOMYOPATHY  PANEL (296)","31000153","CDM","310","RC","81439","HCPCS","facility","both","","","","619.66","619.66","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CARDIOMYOPATHY  PANEL (296)","31000153","CDM","310","RC","81439","HCPCS","facility","both","","","","793.18","793.18","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COMBINED CARDIAC  PANEL SEQUENCING AT LEAST 10 GENES (148)","31000154","CDM","310","RC","81413","HCPCS","facility","both","","","","331","331","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMBINED CARDIAC  PANEL SEQUENCING AT LEAST 10 GENES (148)","31000154","CDM","310","RC","81413","HCPCS","facility","both","","","","396.59","396.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COMBINED CARDIAC  PANEL SEQUENCING AT LEAST 10 GENES (148)","31000154","CDM","310","RC","81413","HCPCS","facility","both","","","","309.83","309.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMBINED CARDIAC  PANEL ANALYSIS AT LEAST 2 GENES (148)","31000155","CDM","310","RC","81414","HCPCS","facility","both","","","","396.59","396.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COMBINED CARDIAC  PANEL ANALYSIS AT LEAST 2 GENES (148)","31000155","CDM","310","RC","81414","HCPCS","facility","both","","","","309.83","309.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMBINED CARDIAC  PANEL ANALYSIS AT LEAST 2 GENES (148)","31000155","CDM","310","RC","81414","HCPCS","facility","both","","","","331","331","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOMEXPRESS (1109)","31000156","CDM","310","RC","81425","HCPCS","facility","both","","","","2321.62","2321.62","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GENOMEXPRESS (1109)","31000156","CDM","310","RC","81425","HCPCS","facility","both","","","","2477","2477","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOMEXPRESS (1109)","31000156","CDM","310","RC","81425","HCPCS","facility","both","","","","2971.73","2971.73","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENOMEXPRESS SEQUENCE ANALYSIS, EA COMPARATOR GENOME (554)","31000157","CDM","310","RC","81426","HCPCS","facility","both","","","","1484.53","1484.53","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENOMEXPRESS SEQUENCE ANALYSIS, EA COMPARATOR GENOME (554)","31000157","CDM","310","RC","81426","HCPCS","facility","both","","","","1159.76","1159.76","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GENOMEXPRESS SEQUENCE ANALYSIS, EA COMPARATOR GENOME (554)","31000157","CDM","310","RC","81426","HCPCS","facility","both","","","","1238","1238","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WHOLE MITO GENOME SEQUENCING & DELETION TESTING (148)","31000158","CDM","310","RC","81460","HCPCS","facility","both","","","","331","331","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WHOLE MITO GENOME SEQUENCING & DELETION TESTING (148)","31000158","CDM","310","RC","81460","HCPCS","facility","both","","","","309.83","309.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC WHOLE MITO GENOME SEQUENCING & DELETION TESTING (148)","31000158","CDM","310","RC","81460","HCPCS","facility","both","","","","396.59","396.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MITO GENOME SEQUENCING HETEROPLASMY DETECTION, IF PERFRMD (148)","31000159","CDM","310","RC","81465","HCPCS","facility","both","","","","396.59","396.59","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MITO GENOME SEQUENCING HETEROPLASMY DETECTION, IF PERFRMD (148)","31000159","CDM","310","RC","81465","HCPCS","facility","both","","","","331","331","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MITO GENOME SEQUENCING HETEROPLASMY DETECTION, IF PERFRMD (148)","31000159","CDM","310","RC","81465","HCPCS","facility","both","","","","309.83","309.83","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC NOONAN AND COMPREHENSIVE RASOPATHIES  PANEL (296)","31000160","CDM","310","RC","81442","HCPCS","facility","both","","","","793.18","793.18","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NOONAN AND COMPREHENSIVE RASOPATHIES  PANEL (296)","31000160","CDM","310","RC","81442","HCPCS","facility","both","","","","661","661","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NOONAN AND COMPREHENSIVE RASOPATHIES  PANEL (296)","31000160","CDM","310","RC","81442","HCPCS","facility","both","","","","619.66","619.66","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ONE KNOWN FAMILIAL VARIANT (136)","31000161","CDM","310","RC","81455","HCPCS","facility","both","","","","364.43","364.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ONE KNOWN FAMILIAL VARIANT (136)","31000161","CDM","310","RC","81455","HCPCS","facility","both","","","","305","305","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ONE KNOWN FAMILIAL VARIANT (136)","31000161","CDM","310","RC","81455","HCPCS","facility","both","","","","284.71","284.71","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PRENATAL KNOWN FAMILIAL MUTATION (INCLUDES MCC) (370)","31000162","CDM","310","RC","81265","HCPCS","facility","both","","","","774.57","774.57","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PRENATAL KNOWN FAMILIAL MUTATION (INCLUDES MCC) (370)","31000162","CDM","310","RC","81265","HCPCS","facility","both","","","","826","826","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRENATAL KNOWN FAMILIAL MUTATION (INCLUDES MCC) (370)","31000162","CDM","310","RC","81265","HCPCS","facility","both","","","","991.47","991.47","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE (370)","31000163","CDM","310","RC","81479","HCPCS","facility","both","","","","826","826","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE (370)","31000163","CDM","310","RC","81479","HCPCS","facility","both","","","","774.57","774.57","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE (370)","31000163","CDM","310","RC","81479","HCPCS","facility","both","","","","991.47","991.47","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TWO KNOWN FAMILIAL VARIANTS IN A NUCLEAR GENE (98)","31000164","CDM","310","RC","81455","HCPCS","facility","both","","","","262.61","262.61","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TWO KNOWN FAMILIAL VARIANTS IN A NUCLEAR GENE (98)","31000164","CDM","310","RC","81455","HCPCS","facility","both","","","","205.16","205.16","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TWO KNOWN FAMILIAL VARIANTS IN A NUCLEAR GENE (98)","31000164","CDM","310","RC","81455","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMOSOMAL MICROARRAY (MICROARRAYDX) (296)","31000165","CDM","310","RC","81229","HCPCS","facility","both","","","","661","661","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHROMOSOMAL MICROARRAY (MICROARRAYDX) (296)","31000165","CDM","310","RC","81229","HCPCS","facility","both","","","","619.66","619.66","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROMOSOMAL MICROARRAY (MICROARRAYDX) (296)","31000165","CDM","310","RC","81229","HCPCS","facility","both","","","","793.18","793.18","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC XOMEDXXPRESS (739)","31000166","CDM","310","RC","81415","HCPCS","facility","both","","","","1547.05","1547.05","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC XOMEDXXPRESS (739)","31000166","CDM","310","RC","81415","HCPCS","facility","both","","","","1651","1651","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC XOMEDXXPRESS (739)","31000166","CDM","310","RC","81415","HCPCS","facility","both","","","","1980.27","1980.27","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC XOMEDXXPRESS SEQ ANALYSIS, EA COMPARATOR EXOME (370)","31000167","CDM","310","RC","81416","HCPCS","facility","both","","","","826","826","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC XOMEDXXPRESS SEQ ANALYSIS, EA COMPARATOR EXOME (370)","31000167","CDM","310","RC","81416","HCPCS","facility","both","","","","774.57","774.57","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC XOMEDXXPRESS SEQ ANALYSIS, EA COMPARATOR EXOME (370)","31000167","CDM","310","RC","81416","HCPCS","facility","both","","","","991.47","991.47","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOKINE 13 PANEL (13)","31000168","CDM","310","RC","83520","HCPCS","facility","both","","","","34.84","34.84","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOKINE 13 PANEL (13)","31000168","CDM","310","RC","83520","HCPCS","facility","both","","","","27.22","27.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOKINE 13 PANEL (13)","31000168","CDM","310","RC","83520","HCPCS","facility","both","","","","26","26","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOLECULAR PATH PROC, LEVEL 4  (71)","31000169","CDM","310","RC","81403","HCPCS","facility","both","","","","611","611","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOLECULAR PATH PROC, LEVEL 4  (71)","31000169","CDM","310","RC","81403","HCPCS","facility","both","","","","148.64","148.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOLECULAR PATH PROC, LEVEL 4  (71)","31000169","CDM","310","RC","81403","HCPCS","facility","both","","","","190.26","190.26","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC-NPM1 GENE (874)","31000170","CDM","310","RC","81310","HCPCS","facility","both","","","","2342.02","2342.02","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC-NPM1 GENE (874)","31000170","CDM","310","RC","81310","HCPCS","facility","both","","","","1263","1263","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC-NPM1 GENE (874)","31000170","CDM","310","RC","81310","HCPCS","facility","both","","","","1829.66","1829.66","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TARGETED GENOMIC SEQ ANALYSIS 324 GENES (795)","31000171","CDM","310","RC","","","facility","both","","","","2130.33","2130.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TARGETED GENOMIC SEQ ANALYSIS 324 GENES (795)","31000171","CDM","310","RC","","","facility","both","","","","1664.28","1664.28","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 5 (246)","31000172","CDM","310","RC","81404","HCPCS","facility","both","","","","514.99","514.99","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 5 (246)","31000172","CDM","310","RC","81404","HCPCS","facility","both","","","","659.19","659.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 5 (246)","31000172","CDM","310","RC","81404","HCPCS","facility","both","","","","551","551","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 6 (123)","31000173","CDM","310","RC","81405","HCPCS","facility","both","","","","329.6","329.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 6 (123)","31000173","CDM","310","RC","81405","HCPCS","facility","both","","","","257.49","257.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 6 (123)","31000173","CDM","310","RC","81405","HCPCS","facility","both","","","","276","276","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 7 (83)","31000174","CDM","310","RC","81406","HCPCS","facility","both","","","","173.75","173.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 7 (83)","31000174","CDM","310","RC","81406","HCPCS","facility","both","","","","222.41","222.41","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 7 (83)","31000174","CDM","310","RC","81406","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPARATOR EXOME (247)","31000175","CDM","310","RC","81416","HCPCS","facility","both","","","","517.08","517.08","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPARATOR EXOME (247)","31000175","CDM","310","RC","81416","HCPCS","facility","both","","","","551","551","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPARATOR EXOME (247)","31000175","CDM","310","RC","81416","HCPCS","facility","both","","","","661.88","661.88","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC COMPARATOR EXOME (493)","31000176","CDM","310","RC","81416","HCPCS","facility","both","","","","1032.06","1032.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPARATOR EXOME (493)","31000176","CDM","310","RC","81416","HCPCS","facility","both","","","","1101","1101","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPARATOR EXOME (493)","31000176","CDM","310","RC","81416","HCPCS","facility","both","","","","1321.08","1321.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC EXOME SEQUENCE ANALYSIS (1232)","31000177","CDM","310","RC","81415","HCPCS","facility","both","","","","2752","2752","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXOME SEQUENCE ANALYSIS (1232)","31000177","CDM","310","RC","81415","HCPCS","facility","both","","","","3301.33","3301.33","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC EXOME SEQUENCE ANALYSIS (1232)","31000177","CDM","310","RC","81415","HCPCS","facility","both","","","","2579.11","2579.11","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC EXOME RE-EVALUATION (493)","31000178","CDM","310","RC","81417","HCPCS","facility","both","","","","1032.06","1032.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC EXOME RE-EVALUATION (493)","31000178","CDM","310","RC","81417","HCPCS","facility","both","","","","1321.08","1321.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC EXOME RE-EVALUATION (493)","31000178","CDM","310","RC","81417","HCPCS","facility","both","","","","1101","1101","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOME SEQUENCE ANALYSIS (1970)","31000179","CDM","310","RC","81425","HCPCS","facility","both","","","","5278.93","5278.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENOME SEQUENCE ANALYSIS (1970)","31000179","CDM","310","RC","81425","HCPCS","facility","both","","","","4124.07","4124.07","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GENOME SEQUENCE ANALYSIS (1970)","31000179","CDM","310","RC","81425","HCPCS","facility","both","","","","4402","4402","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOME SEQUENCE ANALYSIS (985)","31000180","CDM","310","RC","81425","HCPCS","facility","both","","","","2639.46","2639.46","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENOME SEQUENCE ANALYSIS (985)","31000180","CDM","310","RC","81425","HCPCS","facility","both","","","","2062.04","2062.04","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GENOME SEQUENCE ANALYSIS (985)","31000180","CDM","310","RC","81425","HCPCS","facility","both","","","","2201","2201","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOME SEQ ANALYSIS, EA CMPRTR (493)","31000181","CDM","310","RC","81426","HCPCS","facility","both","","","","1032.06","1032.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GENOME SEQ ANALYSIS, EA CMPRTR (493)","31000181","CDM","310","RC","81426","HCPCS","facility","both","","","","1321.08","1321.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC GENOME SEQ ANALYSIS, EA CMPRTR (493)","31000181","CDM","310","RC","81426","HCPCS","facility","both","","","","1101","1101","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOME SEQ ANALYSIS, EA CMPRTR (985)","31000182","CDM","310","RC","81426","HCPCS","facility","both","","","","2201","2201","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENOME SEQ ANALYSIS, EA CMPRTR (985)","31000182","CDM","310","RC","81426","HCPCS","facility","both","","","","2062.04","2062.04","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GENOME SEQ ANALYSIS, EA CMPRTR (985)","31000182","CDM","310","RC","81426","HCPCS","facility","both","","","","2639.46","2639.46","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 6 (99)","31000183","CDM","310","RC","81405","HCPCS","facility","both","","","","207.25","207.25","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 6 (99)","31000183","CDM","310","RC","81405","HCPCS","facility","both","","","","221","221","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 6 (99)","31000183","CDM","310","RC","81405","HCPCS","facility","both","","","","265.29","265.29","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 7 (49)","31000184","CDM","310","RC","81406","HCPCS","facility","both","","","","102.58","102.58","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 7 (49)","31000184","CDM","310","RC","81406","HCPCS","facility","both","","","","131.31","131.31","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 7 (49)","31000184","CDM","310","RC","81406","HCPCS","facility","both","","","","111","111","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 2 (99)","31000185","CDM","310","RC","81401","HCPCS","facility","both","","","","207.25","207.25","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MOPATH PROCEDURE LEVEL 2 (99)","31000185","CDM","310","RC","81401","HCPCS","facility","both","","","","221","221","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 2 (99)","31000185","CDM","310","RC","81401","HCPCS","facility","both","","","","265.29","265.29","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 2 (49)","31000186","CDM","310","RC","81401","HCPCS","facility","both","","","","111","111","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOPATH PROCEDURE LEVEL 2 (49)","31000186","CDM","310","RC","81401","HCPCS","facility","both","","","","131.31","131.31","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MOPATH PROCEDURE LEVEL 2 (49)","31000186","CDM","310","RC","81401","HCPCS","facility","both","","","","102.58","102.58","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACTIONABLE PHARMACOGENOMICS PANEL (284)","31000187","CDM","310","RC","81418","HCPCS","facility","both","","","","594.54","594.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ACTIONABLE PHARMACOGENOMICS PANEL (284)","31000187","CDM","310","RC","81418","HCPCS","facility","both","","","","761.01","761.01","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ACTIONABLE PHARMACOGENOMICS PANEL (284)","31000187","CDM","310","RC","81418","HCPCS","facility","both","","","","1510","1510","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOG GEN-WIDE ALYS HEM MAL STRUX VRNT&CNV OGM (271)","31000188","CDM","310","RC","81195","HCPCS","facility","both","","","","4106","4106","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOG GEN-WIDE ALYS HEM MAL STRUX VRNT&CNV OGM (271)","31000188","CDM","310","RC","81195","HCPCS","facility","both","","","","726.19","726.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOG GEN-WIDE ALYS HEM MAL STRUX VRNT&CNV OGM (271)","31000188","CDM","310","RC","81195","HCPCS","facility","both","","","","567.32","567.32","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC HEMATOLYMPHOID NEO/DO GSAP 5-50DNA/DNA&RNA ALYS (261)","31000189","CDM","310","RC","81450","HCPCS","facility","both","","","","699.39","699.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HEMATOLYMPHOID NEO/DO GSAP 5-50DNA/DNA&RNA ALYS (261)","31000189","CDM","310","RC","81450","HCPCS","facility","both","","","","546.39","546.39","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC  NFCT DS STRN TYP WHL GENOME SEQUENCING PR ISOL","31000190","CDM","310","RC","","","facility","both","","","","372.48","372.48","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC  NFCT DS STRN TYP WHL GENOME SEQUENCING PR ISOL","31000190","CDM","310","RC","","","facility","both","","","","290.99","290.99","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC 14-3-3 PROTEIN, CSF - PRION DISEASE, RT-QUIC","31000191","CDM","310","RC","","","facility","both","","","","228.19","228.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC 14-3-3 PROTEIN, CSF - PRION DISEASE, RT-QUIC","31000191","CDM","310","RC","","","facility","both","","","","292.08","292.08","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MO PATH LEVEL 2, CBFB-MYH11,QUANT, V (481)","31000192","CDM","310","RC","81401","HCPCS","facility","both","","","","1006.94","1006.94","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MO PATH LEVEL 2, CBFB-MYH11,QUANT, V (481)","31000192","CDM","310","RC","81401","HCPCS","facility","both","","","","1288.92","1288.92","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NFCT DS CSF METAGENOMIC NGS BIOINFORMATIC ALYS","31000193","CDM","310","RC","","","facility","both","","","","4172.22","4172.22","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC NFCT DS CSF METAGENOMIC NGS BIOINFORMATIC ALYS","31000193","CDM","310","RC","","","facility","both","","","","3259.48","3259.48","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CLONOSEQ MRD ASSAY - PCR & NGS","31000194","CDM","310","RC","","","facility","both","","","","2411.69","2411.69","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CFTR GENE COM VARIAN (41)","31000195","CDM","310","RC","81220","HCPCS","facility","both","","","","109.84","109.84","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DMPK,MYOTONIC DYSTROPHY,TYPE-1","31060012","CDM","310","RC","81234","HCPCS","facility","both","","","","543","543","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYTOGENOMIC NEO MICRORA ALYS (715)","31060019","CDM","310","RC","81277","HCPCS","facility","both","","","","1915.96","1915.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOGENOMIC NEO MICRORA ALYS (715)","31060019","CDM","310","RC","81277","HCPCS","facility","both","","","","1496.8","1496.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LAB CYCTOLOGY","31100000","CDM","311","RC","","","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LAB CYCTOLOGY","31100000","CDM","311","RC","","","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOPATH CELL ENHANCE TECH","31100001","CDM","311","RC","88112","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOPATH CELL ENHANCE TECH","31100001","CDM","311","RC","88112","HCPCS","facility","both","","","","487","487","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOPATH CELL ENHANCE TECH","31100001","CDM","311","RC","88112","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CP CERV/VAG; ATL; MANUAL SCRN","31100002","CDM","311","RC","88142","HCPCS","facility","both","","","","363","363","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CP CERV/VAG; ATL; MANUAL SCRN","31100002","CDM","311","RC","88142","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CP CERV/VAG; ATL; MANUAL SCRN","31100002","CDM","311","RC","88142","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CP SMR OTHR; PREP SCRN INT","31100003","CDM","311","RC","88161","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CP SMR OTHR; PREP SCRN INT","31100003","CDM","311","RC","88161","HCPCS","facility","both","","","","442","442","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CP SMR OTHR; PREP SCRN INT","31100003","CDM","311","RC","88161","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTP DX EVAL FNA 1ST EA SITE","31100004","CDM","311","RC","88172","HCPCS","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTP DX EVAL FNA 1ST EA SITE","31100004","CDM","311","RC","88172","HCPCS","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTP DX EVAL FNA 1ST EA SITE","31100004","CDM","311","RC","88172","HCPCS","facility","both","","","","314","314","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC EVAL OF FNA; INT & REP","31100005","CDM","311","RC","88173","HCPCS","facility","both","","","","171","171","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC EVAL OF FNA; INT & REP","31100005","CDM","311","RC","88173","HCPCS","facility","both","","","","188.41","188.41","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC EVAL OF FNA; INT & REP","31100005","CDM","311","RC","88173","HCPCS","facility","both","","","","241.17","241.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLOW CYTOMETRY TC 1ST MARKER","31100006","CDM","311","RC","88184","HCPCS","facility","both","","","","127","127","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FLOW CYTOMETRY TC 1ST MARKER","31100006","CDM","311","RC","88184","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FLOW CYTOMETRY TC 1ST MARKER","31100006","CDM","311","RC","88184","HCPCS","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: JHH CYTOGENETICS GRAFT ENGINEERING FEE SCHEDULE"
"HC FLOW CYTOMETRY TC 1ST MARKER","31100006","CDM","311","RC","88184","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FLOW CYTOMETRY TC 1ST MARKER","31100006","CDM","311","RC","88184","HCPCS","facility","both","","","","449","449","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CRYOPRESERVATION EA CELL LINE","31100007","CDM","310","RC","88240","HCPCS","facility","both","","","","41","41","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CRYOPRESERVATION EA CELL LINE","31100007","CDM","310","RC","88240","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CRYOPRESERVATION EA CELL LINE","31100007","CDM","310","RC","88240","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CRYOPRESERVATION EA CELL LINE","31100007","CDM","310","RC","88240","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC THAW FROZEN CELLS/ALIQUOT","31100008","CDM","319","RC","88241","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC THAW FROZEN CELLS/ALIQUOT","31100008","CDM","319","RC","88241","HCPCS","facility","both","","","","41","41","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC THAW FROZEN CELLS/ALIQUOT","31100008","CDM","319","RC","88241","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC THAW FROZEN CELLS/ALIQUOT","31100008","CDM","319","RC","88241","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ELECTRON MICRO; DX","31100009","CDM","310","RC","88348","HCPCS","facility","both","","","","3799","3799","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ELECTRON MICRO; DX","31100009","CDM","310","RC","88348","HCPCS","facility","both","","","","837.38","837.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ELECTRON MICRO; DX","31100009","CDM","310","RC","88348","HCPCS","facility","both","","","","1071.86","1071.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ISH SINGLE PROBE 1ST","31100010","CDM","312","RC","88365","HCPCS","facility","both","","","","188.41","188.41","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ISH SINGLE PROBE 1ST","31100010","CDM","312","RC","88365","HCPCS","facility","both","","","","488","488","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ISH SINGLE PROBE 1ST","31100010","CDM","312","RC","88365","HCPCS","facility","both","","","","241.17","241.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BETHESDA PAP; MAN SCRN","31100011","CDM","311","RC","88164","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BETHESDA PAP; MAN SCRN","31100011","CDM","311","RC","88164","HCPCS","facility","both","","","","190","190","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BETHESDA PAP; MAN SCRN","31100011","CDM","311","RC","88164","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BETHESDA PAP; MAN SCRN","31100011","CDM","311","RC","88164","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CYTOPATH C/V INTERPRET","31100050","CDM","311","RC","88141","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CYTOPATH C/V INTERPRET","31100050","CDM","311","RC","88141","HCPCS","facility","both","","","","344","344","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOPATH C/V INTERPRET","31100050","CDM","311","RC","88141","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CELL MARKER STUDY","31100051","CDM","319","RC","88182","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CELL MARKER STUDY","31100051","CDM","319","RC","88182","HCPCS","facility","both","","","","185.3","185.3","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC CELL MARKER STUDY","31100051","CDM","319","RC","88182","HCPCS","facility","both","","","","400","400","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CELL MARKER STUDY","31100051","CDM","319","RC","88182","HCPCS","facility","both","","","","839","839","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CELL MARKER STUDY","31100051","CDM","319","RC","88182","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"DEAC 4/1/2025 HC FLOW CYTOMETRY INTERP 9-15 MARKERS","31100052","CDM","319","RC","88188","HCPCS","facility","both","","","","893","893","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"DEAC 4/1/2025 HC FLOW CYTOMETRY INTERP 16 & > MARKERS","31100053","CDM","319","RC","88189","HCPCS","facility","both","","","","485","485","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOPATH FL NONGYN FILTER","31100054","CDM","311","RC","88106","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SEX C  ID; BARR BODIES","31100055","CDM","311","RC","88130","HCPCS","facility","both","","","","225","225","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DX PAP; MANUAL SCREEN","31100056","CDM","311","RC","88150","HCPCS","facility","both","","","","190","190","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOPATH C/V INDEX ADD-ON","31100057","CDM","311","RC","88155","HCPCS","facility","both","","","","107","107","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CYTOPATH C/V INDEX ADD-ON","31100057","CDM","311","RC","88155","HCPCS","facility","both","","","","58.96","58.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CYTOPATH C/V INDEX ADD-ON","31100057","CDM","311","RC","88155","HCPCS","facility","both","","","","46.06","46.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CP SMR OTHR; > 5 SLIDES","31100058","CDM","311","RC","88162","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC UNLISTED CYTOPATHOLOGY","31100059","CDM","311","RC","88199","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ISH PROBE ADDITIONAL","31100061","CDM","312","RC","88364","HCPCS","facility","both","","","","241.17","241.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ISH PROBE ADDITIONAL","31100061","CDM","312","RC","88364","HCPCS","facility","both","","","","188.41","188.41","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ISH PROBE ADDITIONAL","31100061","CDM","312","RC","88364","HCPCS","facility","both","","","","488","488","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC ISH MULTIPLEX PROBE","31100062","CDM","310","RC","88366","HCPCS","facility","both","","","","241.17","241.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC ISH MULTIPLEX PROBE","31100062","CDM","310","RC","88366","HCPCS","facility","both","","","","188.41","188.41","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC ISH MULTIPLEX PROBE","31100062","CDM","310","RC","88366","HCPCS","facility","both","","","","448","448","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LAB HISTOLOGY","31200000","CDM","312","RC","","","facility","both","","","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LAB HISTOLOGY","31200000","CDM","312","RC","","","facility","both","","","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CP CONCENTR TECH SMEAR","31200001","CDM","311","RC","88108","HCPCS","facility","both","","","","29.5","29.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CP CONCENTR TECH SMEAR","31200001","CDM","311","RC","88108","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CP CONCENTR TECH SMEAR","31200001","CDM","311","RC","88108","HCPCS","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CP CONCENTR TECH SMEAR","31200001","CDM","311","RC","88108","HCPCS","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SURG PATH LEVEL-I GROSS ONLY","31200002","CDM","310","RC","88300","HCPCS","facility","both","","","","142","142","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SURG PATH LEVEL-I GROSS ONLY","31200002","CDM","310","RC","88300","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SURG PATH LEVEL-I GROSS ONLY","31200002","CDM","310","RC","88300","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SURG PATH LVL 2","31200003","CDM","310","RC","88302","HCPCS","facility","both","","","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SURG PATH LVL 2","31200003","CDM","310","RC","88302","HCPCS","facility","both","","","","66.99","66.99","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SURG PATH LVL 2","31200003","CDM","310","RC","88302","HCPCS","facility","both","","","","250","250","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TISSUE EXAM BY PATHOLOGIST LVL 3","31200004","CDM","310","RC","88304","HCPCS","facility","both","","","","365","365","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TISSUE EXAM BY PATHOLOGIST LVL 3","31200004","CDM","310","RC","88304","HCPCS","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISSUE EXAM BY PATHOLOGIST LVL 3","31200004","CDM","310","RC","88304","HCPCS","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TISSUE EXAM BY PATHOLOGIST LVL 5","31200005","CDM","310","RC","88307","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISSUE EXAM BY PATHOLOGIST LVL 5","31200005","CDM","310","RC","88307","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TISSUE EXAM BY PATHOLOGIST LVL 5","31200005","CDM","310","RC","88307","HCPCS","facility","both","","","","692","692","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TISSUE EXAM BY PATHOLOGIST LVL 5","31200005","CDM","310","RC","88307","HCPCS","facility","both","","","","692","692","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TISSUE EXAM BY PATHOLOGIST LVL 6","31200006","CDM","310","RC","88309","HCPCS","facility","both","","","","261.68","261.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISSUE EXAM BY PATHOLOGIST LVL 6","31200006","CDM","310","RC","88309","HCPCS","facility","both","","","","1032","1032","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TISSUE EXAM BY PATHOLOGIST LVL 6","31200006","CDM","310","RC","88309","HCPCS","facility","both","","","","334.96","334.96","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DECALCIFICATION","31200007","CDM","310","RC","88311","HCPCS","facility","both","","","","208","208","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC DECALCIFICATION","31200007","CDM","310","RC","88311","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DECALCIFICATION","31200007","CDM","310","RC","88311","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SPECIAL STAINS GROUP 1","31200008","CDM","310","RC","88312","HCPCS","facility","both","","","","343","343","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SPECIAL STAINS GROUP 1","31200008","CDM","310","RC","88312","HCPCS","facility","both","","","","31.4","31.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SPECIAL STAINS GROUP 1","31200008","CDM","310","RC","88312","HCPCS","facility","both","","","","40.19","40.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SPECIAL STAINS GROUP 2","31200009","CDM","310","RC","88313","HCPCS","facility","both","","","","20.93","20.93","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SPECIAL STAINS GROUP 2","31200009","CDM","310","RC","88313","HCPCS","facility","both","","","","26.8","26.8","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC SPECIAL STAINS GROUP 2","31200009","CDM","310","RC","88313","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC SPECIAL STAINS GROUP 2","31200009","CDM","310","RC","88313","HCPCS","facility","both","","","","343","343","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC HISTOCHEMICAL STAINS ADD-ON","31200010","CDM","310","RC","88314","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC HISTOCHEMICAL STAINS ADD-ON","31200010","CDM","310","RC","88314","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SP CONSULT; 1ST TB W FS SGL SP","31200011","CDM","310","RC","88331","HCPCS","facility","both","","","","300","300","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC SP CONSULT; 1ST TB W FS SGL SP","31200011","CDM","310","RC","88331","HCPCS","facility","both","","","","62.8","62.8","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC SP CONSULT; 1ST TB W FS SGL SP","31200011","CDM","310","RC","88331","HCPCS","facility","both","","","","80.39","80.39","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PATH CONSULT INTRAOP ADDL","31200012","CDM","310","RC","88332","HCPCS","facility","both","","","","233","233","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PATH CONSULT INTRAOP ADDL","31200012","CDM","310","RC","88332","HCPCS","facility","both","","","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PATH CONSULT INTRAOP ADDL","31200012","CDM","310","RC","88332","HCPCS","facility","both","","","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISSUE CULTURE; SKIN OR SOLID BX","31900001","CDM","319","RC","88233","HCPCS","facility","both","","","","2077","2077","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TISSUE CULTURE; SKIN OR SOLID BX","31900001","CDM","319","RC","88233","HCPCS","facility","both","","","","418.68","418.68","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISSUE CULTURE; SKIN OR SOLID BX","31900001","CDM","319","RC","88233","HCPCS","facility","both","","","","535.93","535.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TISSUE CULTURE; SKIN OR SOLID BX","31900001","CDM","319","RC","88233","HCPCS","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TISSUE CULTURE; AMNIOTIC FLUID","31900002","CDM","319","RC","88235","HCPCS","facility","both","","","","401.94","401.94","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TISSUE CULTURE; AMNIOTIC FLUID","31900002","CDM","319","RC","88235","HCPCS","facility","both","","","","314.02","314.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC TISSUE CULTURE; AMNIOTIC FLUID","31900002","CDM","319","RC","88235","HCPCS","facility","both","","","","600","600","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC TISSUE CULTURE; AMNIOTIC FLUID","31900002","CDM","319","RC","88235","HCPCS","facility","both","","","","2183","2183","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROM ANALY; 50-100 CELLS","31900003","CDM","319","RC","88248","HCPCS","facility","both","","","","1071.86","1071.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHROM ANALY; 50-100 CELLS","31900003","CDM","319","RC","88248","HCPCS","facility","both","","","","837.38","837.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROM ANALY; 50-100 CELLS","31900003","CDM","319","RC","88248","HCPCS","facility","both","","","","2568","2568","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROM ANALY; 50-100 CELLS","31900003","CDM","319","RC","88248","HCPCS","facility","both","","","","708","708","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHROM ANALY; 15-20 CELLS","31900004","CDM","310","RC","88262","HCPCS","facility","both","","","","424.5","424.5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHROM ANALY; 15-20 CELLS","31900004","CDM","310","RC","88262","HCPCS","facility","both","","","","669.9","669.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROM ANALY; 15-20 CELLS","31900004","CDM","310","RC","88262","HCPCS","facility","both","","","","857.5","857.5","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHROM ANALY; 15-20 CELLS","31900004","CDM","310","RC","88262","HCPCS","facility","both","","","","3685","3685","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROM ANALY; 20-25 CELLS","31900005","CDM","310","RC","88264","HCPCS","facility","both","","","","845","845","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROM ANALY; 20-25 CELLS","31900005","CDM","310","RC","88264","HCPCS","facility","both","","","","837.38","837.38","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROM ANALY; 20-25 CELLS","31900005","CDM","310","RC","88264","HCPCS","facility","both","","","","370","370","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHROM ANALY; 20-25 CELLS","31900005","CDM","310","RC","88264","HCPCS","facility","both","","","","1071.86","1071.86","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHROM ANALY; AF/CV 15 CELLS","31900006","CDM","319","RC","88267","HCPCS","facility","both","","","","735","735","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHROM ANALY; AF/CV 15 CELLS","31900006","CDM","319","RC","88267","HCPCS","facility","both","","","","803.9","803.9","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHROM ANALY; AF/CV 15 CELLS","31900006","CDM","319","RC","88267","HCPCS","facility","both","","","","628.03","628.03","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROM ANALY; AF/CV 15 CELLS","31900006","CDM","319","RC","88267","HCPCS","facility","both","","","","2667","2667","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MCG; IP SITU 100-300 CELLS","31900007","CDM","310","RC","88275","HCPCS","facility","both","","","","616.32","616.32","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC MCG; IP SITU 100-300 CELLS","31900007","CDM","310","RC","88275","HCPCS","facility","both","","","","164","164","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC MCG; IP SITU 100-300 CELLS","31900007","CDM","310","RC","88275","HCPCS","facility","both","","","","1714","1714","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MCG; IP SITU 100-300 CELLS","31900007","CDM","310","RC","88275","HCPCS","facility","both","","","","481.49","481.49","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROM ANALY; ADDTL KARYOT EA STUDY","31900008","CDM","310","RC","88280","HCPCS","facility","both","","","","375","375","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROM ANALY; ADDTL KARYOT EA STUDY","31900008","CDM","310","RC","88280","HCPCS","facility","both","","","","41.87","41.87","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROM ANALY; ADDTL KARYOT EA STUDY","31900008","CDM","310","RC","88280","HCPCS","facility","both","","","","103","103","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CHROM ANALY; ADDTL KARYOT EA STUDY","31900008","CDM","310","RC","88280","HCPCS","facility","both","","","","53.6","53.6","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHROM ANALY; ADDTL HI RESOLN","31900009","CDM","319","RC","88289","HCPCS","facility","both","","","","267.97","267.97","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CHROM ANALY; ADDTL HI RESOLN","31900009","CDM","319","RC","88289","HCPCS","facility","both","","","","209.35","209.35","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CHROM ANALY; ADDTL HI RESOLN","31900009","CDM","319","RC","88289","HCPCS","facility","both","","","","1002","1002","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CHROM ANALY; ADDTL HI RESOLN","31900009","CDM","319","RC","88289","HCPCS","facility","both","","","","117","117","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC INSITU HYBRIDIZATION AUTO","31900010","CDM","319","RC","88367","HCPCS","facility","both","","","","449","449","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INSITU HYBRIDIZATION MANUAL","31900011","CDM","319","RC","88368","HCPCS","facility","both","","","","1898","1898","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC MICRODISSECTION LASER (600)","31900012","CDM","319","RC","88380","HCPCS","facility","both","","","","1256.06","1256.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC MICRODISSECTION LASER (600)","31900012","CDM","319","RC","88380","HCPCS","facility","both","","","","1607.79","1607.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CISTERNOGRAPHY, POSITIVE CONTRAST, S & I","32000001","CDM","320","RC","70015","HCPCS","facility","both","","","","857","857","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CISTERNOGRAPHY, POSITIVE CONTRAST, S & I","32000001","CDM","320","RC","70015","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC CISTERNOGRAPHY, POSITIVE CONTRAST, S & I","32000001","CDM","320","RC","70015","HCPCS","facility","both","","","","223","223","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CISTERNOGRAPHY, POSITIVE CONTRAST, S & I","32000001","CDM","320","RC","70015","HCPCS","facility","both","","","","1212.65","1212.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM OF EYE, DETECTION OF FOREIGN BODY","32000002","CDM","320","RC","70030","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM OF EYE, DETECTION OF FOREIGN BODY","32000002","CDM","320","RC","70030","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MANDIBLE, LESS THAN 4 VIEWS","32000003","CDM","320","RC","70100","HCPCS","facility","both","","","","467","467","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MANDIBLE, LESS THAN 4 VIEWS","32000003","CDM","320","RC","70100","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC MANDIBLE, MIN 4 VIEWS","32000004","CDM","320","RC","70110","HCPCS","facility","both","","","","634","634","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MANDIBLE, MIN 4 VIEWS","32000004","CDM","320","RC","70110","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  FACIAL BONES, LESS THAN 3 VIEWS","32000005","CDM","320","RC","70140","HCPCS","facility","both","","","","676","676","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  FACIAL BONES, LESS THAN 3 VIEWS","32000005","CDM","320","RC","70140","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  FACIAL BONES, MIN 3 VIEWS","32000006","CDM","320","RC","70150","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  FACIAL BONES, MIN 3 VIEWS","32000006","CDM","320","RC","70150","HCPCS","facility","both","","","","726","726","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  NASAL BONES, MIN 3 VIEWS","32000007","CDM","320","RC","70160","HCPCS","facility","both","","","","500","500","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  NASAL BONES, MIN 3 VIEWS","32000007","CDM","320","RC","70160","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  ORBITS, MIN 4 VIEWS","32000008","CDM","320","RC","70200","HCPCS","facility","both","","","","806","806","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  ORBITS, MIN 4 VIEWS","32000008","CDM","320","RC","70200","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SINUSES, PARANASAL, LESS THAN 3 VIEWS","32000009","CDM","320","RC","70210","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SINUSES, PARANASAL, LESS THAN 3 VIEWS","32000009","CDM","320","RC","70210","HCPCS","facility","both","","","","609","609","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SINUSES, PARANASAL, MIN 3 VIEWS","32000010","CDM","320","RC","70220","HCPCS","facility","both","","","","906","906","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SINUSES, PARANASAL, MIN 3 VIEWS","32000010","CDM","320","RC","70220","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SKULL, LESS THAN 4 VIEWS","32000011","CDM","320","RC","70250","HCPCS","facility","both","","","","961","961","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SKULL, LESS THAN 4 VIEWS","32000011","CDM","320","RC","70250","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SKULL, MIN 4 VIEWS","32000012","CDM","320","RC","70260","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SKULL, MIN 4 VIEWS","32000012","CDM","320","RC","70260","HCPCS","facility","both","","","","945","945","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  TEMPOROMANDIBULAR JOINT, BILAT","32000013","CDM","320","RC","70330","HCPCS","facility","both","","","","701","701","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  TEMPOROMANDIBULAR JOINT, BILAT","32000013","CDM","320","RC","70330","HCPCS","facility","both","","","","466.41","466.41","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  NECK, SOFT TISSUE","32000014","CDM","320","RC","70360","HCPCS","facility","both","","","","399","399","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  NECK, SOFT TISSUE","32000014","CDM","320","RC","70360","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SPINE, SINGLE VIEW, SPECIFY LEVEL","32000015","CDM","320","RC","72020","HCPCS","facility","both","","","","186.56","186.56","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SPINE, SINGLE VIEW, SPECIFY LEVEL","32000015","CDM","320","RC","72020","HCPCS","facility","both","","","","376","376","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SPINE, CERVICAL, 2 OR 3 VIEWS","32000016","CDM","320","RC","72040","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SPINE, CERVICAL, 2 OR 3 VIEWS","32000016","CDM","320","RC","72040","HCPCS","facility","both","","","","730","730","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SPINE, CERVICAL, MIN 4 VIEWS","32000017","CDM","320","RC","72050","HCPCS","facility","both","","","","904","904","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SPINE, CERVICAL, MIN 4 VIEWS","32000017","CDM","320","RC","72050","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SPINE, CERVICAL, COMPLETE","32000018","CDM","320","RC","72052","HCPCS","facility","both","","","","1084","1084","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SPINE, CERVICAL, COMPLETE","32000018","CDM","320","RC","72052","HCPCS","facility","both","","","","513.04","513.04","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SPINE, THORAX, 2 VIEWS","32000019","CDM","320","RC","72070","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SPINE, THORAX, 2 VIEWS","32000019","CDM","320","RC","72070","HCPCS","facility","both","","","","630","630","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SPINE, THORAX, 3 VIEWS","32000020","CDM","320","RC","72072","HCPCS","facility","both","","","","705","705","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SPINE, THORAX, 3 VIEWS","32000020","CDM","320","RC","72072","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SPINE, THORAX, MIN 4 VIEWS","32000021","CDM","320","RC","72074","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SPINE, THORAX, MIN 4 VIEWS","32000021","CDM","320","RC","72074","HCPCS","facility","both","","","","705","705","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SPINE, THORACOLUMBAR, 2 VIEWS","32000022","CDM","320","RC","72080","HCPCS","facility","both","","","","705","705","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SPINE, THORACOLUMBAR, 2 VIEWS","32000022","CDM","320","RC","72080","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SPINE, SCOLIOSIS STUDY","32000023","CDM","320","RC","72090","HCPCS","facility","both","","","","381","381","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SPINE, SCOLIOSIS STUDY","32000023","CDM","320","RC","72090","HCPCS","facility","both","","","","302.01","302.01","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SPINE, LUMBOSACRAL, 2 OR 3 VIEWS","32000024","CDM","320","RC","72100","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SPINE, LUMBOSACRAL, 2 OR 3 VIEWS","32000024","CDM","320","RC","72100","HCPCS","facility","both","","","","904","904","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SPINE, LUMBOSACRAL, MIN 4 VIEWS","32000025","CDM","320","RC","72110","HCPCS","facility","both","","","","419.74","419.74","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC  SPINE, LUMBOSACRAL, MIN 4 VIEWS","32000025","CDM","320","RC","72110","HCPCS","facility","both","","","","1160","1160","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SPINE, LUMBOSACRAL, MIN 6 VIEWS","32000026","CDM","320","RC","72114","HCPCS","facility","both","","","","1231","1231","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  SPINE, LUMBOSACRAL, MIN 6 VIEWS","32000026","CDM","320","RC","72114","HCPCS","facility","both","","","","606.34","606.34","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM PELVIS, 1 OR 2 VIEWS","32000027","CDM","320","RC","72170","HCPCS","facility","both","","","","539","539","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM PELVIS, 1 OR 2 VIEWS","32000027","CDM","320","RC","72170","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM PELVIS, MIN 3 VIEWS","32000028","CDM","320","RC","72190","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM PELVIS, MIN 3 VIEWS","32000028","CDM","320","RC","72190","HCPCS","facility","both","","","","705","705","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM SACROILIAC JOINTS, 3 OR MORE VIEWS","32000029","CDM","320","RC","72202","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM SACROILIAC JOINTS, 3 OR MORE VIEWS","32000029","CDM","320","RC","72202","HCPCS","facility","both","","","","609","609","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM SACRUM AND COCCYX, MIN 2 VIEWS","32000030","CDM","320","RC","72220","HCPCS","facility","both","","","","834","834","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM SACRUM AND COCCYX, MIN 2 VIEWS","32000030","CDM","320","RC","72220","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC MYELOGRAPHY, CERVICAL S & I","32000031","CDM","320","RC","72240","HCPCS","facility","both","","","","1989","1989","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYELOGRAPHY, CERVICAL S & I","32000031","CDM","320","RC","72240","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC MYELOGRAPHY, THORACIC S & I","32000032","CDM","320","RC","72255","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC MYELOGRAPHY, THORACIC S & I","32000032","CDM","320","RC","72255","HCPCS","facility","both","","","","2890","2890","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYELOGRAPHY, LUMBOSACRAL S & I","32000033","CDM","320","RC","72265","HCPCS","facility","both","","","","1829","1829","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYELOGRAPHY, LUMBOSACRAL S & I","32000033","CDM","320","RC","72265","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC MYELOGRAPHY, 2 OR MORE REGIONS S & I","32000034","CDM","320","RC","72270","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC MYELOGRAPHY, 2 OR MORE REGIONS S & I","32000034","CDM","320","RC","72270","HCPCS","facility","both","","","","2670","2670","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DISCOGRAPHY, CERVICAL OR THORACIC S & I","32000035","CDM","320","RC","72285","HCPCS","facility","both","","","","2284","2284","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DISCOGRAPHY, CERVICAL OR THORACIC S & I","32000035","CDM","320","RC","72285","HCPCS","facility","both","","","","1087.31","1087.31","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DISCOGRAPHY, CERVICAL OR THORACIC S & I","32000035","CDM","320","RC","72285","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC PERCUT VERTOPLASTY/SACROPLASTY W/FLUORO","32000036","CDM","320","RC","72291","HCPCS","facility","both","","","","656","656","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DISCOGRAPHY, LUMBAR","32000037","CDM","320","RC","72295","HCPCS","facility","both","","","","1087.38","1087.38","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DISCOGRAPHY, LUMBAR","32000037","CDM","320","RC","72295","HCPCS","facility","both","","","","3828","3828","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DISCOGRAPHY, LUMBAR","32000037","CDM","320","RC","72295","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC RAD EXAM CLAVICLE, COMPLETE","32000038","CDM","320","RC","73000","HCPCS","facility","both","","","","705","705","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM CLAVICLE, COMPLETE","32000038","CDM","320","RC","73000","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM CLAVICLE, COMPLETE","32000038","CDM","320","RC","73000","HCPCS","facility","both","","","","473","473","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM SCAPULA, COMPLETE","32000039","CDM","320","RC","73010","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM SCAPULA, COMPLETE","32000039","CDM","320","RC","73010","HCPCS","facility","both","","","","500","500","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM SHOULDER, 1 VIEW","32000040","CDM","320","RC","73020","HCPCS","facility","both","","","","186.56","186.56","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM SHOULDER, 1 VIEW","32000040","CDM","320","RC","73020","HCPCS","facility","both","","","","824","824","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM SHOULDER, 1 VIEW","32000040","CDM","320","RC","73020","HCPCS","facility","both","","","","550","550","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM SHOULDER, MIN 2 VIEWS","32000041","CDM","320","RC","73030","HCPCS","facility","both","","","","609","609","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM SHOULDER, MIN 2 VIEWS","32000041","CDM","320","RC","73030","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM SHOULDER, MIN 2 VIEWS","32000041","CDM","320","RC","73030","HCPCS","facility","both","","","","895","895","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ACROMIOCLAVICULAR JOINTS, BILAT","32000042","CDM","320","RC","73050","HCPCS","facility","both","","","","846","846","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ACROMIOCLAVICULAR JOINTS, BILAT","32000042","CDM","320","RC","73050","HCPCS","facility","both","","","","571","571","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ACROMIOCLAVICULAR JOINTS, BILAT","32000042","CDM","320","RC","73050","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM HUMERUS, MIN 2 VIEWS","32000043","CDM","320","RC","73060","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM HUMERUS, MIN 2 VIEWS","32000043","CDM","320","RC","73060","HCPCS","facility","both","","","","549","549","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM HUMERUS, MIN 2 VIEWS","32000043","CDM","320","RC","73060","HCPCS","facility","both","","","","774","774","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ELBOW, 2 VIEWS","32000044","CDM","320","RC","73070","HCPCS","facility","both","","","","535","535","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ELBOW, 2 VIEWS","32000044","CDM","320","RC","73070","HCPCS","facility","both","","","","874","874","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ELBOW, 2 VIEWS","32000044","CDM","320","RC","73070","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM ELBOW, MIN 3 VIEWS","32000045","CDM","320","RC","73080","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM ELBOW, MIN 3 VIEWS","32000045","CDM","320","RC","73080","HCPCS","facility","both","","","","1061","1061","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ELBOW, MIN 3 VIEWS","32000045","CDM","320","RC","73080","HCPCS","facility","both","","","","645","645","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM FOREARM, 2 VIEWS","32000046","CDM","320","RC","73090","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM FOREARM, 2 VIEWS","32000046","CDM","320","RC","73090","HCPCS","facility","both","","","","715","715","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM FOREARM, 2 VIEWS","32000046","CDM","320","RC","73090","HCPCS","facility","both","","","","499","499","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM UPPER EXT INFANT MIN 2 VIEWS","32000047","CDM","320","RC","73092","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM UPPER EXT INFANT MIN 2 VIEWS","32000047","CDM","320","RC","73092","HCPCS","facility","both","","","","806","806","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM UPPER EXT INFANT MIN 2 VIEWS","32000047","CDM","320","RC","73092","HCPCS","facility","both","","","","1311","1311","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM WRIST, 2 VIEWS","32000048","CDM","320","RC","73100","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM WRIST, 2 VIEWS","32000048","CDM","320","RC","73100","HCPCS","facility","both","","","","676","676","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM WRIST, 2 VIEWS","32000048","CDM","320","RC","73100","HCPCS","facility","both","","","","438","438","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM WRIST, MIN 3 VIEWS","32000049","CDM","320","RC","73110","HCPCS","facility","both","","","","513","513","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM WRIST, MIN 3 VIEWS","32000049","CDM","320","RC","73110","HCPCS","facility","both","","","","1281","1281","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM WRIST, MIN 3 VIEWS","32000049","CDM","320","RC","73110","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM HAND, 2 VIEWS","32000050","CDM","320","RC","73120","HCPCS","facility","both","","","","676","676","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM HAND, 2 VIEWS","32000050","CDM","320","RC","73120","HCPCS","facility","both","","","","457","457","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM HAND, 2 VIEWS","32000050","CDM","320","RC","73120","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM HAND, MIN 3 VIEWS","32000051","CDM","320","RC","73130","HCPCS","facility","both","","","","764","764","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM HAND, MIN 3 VIEWS","32000051","CDM","320","RC","73130","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM HAND, MIN 3 VIEWS","32000051","CDM","320","RC","73130","HCPCS","facility","both","","","","530","530","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM FINGER(S), MIN 2 VIEWS","32000052","CDM","320","RC","73140","HCPCS","facility","both","","","","186","186","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM FINGER(S), MIN 2 VIEWS","32000052","CDM","320","RC","73140","HCPCS","facility","both","","","","367","367","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM FINGER(S), MIN 2 VIEWS","32000052","CDM","320","RC","73140","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM HIP UNILATERAL 1 VIEW","32000053","CDM","320","RC","73500","HCPCS","facility","both","","","","380","380","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM HIP UNILATERAL 1 VIEW","32000053","CDM","320","RC","73500","HCPCS","facility","both","","","","550","550","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM HIP UNILATERAL MIN 2 VIEWS","32000054","CDM","320","RC","73510","HCPCS","facility","both","","","","307","307","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM HIPS BILATERAL MIN 2 VIEWS EACH HIP","32000055","CDM","320","RC","73520","HCPCS","facility","both","","","","381","381","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM DURING OP PROC UP TO 4 STUDIES","32000056","CDM","320","RC","73530","HCPCS","facility","both","","","","1595","1595","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM DURING OP PROC UP TO 4 STUDIES","32000056","CDM","320","RC","73530","HCPCS","facility","both","","","","964","964","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM PELVIS & HIPS INFANT/CHILD MIN 2 VIEW","32000057","CDM","320","RC","73540","HCPCS","facility","both","","","","307","307","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM FEMUR 2 VIEWS","32000058","CDM","320","RC","73550","HCPCS","facility","both","","","","429","429","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM FEMUR 2 VIEWS","32000058","CDM","320","RC","73550","HCPCS","facility","both","","","","294","294","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM KNEE 1 OR 2 VIEWS","32000059","CDM","320","RC","73560","HCPCS","facility","both","","","","488","488","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM KNEE 1 OR 2 VIEWS","32000059","CDM","320","RC","73560","HCPCS","facility","both","","","","715","715","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM KNEE 1 OR 2 VIEWS","32000059","CDM","320","RC","73560","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM KNEE 3 VIEWS","32000060","CDM","320","RC","73562","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM KNEE 3 VIEWS","32000060","CDM","320","RC","73562","HCPCS","facility","both","","","","513","513","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM KNEE 3 VIEWS","32000060","CDM","320","RC","73562","HCPCS","facility","both","","","","748","748","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM KNEE 4 OR MORE VIEWS","32000061","CDM","320","RC","73564","HCPCS","facility","both","","","","748","748","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM KNEE 4 OR MORE VIEWS","32000061","CDM","320","RC","73564","HCPCS","facility","both","","","","513","513","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM KNEE 4 OR MORE VIEWS","32000061","CDM","320","RC","73564","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM BOTH KNEES STANDING AP MIN 3 VIEWS","32000062","CDM","320","RC","73565","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM BOTH KNEES STANDING AP MIN 3 VIEWS","32000062","CDM","320","RC","73565","HCPCS","facility","both","","","","473","473","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM TIBIA AND FIBULA 2 VIEWS","32000063","CDM","320","RC","73590","HCPCS","facility","both","","","","715","715","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM TIBIA AND FIBULA 2 VIEWS","32000063","CDM","320","RC","73590","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM TIBIA AND FIBULA 2 VIEWS","32000063","CDM","320","RC","73590","HCPCS","facility","both","","","","488","488","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM LOWER EXT INFANT MIN 2 VIEWS","32000064","CDM","320","RC","73592","HCPCS","facility","both","","","","645","645","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM LOWER EXT INFANT MIN 2 VIEWS","32000064","CDM","320","RC","73592","HCPCS","facility","both","","","","396","396","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM LOWER EXT INFANT MIN 2 VIEWS","32000064","CDM","320","RC","73592","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM ANKLE 2 VIEWS","32000065","CDM","320","RC","73600","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM ANKLE 2 VIEWS","32000065","CDM","320","RC","73600","HCPCS","facility","both","","","","676","676","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ANKLE 2 VIEWS","32000065","CDM","320","RC","73600","HCPCS","facility","both","","","","457","457","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ANKLE MIN 3 VIEWS","32000067","CDM","320","RC","73610","HCPCS","facility","both","","","","1054","1054","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ANKLE MIN 3 VIEWS","32000067","CDM","320","RC","73610","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM ANKLE MIN 3 VIEWS","32000067","CDM","320","RC","73610","HCPCS","facility","both","","","","715","715","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM FOOT MIN 3 VIEWS","32000068","CDM","320","RC","73630","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM FOOT MIN 3 VIEWS","32000068","CDM","320","RC","73630","HCPCS","facility","both","","","","895","895","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM FOOT MIN 3 VIEWS","32000068","CDM","320","RC","73630","HCPCS","facility","both","","","","1462","1462","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM CALCANEUS MIN 2 VIEWS","32000069","CDM","320","RC","73650","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM CALCANEUS MIN 2 VIEWS","32000069","CDM","320","RC","73650","HCPCS","facility","both","","","","665","665","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM CALCANEUS MIN 2 VIEWS","32000069","CDM","320","RC","73650","HCPCS","facility","both","","","","452","452","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM TOE(S) MIN 2 VIEWS","32000070","CDM","320","RC","73660","HCPCS","facility","both","","","","412","412","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM TOE(S) MIN 2 VIEWS","32000070","CDM","320","RC","73660","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EX ABDOMEN SINGLE AP VIEW","32000071","CDM","320","RC","74000","HCPCS","facility","both","","","","127.68","127.68","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EX ABDOMEN SINGLE AP VIEW","32000071","CDM","320","RC","74000","HCPCS","facility","both","","","","336","336","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EX ABDOMEN AP + OBLIQ & CONE VIEWS","32000072","CDM","320","RC","74010","HCPCS","facility","both","","","","223.43","223.43","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EX ABDOMEN AP + OBLIQ & CONE VIEWS","32000072","CDM","320","RC","74010","HCPCS","facility","both","","","","514","514","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EX ABDOMEN DECUBITUS AND/OR ERECT VWS","32000073","CDM","320","RC","74020","HCPCS","facility","both","","","","223.43","223.43","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EX ABDOMEN DECUBITUS AND/OR ERECT VWS","32000073","CDM","320","RC","74020","HCPCS","facility","both","","","","336","336","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXM; COMPL ACUTE ABD SERIES, INCL 2+ VIEWS ABD, & SNGL VIEW CHEST","32000074","CDM","320","RC","74022","HCPCS","facility","both","","","","1198","1198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXM; COMPL ACUTE ABD SERIES, INCL 2+ VIEWS ABD, & SNGL VIEW CHEST","32000074","CDM","320","RC","74022","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC PERITONEOGRAM AFTER INJECTION S & I","32000075","CDM","320","RC","74190","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC RAD EXM; PHRYNX&/CRV ESOPH, INCL SCOUT RAD(S)&DLY IMG(S), CONTR STDY","32000076","CDM","320","RC","74210","HCPCS","facility","both","","","","792.88","792.88","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXM; ESOPH, INCL SCOUT RAD(S)&DLY IMG(S), SNGL-CONTRAST STDY","32000077","CDM","320","RC","74220","HCPCS","facility","both","","","","1040","1040","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXM; ESOPH, INCL SCOUT RAD(S)&DLY IMG(S), SNGL-CONTRAST STDY","32000077","CDM","320","RC","74220","HCPCS","facility","both","","","","839.53","839.53","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EX, SWALL FUNC W/CIN/VID RAD, INCL SCOUT RAD(S)&IMG(S), CONTR STDY","32000078","CDM","320","RC","74230","HCPCS","facility","both","","","","1068","1068","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EX, SWALL FUNC W/CIN/VID RAD, INCL SCOUT RAD(S)&IMG(S), CONTR STDY","32000078","CDM","320","RC","74230","HCPCS","facility","both","","","","1305.93","1305.93","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EX UPPER GASTROINTESTINAL TRACT W/KUB","32000079","CDM","320","RC","74241","HCPCS","facility","both","","","","682.81","682.81","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EX UPPER GASTROINTESTINAL TRACT W/KUB","32000079","CDM","320","RC","74241","HCPCS","facility","both","","","","1141","1141","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EX UPPER GI W/SMALL INTESTINE SERIES","32000080","CDM","320","RC","74245","HCPCS","facility","both","","","","1652","1652","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EX UPPER GI W/SMALL INTESTINE SERIES","32000080","CDM","320","RC","74245","HCPCS","facility","both","","","","1039.06","1039.06","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EX UPPER GI AIR CONTRAST W/KUB","32000081","CDM","320","RC","74247","HCPCS","facility","both","","","","890.62","890.62","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EX UPPER GI AIR CONTRAST W/KUB","32000081","CDM","320","RC","74247","HCPCS","facility","both","","","","1344","1344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXM, SM INT,INCL MULTI IMGS&SCOUT ABD RAD(S), SNGL-CONTR STDY","32000082","CDM","320","RC","74250","HCPCS","facility","both","","","","1026.12","1026.12","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXM, SM INT,INCL MULTI IMGS&SCOUT ABD RAD(S), SNGL-CONTR STDY","32000082","CDM","320","RC","74250","HCPCS","facility","both","","","","1097","1097","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXM, SM INT,INCL MULTI IMGS&SCOUT ABD RAD(S), DBL- CONTR STDY","32000083","CDM","320","RC","74251","HCPCS","facility","both","","","","5037.14","5037.14","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXM, SM INT,INCL MULTI IMGS&SCOUT ABD RAD(S), DBL- CONTR STDY","32000083","CDM","320","RC","74251","HCPCS","facility","both","","","","947","947","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXM, COLON, W/SCOUT ABD RAD(S) & DELAY IMG(S); WHEN PERF; SNGL STDY","32000084","CDM","320","RC","74270","HCPCS","facility","both","","","","1492.49","1492.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXM, COLON, W/SCOUT ABD RAD(S) & DELAY IMG(S); WHEN PERF; SNGL STDY","32000084","CDM","320","RC","74270","HCPCS","facility","both","","","","1499","1499","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXM, COLON,INCL SCOUT ABD RAD(S) & DLY IMG(S), DBL-CONTR STDY","32000085","CDM","320","RC","74280","HCPCS","facility","both","","","","2145.48","2145.48","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXM, COLON,INCL SCOUT ABD RAD(S) & DLY IMG(S), DBL-CONTR STDY","32000085","CDM","320","RC","74280","HCPCS","facility","both","","","","2032","2032","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPEUTIC ENEMA CONTRAST OR AIR FOR OBSTRC","32000086","CDM","320","RC","74283","HCPCS","facility","both","","","","1399.22","1399.22","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CHOLANGIOGRAPHY/PANCREATOGRAPHY INTRAOP","32000087","CDM","320","RC","74300","HCPCS","facility","both","","","","362.44","362.44","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CHOLANGIOGRAPHY/PANCREATOGRAPHY INTRAOP","32000087","CDM","320","RC","74300","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC CHOLANGIOGRAPHY/PANCREATOGRAPHY INTRAOP","32000087","CDM","320","RC","74300","HCPCS","facility","both","","","","999","999","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHOLANGIOGRAPHY/PANCREATOGRAPHY POSTOP","32000088","CDM","320","RC","74305","HCPCS","facility","both","","","","705","705","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHOLANGIOGRAPHY/PANCREATOGRAPHY POSTOP","32000088","CDM","320","RC","74305","HCPCS","facility","both","","","","45.17","45.17","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC CHOLANGIOGRAM PERCUTANEOUS TRANSHEPATIC","32000089","CDM","320","RC","74320","HCPCS","facility","both","","","","1267","1267","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHOLANGIOGRAM PERCUTANEOUS TRANSHEPATIC","32000089","CDM","320","RC","74320","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC POSTOP BILIARY DUCT CALCULUS REMOVAL","32000090","CDM","320","RC","74327","HCPCS","facility","both","","","","1453","1453","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POSTOP BILIARY DUCT CALCULUS REMOVAL","32000090","CDM","320","RC","74327","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ENDOSCOPIC CATH BILIARY DUCTAL SYSTEM","32000091","CDM","320","RC","74328","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ENDOSCOPIC CATH BILIARY DUCTAL SYSTEM","32000091","CDM","320","RC","74328","HCPCS","facility","both","","","","2209","2209","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDOSCOPIC CATH BILIARY DUCTAL SYSTEM","32000091","CDM","320","RC","74328","HCPCS","facility","both","","","","785.26","785.26","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC INTRO LONG GI TUBE INC MULTI FLUORO & FILMS","32000092","CDM","320","RC","74340","HCPCS","facility","both","","","","1833","1833","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRO LONG GI TUBE INC MULTI FLUORO & FILMS","32000092","CDM","320","RC","74340","HCPCS","facility","both","","","","302.01","302.01","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC INTRO LONG GI TUBE INC MULTI FLUORO & FILMS","32000092","CDM","320","RC","74340","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC PERC TRANSHEPATIC DILATION BILIARY DUCT","32000093","CDM","320","RC","74363","HCPCS","facility","both","","","","3296","3296","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERC TRANSHEPATIC DILATION BILIARY DUCT","32000093","CDM","320","RC","74363","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC UROGRAPHY IV W OR W/O KUB/TOMOGRAPH","32000094","CDM","320","RC","74400","HCPCS","facility","both","","","","1305.93","1305.93","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC UROGRAPHY IV W OR W/O KUB/TOMOGRAPH","32000094","CDM","320","RC","74400","HCPCS","facility","both","","","","43.61","43.61","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC UROGRAPHY IV W OR W/O KUB/TOMOGRAPH","32000094","CDM","320","RC","74400","HCPCS","facility","both","","","","1616","1616","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UROGRAPHY RETROGRADE W OR W/O KUB","32000095","CDM","320","RC","74420","HCPCS","facility","both","","","","1445.85","1445.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC UROGRAPHY RETROGRADE W OR W/O KUB","32000095","CDM","320","RC","74420","HCPCS","facility","both","","","","1285","1285","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UROGRAPHY ANTEGRADE S& I","32000096","CDM","320","RC","74425","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC UROGRAPHY ANTEGRADE S& I","32000096","CDM","320","RC","74425","HCPCS","facility","both","","","","604.06","604.06","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC UROGRAPHY ANTEGRADE S& I","32000096","CDM","320","RC","74425","HCPCS","facility","both","","","","984","984","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYSTOGRAPHY MIN 3 VIEWS","32000097","CDM","320","RC","74430","HCPCS","facility","both","","","","902","902","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYSTOGRAPHY MIN 3 VIEWS","32000097","CDM","320","RC","74430","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC CYSTOGRAPHY MIN 3 VIEWS","32000097","CDM","320","RC","74430","HCPCS","facility","both","","","","604.06","604.06","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC URETHROCYSTOGRAPHY RETROGRADE S & I","32000098","CDM","320","RC","74450","HCPCS","facility","both","","","","604.06","604.06","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC URETHROCYSTOGRAPHY RETROGRADE S & I","32000098","CDM","320","RC","74450","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC URETHROCYSTOGRAPHY RETROGRADE S & I","32000098","CDM","320","RC","74450","HCPCS","facility","both","","","","1230","1230","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URETHROCYSTOGRAPHY VOIDING S & I","32000099","CDM","320","RC","74455","HCPCS","facility","both","","","","2366","2366","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC URETHROCYSTOGRAPHY VOIDING S & I","32000099","CDM","320","RC","74455","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC URETHROCYSTOGRAPHY VOIDING S & I","32000099","CDM","320","RC","74455","HCPCS","facility","both","","","","604.06","604.06","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC INSERT INTRACATH OR CATH RENAL PELVIS, PERC","32000100","CDM","320","RC","74475","HCPCS","facility","both","","","","1344","1344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT INTRACATH OR CATH RENAL PELVIS, PERC","32000100","CDM","320","RC","74475","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC INSERT URETERAL CATH/STENT THRU RENAL PELV","32000101","CDM","320","RC","74480","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC INSERT URETERAL CATH/STENT THRU RENAL PELV","32000101","CDM","320","RC","74480","HCPCS","facility","both","","","","1344","1344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DILATE URETER(S) OR URETHRA","32000102","CDM","320","RC","74485","HCPCS","facility","both","","","","1871","1871","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DILATE URETER(S) OR URETHRA","32000102","CDM","320","RC","74485","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC HYSTEROSALPINGOGRAPHY S & I","32000103","CDM","320","RC","74740","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC HYSTEROSALPINGOGRAPHY S & I","32000103","CDM","320","RC","74740","HCPCS","facility","both","","","","483.26","483.26","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC HYSTEROSALPINGOGRAPHY S & I","32000103","CDM","320","RC","74740","HCPCS","facility","both","","","","1363","1363","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERINEOGRAM FOR SEX DETERMIN/ANOMALY","32000104","CDM","320","RC","74775","HCPCS","facility","both","","","","839.53","839.53","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC LYMPHANGIOGRAPHY EXT ONLY UNILAT","32000106","CDM","320","RC","75801","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT","32000107","CDM","320","RC","75805","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT","32000107","CDM","320","RC","75805","HCPCS","facility","both","","","","2679","2679","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SHUNTOGRAM FOR INDWELL NEUROVASC SHUNT","32000108","CDM","320","RC","75809","HCPCS","facility","both","","","","1358","1358","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SHUNTOGRAM FOR INDWELL NEUROVASC SHUNT","32000108","CDM","320","RC","75809","HCPCS","facility","both","","","","362.44","362.44","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC SHUNTOGRAM FOR INDWELL NEUROVASC SHUNT","32000108","CDM","320","RC","75809","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VENOGRAPHY EXT UNILATERAL","32000109","CDM","320","RC","75820","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VENOGRAPHY EXT UNILATERAL","32000109","CDM","320","RC","75820","HCPCS","facility","both","","","","1629","1629","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VENOGRAPHY EXT BILATERAL","32000110","CDM","320","RC","75822","HCPCS","facility","both","","","","1772","1772","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VENOGRAPHY EXT BILATERAL","32000110","CDM","320","RC","75822","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VENOGRAPHY CAVAL INFERIOR W/SERIALOGRAPHY","32000111","CDM","320","RC","75825","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VENOGRAPHY CAVAL INFERIOR W/SERIALOGRAPHY","32000111","CDM","320","RC","75825","HCPCS","facility","both","","","","2824","2824","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VENOGRAPHY CAVAL SUPERIOR W/SERIALOGRAPH","32000112","CDM","320","RC","75827","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VENOGRAPHY CAVAL SUPERIOR W/SERIALOGRAPH","32000112","CDM","320","RC","75827","HCPCS","facility","both","","","","1771","1771","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VENOGRAPHY RENAL UNILATERAL SELECTIVE","32000113","CDM","320","RC","75831","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VENOGRAPHY RENAL UNILATERAL SELECTIVE","32000113","CDM","320","RC","75831","HCPCS","facility","both","","","","2631","2631","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VENOGRAPHY RENAL BILATERAL SELECTIVE","32000114","CDM","320","RC","75833","HCPCS","facility","both","","","","2839","2839","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VENOGRAPHY RENAL BILATERAL SELECTIVE","32000114","CDM","320","RC","75833","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VENOGRAPHY VENOUS SINUS/JUGULAR CATHETER","32000115","CDM","320","RC","75860","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VENOGRAPHY VENOUS SINUS/JUGULAR CATHETER","32000115","CDM","320","RC","75860","HCPCS","facility","both","","","","3220","3220","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VENOGRAPHY SUPERIOR SAGITTAL SINUS","32000116","CDM","320","RC","75870","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC PERCUT TRANSHEPATIC PORTOGRAM W/HDM","32000117","CDM","320","RC","75885","HCPCS","facility","both","","","","3026","3026","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUT TRANSHEPATIC PORTOGRAM W/HDM","32000117","CDM","320","RC","75885","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC PERCUT TRANSHEPATIC PORTOGRAM W/O HDM","32000118","CDM","320","RC","75887","HCPCS","facility","both","","","","3004","3004","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUT TRANSHEPATIC PORTOGRAM W/O HDM","32000118","CDM","320","RC","75887","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC HEPATIC VENOGRAPHY W/ HDM","32000119","CDM","320","RC","75889","HCPCS","facility","both","","","","3053","3053","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPATIC VENOGRAPHY W/ HDM","32000119","CDM","320","RC","75889","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC HEPATIC VENOGRAPHY W/O HDM","32000120","CDM","320","RC","75891","HCPCS","facility","both","","","","3073","3073","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPATIC VENOGRAPHY W/O HDM","32000120","CDM","320","RC","75891","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VENOUS SAMPLING THRU CATH W/W/O ANGIO","32000121","CDM","320","RC","75893","HCPCS","facility","both","","","","5509","5509","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VENOUS SAMPLING THRU CATH W/W/O ANGIO","32000121","CDM","320","RC","75893","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VENOUS SAMPLING THRU CATH W/W/O ANGIO","32000121","CDM","320","RC","75893","HCPCS","facility","both","","","","60.39","60.39","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC TRANSCATHETER THERAPY EMBOLIZATION","32000122","CDM","320","RC","75894","HCPCS","facility","both","","","","3664","3664","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSCATHETER THERAPY EMBOLIZATION","32000122","CDM","320","RC","75894","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC TRANSCATHETER THERAPY INFUSION","32000123","CDM","320","RC","75896","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC TRANSCATHETER THERAPY INFUSION","32000123","CDM","320","RC","75896","HCPCS","facility","both","","","","1071","1071","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIO F/U TRANSCATH TX, EMBOLIZ/INFUSION","32000124","CDM","320","RC","75898","HCPCS","facility","both","","","","1614","1614","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIO F/U TRANSCATH TX, EMBOLIZ/INFUSION","32000124","CDM","320","RC","75898","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC EXCHANGE INTRAVASC CATH DURING THROMB TX","32000125","CDM","320","RC","75900","HCPCS","facility","both","","","","8742","8742","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE OBSTRUCT FROM CENTRAL VENOUS DEV","32000126","CDM","320","RC","75901","HCPCS","facility","both","","","","212","212","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE OBSTRUCT FROM CENTRAL VENOUS DEV","32000126","CDM","320","RC","75901","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC REMOVE INTRALUMIN OBSTRUCT FROM CVD","32000127","CDM","320","RC","75902","HCPCS","facility","both","","","","212","212","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE INTRALUMIN OBSTRUCT FROM CVD","32000127","CDM","320","RC","75902","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC INTRAVASCULAR US NON CORONARY; INITIAL","32000128","CDM","320","RC","75945","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC TRANSCATH INTRO IV CATH PERC AND/OR OPEN","32000129","CDM","320","RC","75960","HCPCS","facility","both","","","","821","821","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSCATH RETRIEVAL PERC IV FOREIGN BODY","32000130","CDM","320","RC","75961","HCPCS","facility","both","","","","1639","1639","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSLUM BALLOON ANGIOPLAST PERPH ARTERY","32000131","CDM","320","RC","75962","HCPCS","facility","both","","","","1043","1043","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSLUM BALLOON ANGIOPLAST PERPH ARTERY","32000131","CDM","320","RC","75962","HCPCS","facility","both","","","","50.21","50.21","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC TRANS BALLOON ANGIOPLASTY EA + PER ARTERY","32000132","CDM","320","RC","75964","HCPCS","facility","both","","","","826","826","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANS BALLOON ANGIOPLASTY EA + PER ARTERY","32000132","CDM","320","RC","75964","HCPCS","facility","both","","","","50.21","50.21","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC TRANS BALLOON ANGIOPLAST RENAL/VISC ARTERY","32000133","CDM","320","RC","75966","HCPCS","facility","both","","","","1952","1952","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANS BALLOON ANGIOPLAST RENAL/VISC ARTERY","32000133","CDM","320","RC","75966","HCPCS","facility","both","","","","50.21","50.21","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC TRANS BALLOON ANGIOPLASTY EA + VISC ARTERY","32000134","CDM","320","RC","75968","HCPCS","facility","both","","","","50.21","50.21","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC TRANS BALLOON ANGIOPLASTY EA + VISC ARTERY","32000134","CDM","320","RC","75968","HCPCS","facility","both","","","","826","826","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSCATHETER BIOPSY","32000135","CDM","320","RC","75970","HCPCS","facility","both","","","","1494","1494","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSCATHETER BIOPSY","32000135","CDM","320","RC","75970","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS","32000136","CDM","320","RC","75978","HCPCS","facility","both","","","","50.21","50.21","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS","32000136","CDM","320","RC","75978","HCPCS","facility","both","","","","1678","1678","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERC TRANSHEP BIL DRAINAGE W/CON MONITOR","32000137","CDM","320","RC","75980","HCPCS","facility","both","","","","1485","1485","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERC TRANSHEP BIL DRAINAGE W/CON MONITOR","32000137","CDM","320","RC","75980","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC PERC BIL DRAIN CATH PLACEMENT - INT & EXT DR","32000138","CDM","320","RC","75982","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC PERC BIL DRAIN CATH PLACEMENT - INT & EXT DR","32000138","CDM","320","RC","75982","HCPCS","facility","both","","","","1412","1412","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHG PERC TUBE/ DRAIN CATH W/CON MONITOR","32000139","CDM","320","RC","75984","HCPCS","facility","both","","","","2052","2052","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHG PERC TUBE/ DRAIN CATH W/CON MONITOR","32000139","CDM","320","RC","75984","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC PERC DRAINAGE CATH PLACEMENT W/ RAD GUID","32000140","CDM","320","RC","75989","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC PERC DRAINAGE CATH PLACEMENT W/ RAD GUID","32000140","CDM","320","RC","75989","HCPCS","facility","both","","","","483.28","483.28","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC PERC DRAINAGE CATH PLACEMENT W/ RAD GUID","32000140","CDM","320","RC","75989","HCPCS","facility","both","","","","3874","3874","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLUOROSCOPE EXAMINATION UP TO 1 HOUR","32000141","CDM","320","RC","76000","HCPCS","facility","both","","","","513.04","513.04","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC FLUOROSCOPE EXAMINATION UP TO 1 HOUR","32000141","CDM","320","RC","76000","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC FLUOROSCOPE EXAMINATION UP TO 1 HOUR","32000141","CDM","320","RC","76000","HCPCS","facility","both","","","","1112","1112","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLUOROSCOPE EXAMINATION MORE THAN 1 HR","32000142","CDM","320","RC","76001","HCPCS","facility","both","","","","44.34","44.34","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC FLUOROSCOPE EXAMINATION MORE THAN 1 HR","32000142","CDM","320","RC","76001","HCPCS","facility","both","","","","280.46","280.46","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EX FISTULA OR SINUS TRACT STUDY S & I","32000143","CDM","320","RC","76080","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EX FISTULA OR SINUS TRACT STUDY S & I","32000143","CDM","320","RC","76080","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC RAD EX FISTULA OR SINUS TRACT STUDY S & I","32000143","CDM","320","RC","76080","HCPCS","facility","both","","","","1286","1286","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM SURGICAL SPECIMEN","32000144","CDM","320","RC","76098","HCPCS","facility","both","","","","555","555","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM SURGICAL SPECIMEN","32000144","CDM","320","RC","76098","HCPCS","facility","both","","","","93.27","93.27","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE","32000145","CDM","320","RC","76499","HCPCS","facility","both","","","","111","111","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE","32000145","CDM","320","RC","76499","HCPCS","facility","both","","","","186.56","186.56","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE","32000145","CDM","320","RC","76499","HCPCS","facility","both","","","","851.09","851.09","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE","32000145","CDM","320","RC","76499","HCPCS","facility","both","","","","53.45","53.45","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC FLUOROGUIDE CENTRAL VEN ACCESS DEV PLCMNT","32000146","CDM","320","RC","77001","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC FLUOROGUIDE CENTRAL VEN ACCESS DEV PLCMNT","32000146","CDM","320","RC","77001","HCPCS","facility","both","","","","1289","1289","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLUOROSCOPIC GUIDANCE FOR NEEDLE PLCMNT","32000147","CDM","320","RC","77002","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLUOROSCOPIC GUIDANCE FOR NEEDLE PLCMNT","32000147","CDM","320","RC","77002","HCPCS","facility","both","","","","1449.72","1449.72","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC FLUOROSCOPIC GUIDANCE FOR NEEDLE PLCMNT","32000147","CDM","320","RC","77002","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC FLUOROSCOPIC GUIDANCE FOR SPINE INJECTION","32000148","CDM","320","RC","77003","HCPCS","facility","both","","","","1449.83","1449.83","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC FLUOROSCOPIC GUIDANCE FOR SPINE INJECTION","32000148","CDM","320","RC","77003","HCPCS","facility","both","","","","1273","1273","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLUOROSCOPIC GUIDANCE FOR SPINE INJECTION","32000148","CDM","320","RC","77003","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC STEREOTACTIC GUID BREAST BX/NEEDLE PLCMNT","32000149","CDM","320","RC","77031","HCPCS","facility","both","","","","1559","1559","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STEREOTACTIC GUID BREAST BX/NEEDLE PLCMNT","32000149","CDM","320","RC","77031","HCPCS","facility","both","","","","2339","2339","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAMMOGRAPHIC GUID NEEDLE PLCMNT BREAST","32000150","CDM","320","RC","77032","HCPCS","facility","both","","","","1418","1418","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAMMOGRAPHIC GUID NEEDLE PLCMNT BREAST","32000150","CDM","320","RC","77032","HCPCS","facility","both","","","","746","746","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE","32000151","CDM","320","RC","77053","HCPCS","facility","both","","","","1366","1366","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE","32000151","CDM","320","RC","77053","HCPCS","facility","both","","","","513.04","513.04","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC BONE AGE STUDIES","32000152","CDM","320","RC","77072","HCPCS","facility","both","","","","186.56","186.56","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC BONE AGE STUDIES","32000152","CDM","320","RC","77072","HCPCS","facility","both","","","","576","576","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE LENGTH STUDIES","32000153","CDM","320","RC","77073","HCPCS","facility","both","","","","834","834","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE LENGTH STUDIES","32000153","CDM","320","RC","77073","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM OSSEOUS SURVEY LIMITED","32000154","CDM","320","RC","77074","HCPCS","facility","both","","","","559.68","559.68","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM OSSEOUS SURVEY LIMITED","32000154","CDM","320","RC","77074","HCPCS","facility","both","","","","1442","1442","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM OSSEOUS SURVEY COMPLETE","32000155","CDM","320","RC","77075","HCPCS","facility","both","","","","1701","1701","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM OSSEOUS SURVEY COMPLETE","32000155","CDM","320","RC","77075","HCPCS","facility","both","","","","792.88","792.88","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM OSSEOUS SURVEY INFANT","32000156","CDM","320","RC","77076","HCPCS","facility","both","","","","792.88","792.88","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM OSSEOUS SURVEY INFANT","32000156","CDM","320","RC","77076","HCPCS","facility","both","","","","806","806","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DXA BONE DENSITY STUDY, AXIAL 1+ SITES","32000157","CDM","320","RC","77080","HCPCS","facility","both","","","","808","808","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DXA BONE DENSITY STUDY, AXIAL 1+ SITES","32000157","CDM","320","RC","77080","HCPCS","facility","both","","","","419.74","419.74","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DXA BONE DENSITY PERIPHERAL, AXIAL 1+ SITES","32000158","CDM","320","RC","77081","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DXA BONE DENSITY PERIPHERAL, AXIAL 1+ SITES","32000158","CDM","320","RC","77081","HCPCS","facility","both","","","","808","808","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DXA BONE DENSITY PERIPHERAL, AXIAL 1+ SITES","32000158","CDM","320","RC","77081","HCPCS","facility","both","","","","560.18","560.18","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC TRANSCERVICAL CATHETERIZATION OF FALLOPIAN TUBE","32000160","CDM","320","RC","74742","HCPCS","facility","both","","","","1358","1358","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSCERVICAL CATHETERIZATION OF FALLOPIAN TUBE","32000160","CDM","320","RC","74742","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC SELECTIVE ADRENAL VENOGRAM, BILATERAL","32000161","CDM","320","RC","75842","HCPCS","facility","both","","","","5302","5302","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELECTIVE ADRENAL VENOGRAM, BILATERAL","32000161","CDM","320","RC","75842","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC SELECTIVE ADRENAL VENOGRAM, UNILATERAL","32000162","CDM","320","RC","75840","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC SELECTIVE ADRENAL VENOGRAM, UNILATERAL","32000162","CDM","320","RC","75840","HCPCS","facility","both","","","","3792","3792","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM OF MASTOIDS 3+ VIEWS","32000200","CDM","320","RC","70130","HCPCS","facility","both","","","","814","814","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM OF MASTOIDS 3+ VIEWS","32000200","CDM","320","RC","70130","HCPCS","facility","both","","","","466.41","466.41","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC TMJ JOINT - UNILATERAL","32000201","CDM","320","RC","70328","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC TMJ JOINT - UNILATERAL","32000201","CDM","320","RC","70328","HCPCS","facility","both","","","","609","609","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CINE OR VIDEO SPEECH EVAL","32000202","CDM","320","RC","70371","HCPCS","facility","both","","","","1035","1035","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CINE OR VIDEO SPEECH EVAL","32000202","CDM","320","RC","70371","HCPCS","facility","both","","","","606.34","606.34","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RADIOLOGIC EXAM, SPINE, LUMBOSACRAL; BENDING VIEWS ONLY, 2 OR 3 VIEWS","32000203","CDM","320","RC","72120","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RADIOLOGIC EXAM, SPINE, LUMBOSACRAL; BENDING VIEWS ONLY, 2 OR 3 VIEWS","32000203","CDM","320","RC","72120","HCPCS","facility","both","","","","850","850","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM SACROILIAC JOINTS <3 VIEWS","32000204","CDM","320","RC","72200","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM SACROILIAC JOINTS <3 VIEWS","32000204","CDM","320","RC","72200","HCPCS","facility","both","","","","521","521","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 1/1/2022 HC EPIDUROGRAM","32000205","CDM","320","RC","72275","HCPCS","facility","both","","","","702","702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM OF FOOT; 2 VIEWS","32000206","CDM","320","RC","73620","HCPCS","facility","both","","","","726","726","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM OF FOOT; 2 VIEWS","32000206","CDM","320","RC","73620","HCPCS","facility","both","","","","1090","1090","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM OF FOOT; 2 VIEWS","32000206","CDM","320","RC","73620","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXM, UGI, W/SCOUT ABD RAD(S) & DELAY IMG(S); WHEN PERF; SNGL STDY","32000207","CDM","320","RC","74240","HCPCS","facility","both","","","","1072.72","1072.72","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXM, UGI, W/SCOUT ABD RAD(S) & DELAY IMG(S); WHEN PERF; SNGL STDY","32000207","CDM","320","RC","74240","HCPCS","facility","both","","","","1404","1404","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXM, UGI, W/SCOUT ABD RAD(S) & DELAY IMG(S); WHEN PERF; DBL STDY","32000208","CDM","320","RC","74246","HCPCS","facility","both","","","","1212.65","1212.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXM, UGI, W/SCOUT ABD RAD(S) & DELAY IMG(S); WHEN PERF; DBL STDY","32000208","CDM","320","RC","74246","HCPCS","facility","both","","","","838","838","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UGI W AIR & BARIUM W SB","32000209","CDM","320","RC","74249","HCPCS","facility","both","","","","1579","1579","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHOLANGIOGRAM ADDTL INTRAOP","32000210","CDM","320","RC","74301","HCPCS","facility","both","","","","846","846","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHOLANGIOGRAM ADDTL INTRAOP","32000210","CDM","320","RC","74301","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ENDO CATH - BIL & PANCR D","32000211","CDM","320","RC","74330","HCPCS","facility","both","","","","2209","2209","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDO CATH - BIL & PANCR D","32000211","CDM","320","RC","74330","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ENDO CATH - BIL & PANCR D","32000211","CDM","320","RC","74330","HCPCS","facility","both","","","","1147.68","1147.68","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC IVP W TOMOGRAPHY","32000212","CDM","320","RC","74415","HCPCS","facility","both","","","","1767","1767","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IVP W TOMOGRAPHY","32000212","CDM","320","RC","74415","HCPCS","facility","both","","","","1445.85","1445.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC IR ABD ANEURYSM REPAIR","32000213","CDM","320","RC","75952","HCPCS","facility","both","","","","45.3","45.3","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC IR ABD ANEURYSM REPAIR","32000213","CDM","320","RC","75952","HCPCS","facility","both","","","","4517","4517","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ILIAC ANEURYSM ENDOVAS RPR","32000214","CDM","320","RC","75953","HCPCS","facility","both","","","","1956","1956","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ILIAC ANEURYSM ENDOVAS RPR","32000214","CDM","320","RC","75953","HCPCS","facility","both","","","","45.3","45.3","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC NOSE TO RECTUM FOR FB CHILD","32000215","CDM","320","RC","76010","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC NOSE TO RECTUM FOR FB CHILD","32000215","CDM","320","RC","76010","HCPCS","facility","both","","","","1308","1308","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM OF MASTOIDS <3 VIEWS","32000216","CDM","320","RC","70120","HCPCS","facility","both","","","","571","571","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY SELLA TURCICA","32000217","CDM","320","RC","70240","HCPCS","facility","both","","","","467","467","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY SELLA TURCICA","32000217","CDM","320","RC","70240","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY SIALOGRAM","32000218","CDM","320","RC","70390","HCPCS","facility","both","","","","1230","1230","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY SPINE THORACOLUMBAR STANDING","32000219","CDM","320","RC","72069","HCPCS","facility","both","","","","226","226","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY SPINE THORACOLUMBAR STANDING","32000219","CDM","320","RC","72069","HCPCS","facility","both","","","","181.24","181.24","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ENDO CATH PANCREATIC DUCT SYSTEM","32000222","CDM","320","RC","74329","HCPCS","facility","both","","","","1960","1960","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UROGRAPHY, INFUSION IVP, DRIP/BOLUS","32000223","CDM","320","RC","74410","HCPCS","facility","both","","","","1616","1616","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY VASOGRAM VESICULOGRAM","32000224","CDM","320","RC","74440","HCPCS","facility","both","","","","966","966","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY CORPORA CAVERNOSOGRAM","32000225","CDM","320","RC","74445","HCPCS","facility","both","","","","1539","1539","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY CORPORA CAVERNOSOGRAM","32000225","CDM","320","RC","74445","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC X-RAY RENAL CYST STUDY","32000226","CDM","320","RC","74470","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC X-RAY RENAL CYST STUDY","32000226","CDM","320","RC","74470","HCPCS","facility","both","","","","1069","1069","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRALUMINAL DILATION OF STRICTURES/OBSTRUCTIONS","32000229","CDM","320","RC","74360","HCPCS","facility","both","","","","2091","2091","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRALUMINAL DILATION OF STRICTURES/OBSTRUCTIONS","32000229","CDM","320","RC","74360","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC X-RAY OF MAMMARY DUCTS","32000235","CDM","320","RC","77054","HCPCS","facility","both","","","","1697","1697","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC XRAY EXAM, ENTIRE SPINE AP & LAT","32000240","CDM","320","RC","72010","HCPCS","facility","both","","","","649","649","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC XRAY EXAM, ENTIRE SPINE AP & LAT","32000240","CDM","320","RC","72010","HCPCS","facility","both","","","","543.65","543.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC VESSEL MAP FOR HEMODIALYSIS ACCESS","32000254","CDM","320","RC","","","facility","both","","","","1543.75","1543.75","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC LYMPHANGIOGRAM PELVIC/ABD; BILAT","32000255","CDM","320","RC","75807","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ILIAC ANEURYSM ENDOVAS RPR","32000256","CDM","320","RC","75954","HCPCS","facility","both","","","","45.3","45.3","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VERTEBRAL FRACTURE ASSESSMENT VIA DXA","32000258","CDM","320","RC","77086","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VERTEBRAL FRACTURE ASSESSMENT VIA DXA","32000258","CDM","320","RC","77086","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC VERTEBRAL FRACTURE ASSESSMENT VIA DXA","32000258","CDM","320","RC","77086","HCPCS","facility","both","","","","706","706","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM ENTIRE SPINE, 1 VW","32000262","CDM","320","RC","72081","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM ENTIRE SPINE, 1 VW","32000262","CDM","320","RC","72081","HCPCS","facility","both","","","","705","705","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM ENTIRE SPINE,  2/3 VW","32000263","CDM","320","RC","72082","HCPCS","facility","both","","","","1204","1204","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM ENTIRE SPINE,  2/3 VW","32000263","CDM","320","RC","72082","HCPCS","facility","both","","","","606.34","606.34","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM ENTIRE SPINE,  4/5 VW","32000264","CDM","320","RC","72083","HCPCS","facility","both","","","","2289","2289","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM ENTIRE SPINE,  4/5 VW","32000264","CDM","320","RC","72083","HCPCS","facility","both","","","","652.97","652.97","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM ENTIRE SPINE,  6/> VW","32000265","CDM","320","RC","72084","HCPCS","facility","both","","","","2289","2289","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM ENTIRE SPINE,  6/> VW","32000265","CDM","320","RC","72084","HCPCS","facility","both","","","","792.88","792.88","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM HIP UNIL, W/PELVIS WHEN PERFORMED,  1 VW","32000266","CDM","320","RC","73501","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM HIP UNIL, W/PELVIS WHEN PERFORMED,  1 VW","32000266","CDM","320","RC","73501","HCPCS","facility","both","","","","571","571","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM HIP UNIL, W/PELVIS WHEN PERFORMED, 2-3 VW","32000267","CDM","320","RC","73502","HCPCS","facility","both","","","","704","704","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM HIP UNIL, W/PELVIS WHEN PERFORMED, 2-3 VW","32000267","CDM","320","RC","73502","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM HIP UNIL, W/PELVIS WHEN PERFORMED, 4/> VW","32000268","CDM","320","RC","73503","HCPCS","facility","both","","","","1788","1788","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM HIPS BIL, W/PELVIS WHEN PERFORMED, 2 VW","32000269","CDM","320","RC","73521","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM HIPS BIL, W/PELVIS WHEN PERFORMED, 2 VW","32000269","CDM","320","RC","73521","HCPCS","facility","both","","","","853","853","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM HIPS BIL, W/PELVIS WHEN PERFORMED, 3-4 VW","32000270","CDM","320","RC","73522","HCPCS","facility","both","","","","419.74","419.74","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM HIPS BIL, W/PELVIS WHEN PERFORMED, 3-4 VW","32000270","CDM","320","RC","73522","HCPCS","facility","both","","","","1054","1054","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM HIPS BIL, W/PELVIS WHEN PERFORMED, 5/> VW","32000271","CDM","320","RC","73523","HCPCS","facility","both","","","","2679","2679","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM OF FEMUR,  1 VIEW","32000272","CDM","320","RC","73551","HCPCS","facility","both","","","","544","544","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM OF FEMUR,  1 VIEW","32000272","CDM","320","RC","73551","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM OF FEMUR,  2/> VIEWS","32000273","CDM","320","RC","73552","HCPCS","facility","both","","","","673","673","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM OF FEMUR,  2/> VIEWS","32000273","CDM","320","RC","73552","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC PANORAMIC X-RAY OF JAWS","32000274","CDM","320","RC","70355","HCPCS","facility","both","","","","139.91","139.91","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC LYMPHANGIOGRAPHY, EXTREMITY ONLY, BILATERAL","32000277","CDM","320","RC","75803","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC X-RAY EXAM ABDOMEN 1 VIEW","32000278","CDM","320","RC","74018","HCPCS","facility","both","","","","531","531","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM ABDOMEN 1 VIEW","32000278","CDM","320","RC","74018","HCPCS","facility","both","","","","186.56","186.56","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM ABDOMEN 2 VIEWS","32000279","CDM","320","RC","74019","HCPCS","facility","both","","","","807","807","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM ABDOMEN 2 VIEWS","32000279","CDM","320","RC","74019","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM ABDOMEN 3 OR MORE VIEWS","32000280","CDM","320","RC","74021","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM ABDOMEN 3 OR MORE VIEWS","32000280","CDM","320","RC","74021","HCPCS","facility","both","","","","1198","1198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY","32000281","CDM","320","RC","74248","HCPCS","facility","both","","","","1042","1042","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY","32000281","CDM","320","RC","74248","HCPCS","facility","both","","","","606.34","606.34","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX SCAN ARTERIAL INFLOW & VENOUS OUTFLOW, PREOP, COMPLT BIL STUDY","32000282","CDM","921","RC","93985","HCPCS","facility","both","","","","2984.98","2984.98","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX SCAN ARTERIAL INFLOW & VENOUS OUTFLOW, PREOP, COMPLT UNI STUDY","32000283","CDM","921","RC","93986","HCPCS","facility","both","","","","1725.68","1725.68","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CT CORONARY FFR, W/INTR & RPT","32000287","CDM","350","RC","75580","HCPCS","facility","both","","","","1840.15","1840.15","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC ESOPHOGRAM, INCL IMG, DOUBLE CONTRAST STUDY","32000288","CDM","320","RC","74221","HCPCS","facility","both","","","","1062.09","1062.09","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC MAMMOGRAPHIC GUID NEEDLE PLCMNT BREAST EACH ADDITIONAL","32002150","CDM","320","RC","77032","HCPCS","facility","both","","","","597","597","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAMMOGRAPHIC GUID NEEDLE PLCMNT BREAST EACH ADDITIONAL","32002150","CDM","320","RC","77032","HCPCS","facility","both","","","","981","981","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM SHOULDER, ARTHROGRAPHY","32200001","CDM","322","RC","73040","HCPCS","facility","both","","","","543.65","543.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM SHOULDER, ARTHROGRAPHY","32200001","CDM","322","RC","73040","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC RAD EXAM SHOULDER, ARTHROGRAPHY","32200001","CDM","322","RC","73040","HCPCS","facility","both","","","","1537","1537","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM SHOULDER, ARTHROGRAPHY","32200001","CDM","322","RC","73040","HCPCS","facility","both","","","","2538","2538","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ELBOW, ARTHROGRAPHY","32200002","CDM","322","RC","73085","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC RAD EXAM ELBOW, ARTHROGRAPHY","32200002","CDM","322","RC","73085","HCPCS","facility","both","","","","543.65","543.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM ELBOW, ARTHROGRAPHY","32200002","CDM","322","RC","73085","HCPCS","facility","both","","","","1714","1714","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ELBOW, ARTHROGRAPHY","32200002","CDM","322","RC","73085","HCPCS","facility","both","","","","2840","2840","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM WRIST ARTHROGRAPHY","32200003","CDM","322","RC","73115","HCPCS","facility","both","","","","543.65","543.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM WRIST ARTHROGRAPHY","32200003","CDM","322","RC","73115","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC RAD EXAM WRIST ARTHROGRAPHY","32200003","CDM","322","RC","73115","HCPCS","facility","both","","","","2399","2399","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM WRIST ARTHROGRAPHY","32200003","CDM","322","RC","73115","HCPCS","facility","both","","","","1448","1448","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM HIP ARTHROGRAPHY","32200004","CDM","322","RC","73525","HCPCS","facility","both","","","","543.65","543.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM HIP ARTHROGRAPHY","32200004","CDM","322","RC","73525","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC RAD EXAM HIP ARTHROGRAPHY","32200004","CDM","322","RC","73525","HCPCS","facility","both","","","","1537","1537","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM HIP ARTHROGRAPHY","32200004","CDM","322","RC","73525","HCPCS","facility","both","","","","2538","2538","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM KNEE ARTHROGRAPHY","32200005","CDM","322","RC","73580","HCPCS","facility","both","","","","3348","3348","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM KNEE ARTHROGRAPHY","32200005","CDM","322","RC","73580","HCPCS","facility","both","","","","2020","2020","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM KNEE ARTHROGRAPHY","32200005","CDM","322","RC","73580","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC RAD EXAM KNEE ARTHROGRAPHY","32200005","CDM","322","RC","73580","HCPCS","facility","both","","","","543.65","543.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM ANKLE ARTHROGRAPHY","32200006","CDM","322","RC","73615","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC RAD EXAM ANKLE ARTHROGRAPHY","32200006","CDM","322","RC","73615","HCPCS","facility","both","","","","2892","2892","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD EXAM ANKLE ARTHROGRAPHY","32200006","CDM","322","RC","73615","HCPCS","facility","both","","","","543.65","543.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RAD EXAM ANKLE ARTHROGRAPHY","32200006","CDM","322","RC","73615","HCPCS","facility","both","","","","1751","1751","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY TMJ JOINT ARTHROGRAPHY","32200007","CDM","322","RC","70332","HCPCS","facility","both","","","","2892","2892","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY TMJ JOINT ARTHROGRAPHY","32200007","CDM","322","RC","70332","HCPCS","facility","both","","","","1751","1751","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AORTOGRAPHY THORACIC BY SERIALOGRAPHY","32300001","CDM","323","RC","75605","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC AORTOGRAPHY THORACIC BY SERIALOGRAPHY","32300001","CDM","323","RC","75605","HCPCS","facility","both","","","","5493","5493","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AORTOGRAPHY ABDOMINAL BY SERIALOGRAPHY","32300002","CDM","323","RC","75625","HCPCS","facility","both","","","","3116","3116","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AORTOGRAPHY ABDOMINAL BY SERIALOGRAPHY","32300002","CDM","323","RC","75625","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC AORTOGRAM ABDOMINAL W/ BILATERAL RUNOFF","32300003","CDM","323","RC","75630","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC AORTOGRAM ABDOMINAL W/ BILATERAL RUNOFF","32300003","CDM","323","RC","75630","HCPCS","facility","both","","","","4790","4790","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY CERVICOCEREBRAL, CATHETER","32300004","CDM","323","RC","75650","HCPCS","facility","both","","","","1783","1783","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY EXTERNAL CAROTID, UNILAT","32300005","CDM","323","RC","75660","HCPCS","facility","both","","","","1198","1198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY EXTERNAL CAROTID, BILAT","32300006","CDM","323","RC","75662","HCPCS","facility","both","","","","2394","2394","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY, CAROTID, CEREBRAL, UNILAT","32300007","CDM","323","RC","75665","HCPCS","facility","both","","","","1444","1444","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY, CAROTID, CEREBRAL, BILAT","32300008","CDM","323","RC","75671","HCPCS","facility","both","","","","2604","2604","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY, CAROTID, CERVICAL, UNILAT","32300009","CDM","323","RC","75676","HCPCS","facility","both","","","","1344","1344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY, CAROTID, CERVICAL, BILAT","32300010","CDM","323","RC","75680","HCPCS","facility","both","","","","2263","2263","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY, VERTEBRAL, CERVIC/INTRACRAN","32300011","CDM","323","RC","75685","HCPCS","facility","both","","","","1171","1171","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY SPINAL SELECTIVE","32300012","CDM","323","RC","75705","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ANGIOGRAPHY SPINAL SELECTIVE","32300012","CDM","323","RC","75705","HCPCS","facility","both","","","","6241","6241","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY EXT UNILATERAL S & I","32300013","CDM","323","RC","75710","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ANGIOGRAPHY EXT UNILATERAL S & I","32300013","CDM","323","RC","75710","HCPCS","facility","both","","","","543.65","543.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ANGIOGRAPHY EXT UNILATERAL S & I","32300013","CDM","323","RC","75710","HCPCS","facility","both","","","","2814","2814","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY EXT BILATERAL S & I","32300014","CDM","323","RC","75716","HCPCS","facility","both","","","","3055","3055","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY EXT BILATERAL S & I","32300014","CDM","323","RC","75716","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ANGIOGRAPHY VISCERAL SELECT/SUPRASELECT","32300015","CDM","323","RC","75726","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ANGIOGRAPHY VISCERAL SELECT/SUPRASELECT","32300015","CDM","323","RC","75726","HCPCS","facility","both","","","","5027","5027","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY ADRENAL UNILATERAL SELECTIVE","32300016","CDM","323","RC","75731","HCPCS","facility","both","","","","2471","2471","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY ADRENAL UNILATERAL SELECTIVE","32300016","CDM","323","RC","75731","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ANGIOGRAPHY ADRENAL BILATERAL SELECTIVE","32300017","CDM","323","RC","75733","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ANGIOGRAPHY ADRENAL BILATERAL SELECTIVE","32300017","CDM","323","RC","75733","HCPCS","facility","both","","","","3792","3792","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY PELVIC SELECT/SUPRASELECT","32300018","CDM","323","RC","75736","HCPCS","facility","both","","","","4925","4925","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY PELVIC SELECT/SUPRASELECT","32300018","CDM","323","RC","75736","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ANGIOGRAPHY PELVIC SELECT/SUPRASELECT","32300018","CDM","323","RC","75736","HCPCS","facility","both","","","","171.08","171.08","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC ANGIOGRAPHY PULMONARY UNILAT SELECTIVE","32300019","CDM","323","RC","75741","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ANGIOGRAPHY PULMONARY UNILAT SELECTIVE","32300019","CDM","323","RC","75741","HCPCS","facility","both","","","","2729","2729","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY PULMONARY BILAT  SELECTIVE","32300020","CDM","323","RC","75743","HCPCS","facility","both","","","","3368","3368","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY PULMONARY BILAT  SELECTIVE","32300020","CDM","323","RC","75743","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ANGIOGRAPHY PULMONARY NONSEL CATH/INJECT","32300021","CDM","323","RC","75746","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ANGIOGRAPHY PULMONARY NONSEL CATH/INJECT","32300021","CDM","323","RC","75746","HCPCS","facility","both","","","","2869","2869","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY INTERNAL MAMMARY S & I","32300022","CDM","323","RC","75756","HCPCS","facility","both","","","","3194","3194","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANGIOGRAPHY INTERNAL MAMMARY S & I","32300022","CDM","323","RC","75756","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ANGIOGRAPHY SELECTIVE EA ADDTL VESSEL","32300023","CDM","323","RC","75774","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC ANGIOGRAPHY SELECTIVE EA ADDTL VESSEL","32300023","CDM","323","RC","75774","HCPCS","facility","both","","","","824","824","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RETROGRADE BRACHIAL ANGIOGRAM","32300025","CDM","323","RC","75658","HCPCS","facility","both","","","","1220","1220","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RETROGRADE BRACHIAL ANGIOGRAM","32300025","CDM","323","RC","75658","HCPCS","facility","both","","","","45.3","45.3","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC AV DIALYSIS SHUNT IMAGING","32300052","CDM","323","RC","75791","HCPCS","facility","both","","","","1530","1530","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AV DIALYSIS SHUNT IMAGING","32300052","CDM","323","RC","75791","HCPCS","facility","both","","","","50.21","50.21","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC CHEST X-RAY SINGLE VIEW, POSTEROANTERIOR","32400001","CDM","324","RC","71010","HCPCS","facility","both","","","","127.68","127.68","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CHEST X-RAY SINGLE VIEW, POSTEROANTERIOR","32400001","CDM","324","RC","71010","HCPCS","facility","both","","","","386","386","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEST X-RAY 2 VIEWS, FRONTAL AND LATERAL","32400002","CDM","324","RC","71020","HCPCS","facility","both","","","","159.6","159.6","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CHEST X-RAY 2 VIEWS, FRONTAL AND LATERAL","32400002","CDM","324","RC","71020","HCPCS","facility","both","","","","407","407","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEST X-RAY 2 VIEWS W/APICAL LORDOTIC PROJ","32400003","CDM","324","RC","71021","HCPCS","facility","both","","","","410","410","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEST X-RAY 2 VIEWS W/APICAL LORDOTIC PROJ","32400003","CDM","324","RC","71021","HCPCS","facility","both","","","","191.51","191.51","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CHEST X-RAY 2 VIEWS W/OBLIQUE PROJECTION","32400004","CDM","324","RC","71022","HCPCS","facility","both","","","","223.43","223.43","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CHEST X-RAY 2 VIEWS W/OBLIQUE PROJECTION","32400004","CDM","324","RC","71022","HCPCS","facility","both","","","","519","519","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEST X-RAY COMPLETE MIN 4 VIEWS","32400005","CDM","324","RC","71030","HCPCS","facility","both","","","","223.43","223.43","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CHEST X-RAY COMPLETE MIN 4 VIEWS","32400005","CDM","324","RC","71030","HCPCS","facility","both","","","","482","482","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEST X-RAY MIN 4 VIEWS W/FLUORO","32400006","CDM","324","RC","71034","HCPCS","facility","both","","","","542.61","542.61","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CHEST X-RAY SPECIAL VIEW(LATERAL DECUBITUS)","32400007","CDM","324","RC","71035","HCPCS","facility","both","","","","309","309","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEST X-RAY SPECIAL VIEW(LATERAL DECUBITUS)","32400007","CDM","324","RC","71035","HCPCS","facility","both","","","","223.43","223.43","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RIBS X-RAY, UNILAT, MIN 3 VIEWS INCL CHEST","32400009","CDM","320","RC","71101","HCPCS","facility","both","","","","700","700","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RIBS X-RAY, UNILAT, MIN 3 VIEWS INCL CHEST","32400009","CDM","320","RC","71101","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RIBS X-RAY, BILAT, MIN 4 VIEWS INCL CHEST","32400010","CDM","320","RC","71111","HCPCS","facility","both","","","","419.74","419.74","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC RIBS X-RAY, BILAT, MIN 4 VIEWS INCL CHEST","32400010","CDM","320","RC","71111","HCPCS","facility","both","","","","889","889","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STERNUM X-RAY MIN 2 VIEWS","32400011","CDM","320","RC","71120","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC STERNUM X-RAY MIN 2 VIEWS","32400011","CDM","320","RC","71120","HCPCS","facility","both","","","","571","571","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STERNOCLAVICULAR JT(S) X-RAY MIN 3 VIEWS","32400012","CDM","320","RC","71130","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC STERNOCLAVICULAR JT(S) X-RAY MIN 3 VIEWS","32400012","CDM","320","RC","71130","HCPCS","facility","both","","","","1051","1051","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STERNOCLAVICULAR JT(S) X-RAY MIN 3 VIEWS","32400012","CDM","320","RC","71130","HCPCS","facility","both","","","","641","641","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STERNOCLAVICULAR JT(S) X-RAY MIN 3 VIEWS","32400012","CDM","320","RC","71130","HCPCS","facility","both","","","","641","641","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM OF RIBS 2 VIEWS UNILAT","32400020","CDM","320","RC","71100","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM OF RIBS 2 VIEWS UNILAT","32400020","CDM","320","RC","71100","HCPCS","facility","both","","","","584","584","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM OF RIBS 3 VIEWS BILAT","32400022","CDM","320","RC","71110","HCPCS","facility","both","","","","748","748","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM OF RIBS 3 VIEWS BILAT","32400022","CDM","320","RC","71110","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CHEST X-RAY 2 VIEWS FR&LAT W FLUORO","32400024","CDM","324","RC","71023","HCPCS","facility","both","","","","383.03","383.03","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CHEST X-RAY 2 VIEWS FR&LAT W FLUORO","32400024","CDM","324","RC","71023","HCPCS","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM CHEST 1 VIEW","32400025","CDM","324","RC","71045","HCPCS","facility","both","","","","661","661","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM CHEST 1 VIEW","32400025","CDM","324","RC","71045","HCPCS","facility","both","","","","186.56","186.56","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM CHEST 2 VIEWS","32400026","CDM","324","RC","71046","HCPCS","facility","both","","","","698","698","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM CHEST 2 VIEWS","32400026","CDM","324","RC","71046","HCPCS","facility","both","","","","233.21","233.21","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM CHEST 3 VIEWS","32400027","CDM","324","RC","71047","HCPCS","facility","both","","","","773","773","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM CHEST 3 VIEWS","32400027","CDM","324","RC","71047","HCPCS","facility","both","","","","279.85","279.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC X-RAY EXAM CHEST 4 OR MORE VIEWS","32400028","CDM","324","RC","71048","HCPCS","facility","both","","","","827","827","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC X-RAY EXAM CHEST 4 OR MORE VIEWS","32400028","CDM","324","RC","71048","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CHEMOTHERAPY ADMIN, IM/SQ, NON-HORMONAL","33100001","CDM","331","RC","96401","HCPCS","facility","both","","","","168.65","168.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, IM/SQ, NON-HORMONAL","33100001","CDM","331","RC","96401","HCPCS","facility","both","","","","260.17","260.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, IM/SQ, NON-HORMONAL","33100001","CDM","331","RC","96401","HCPCS","facility","both","","","","450.86","450.86","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, IM/SQ, NON-HORMONAL","33100001","CDM","331","RC","96401","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC CHEMOTHERAPY ADMIN, IM/SQ, NON-HORMONAL","33100001","CDM","331","RC","96401","HCPCS","facility","both","","","","516","516","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY ADMIN, IM/SQ, HORMONAL","33100002","CDM","331","RC","96402","HCPCS","facility","both","","","","168.65","168.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, IM/SQ, HORMONAL","33100002","CDM","331","RC","96402","HCPCS","facility","both","","","","317","317","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY ADMIN, IM/SQ, HORMONAL","33100002","CDM","331","RC","96402","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC CHEMOTHERAPY ADMIN, IM/SQ, HORMONAL","33100002","CDM","331","RC","96402","HCPCS","facility","both","","","","450.86","450.86","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, IM/SQ, HORMONAL","33100002","CDM","331","RC","96402","HCPCS","facility","both","","","","260.17","260.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL","33100003","CDM","331","RC","96409","HCPCS","facility","both","","","","1111","1111","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL","33100003","CDM","331","RC","96409","HCPCS","facility","both","","","","371.65","371.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL","33100003","CDM","331","RC","96409","HCPCS","facility","both","","","","644.11","644.11","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL","33100003","CDM","331","RC","96409","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL","33100003","CDM","331","RC","96409","HCPCS","facility","both","","","","240.95","240.95","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, IVP EA ADDL","33100004","CDM","331","RC","96411","HCPCS","facility","both","","","","662","662","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY ADMIN, IVP EA ADDL","33100004","CDM","331","RC","96411","HCPCS","facility","both","","","","97.42","97.42","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC CHEMOTHERAPY ADMIN, IVP EA ADDL","33100004","CDM","331","RC","96411","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, IVP EA ADDL","33100004","CDM","331","RC","96411","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, IVP EA ADDL","33100004","CDM","331","RC","96411","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, CNS W/LP","33100005","CDM","331","RC","96450","HCPCS","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, CNS W/LP","33100005","CDM","331","RC","96450","HCPCS","facility","both","","","","1209","1209","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY ADMIN, CNS W/LP","33100005","CDM","331","RC","96450","HCPCS","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, CNS W/LP","33100005","CDM","331","RC","96450","HCPCS","facility","both","","","","627.66","627.66","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC CHEMOTHERAPY ADMIN, CNS W/LP","33100005","CDM","331","RC","96450","HCPCS","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, CNS W/LP","33100005","CDM","331","RC","96450","HCPCS","facility","both","","","","389.7","389.7","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC CHEMOTHERAPY INJ VIA SQ RESERVOIR","33100006","CDM","331","RC","96542","HCPCS","facility","both","","","","222.98","222.98","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMOTHERAPY INJ VIA SQ RESERVOIR","33100006","CDM","331","RC","96542","HCPCS","facility","both","","","","144.56","144.56","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CHEMOTHERAPY INJ VIA SQ RESERVOIR","33100006","CDM","331","RC","96542","HCPCS","facility","both","","","","386.48","386.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CHEMOTHERAPY INJ VIA SQ RESERVOIR","33100006","CDM","331","RC","96542","HCPCS","facility","both","","","","584.55","584.55","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC CHEMO INTRALESIONAL UP TO 7","33100007","CDM","331","RC","96405","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC CHEMO INTRALESIONAL UP TO 7","33100007","CDM","331","RC","96405","HCPCS","facility","both","","","","260.17","260.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMO INTRALESIONAL UP TO 7","33100007","CDM","331","RC","96405","HCPCS","facility","both","","","","168.65","168.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CHEMO INTRALESIONAL UP TO 7","33100007","CDM","331","RC","96405","HCPCS","facility","both","","","","381","381","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMO INTRALESIONAL UP TO 7","33100007","CDM","331","RC","96405","HCPCS","facility","both","","","","450.86","450.86","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CHEMO INTRALESIONAL OVER 7","33100008","CDM","331","RC","96406","HCPCS","facility","both","","","","260.17","260.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMO INTRALESIONAL OVER 7","33100008","CDM","331","RC","96406","HCPCS","facility","both","","","","450.86","450.86","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CHEMO INTRALESIONAL OVER 7","33100008","CDM","331","RC","96406","HCPCS","facility","both","","","","168.65","168.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CHEMO INTRALESIONAL OVER 7","33100008","CDM","331","RC","96406","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC CHEMO INTRALESIONAL OVER 7","33100008","CDM","331","RC","96406","HCPCS","facility","both","","","","660","660","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY ADM, INTRA-ARTERIAL; PUSH TECHNIQUE","33100009","CDM","331","RC","96420","HCPCS","facility","both","","","","2161","2161","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL","33191101","CDM","331","RC","96409","HCPCS","facility","both","","","","23","23","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL","33191102","CDM","331","RC","96409","HCPCS","facility","both","","","","541","541","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY ADMIN, IVP, SINGLE/INITIAL","33191103","CDM","331","RC","96409","HCPCS","facility","both","","","","449","449","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY ADMIN, IM/SQ, HORMONAL","33191104","CDM","331","RC","96402","HCPCS","facility","both","","","","117","117","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED CHEMOTHERAPY ADMIN, ORAL","33200001","CDM","332","RC","96549","HCPCS","facility","both","","","","92.14","92.14","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC UNLISTED CHEMOTHERAPY ADMIN, ORAL","33200001","CDM","332","RC","96549","HCPCS","facility","both","","","","97.42","97.42","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC UNLISTED CHEMOTHERAPY ADMIN, ORAL","33200001","CDM","332","RC","96549","HCPCS","facility","both","","","","174.51","174.51","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC UNLISTED CHEMOTHERAPY ADMIN, ORAL","33200001","CDM","332","RC","96549","HCPCS","facility","both","","","","65.3","65.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC THERA RAD SIMULATE-ADD FIELD SET, SIMPLE","33300001","CDM","333","RC","77280","HCPCS","facility","both","","","","2823","2823","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERA RAD SIMULATE-ADD FIELD SET, SIMPLE","33300001","CDM","333","RC","77280","HCPCS","facility","both","","","","1023.93","1023.93","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC THERA RAD SIMULATE-ADD FIELD SET, COMPLX","33300002","CDM","333","RC","77290","HCPCS","facility","both","","","","1861.7","1861.7","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC THERA RAD SIMULATE-ADD FIELD SET, COMPLX","33300002","CDM","333","RC","77290","HCPCS","facility","both","","","","5086","5086","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERA RAD SIMULATE-ADD FIELD SET, 3D","33300003","CDM","333","RC","77295","HCPCS","facility","both","","","","1148.02","1148.02","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC THERA RAD SIMULATE-ADD FIELD SET, 3D","33300003","CDM","333","RC","77295","HCPCS","facility","both","","","","6897","6897","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BASIC RADIATION DOSIMETRY CALCULATION","33300004","CDM","333","RC","77300","HCPCS","facility","both","","","","1201","1201","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BASIC RADIATION DOSIMETRY CALCULATION","33300004","CDM","333","RC","77300","HCPCS","facility","both","","","","40.02","40.02","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC BASIC RADIATION DOSIMETRY CALCULATION","33300004","CDM","333","RC","77300","HCPCS","facility","both","","","","139.66","139.66","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC INTENSITY MODULATED RADIOTHERAPY PLAN","33300005","CDM","333","RC","77301","HCPCS","facility","both","","","","13830","13830","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTENSITY MODULATED RADIOTHERAPY PLAN","33300005","CDM","333","RC","77301","HCPCS","facility","both","","","","6593.56","6593.56","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC TELETHERAPY ISODOSE PLAN SIMPLE 1-2 PORTS","33300006","CDM","333","RC","77305","HCPCS","facility","both","","","","767","767","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TELETHERAPY ISODOSE PLAN INTERMED 3+ PORTS","33300007","CDM","333","RC","77310","HCPCS","facility","both","","","","1045","1045","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TELETHERAPY ISODOSE PLAN COMPLEX","33300008","CDM","333","RC","77315","HCPCS","facility","both","","","","1315","1315","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRACHTX ISODOSE PLAN SIMPLE 1-4 SOURCES","33300009","CDM","333","RC","77326","HCPCS","facility","both","","","","628","628","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRACHTX ISODOSE PLAN INTERM 5-10 SOURCES","33300010","CDM","333","RC","77327","HCPCS","facility","both","","","","803","803","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRACHTX ISODOSE PLAN COMPLX 10+ SOURCES","33300011","CDM","333","RC","77328","HCPCS","facility","both","","","","980","980","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECIAL DOSIMETRY","33300012","CDM","333","RC","77331","HCPCS","facility","both","","","","999","999","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECIAL DOSIMETRY","33300012","CDM","333","RC","77331","HCPCS","facility","both","","","","77.58","77.58","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC TREATMENT DEVICES SIMPLE","33300013","CDM","333","RC","77332","HCPCS","facility","both","","","","232.75","232.75","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC TREATMENT DEVICES SIMPLE","33300013","CDM","333","RC","77332","HCPCS","facility","both","","","","1190","1190","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TREATMENT DEVICES INTERMEDIATE","33300014","CDM","333","RC","77333","HCPCS","facility","both","","","","310.25","310.25","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC TREATMENT DEVICES INTERMEDIATE","33300014","CDM","333","RC","77333","HCPCS","facility","both","","","","2313","2313","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TREATMENT DEVICES COMPLEX","33300015","CDM","333","RC","77334","HCPCS","facility","both","","","","2682","2682","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TREATMENT DEVICES COMPLEX","33300015","CDM","333","RC","77334","HCPCS","facility","both","","","","387.87","387.87","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC QUALITY ASSURANCE CHECK FOR RADIATION THERAPY; PER WEEK BY MED TECHNICIAN","33300016","CDM","333","RC","77336","HCPCS","facility","both","","","","325.8","325.8","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC QUALITY ASSURANCE CHECK FOR RADIATION THERAPY; PER WEEK BY MED TECHNICIAN","33300016","CDM","333","RC","77336","HCPCS","facility","both","","","","1840","1840","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESIGN MLC DEVICE FOR INTENSITY MOD RAD TX","33300017","CDM","333","RC","77338","HCPCS","facility","both","","","","1225.65","1225.65","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC DESIGN MLC DEVICE FOR INTENSITY MOD RAD TX","33300017","CDM","333","RC","77338","HCPCS","facility","both","","","","2570","2570","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECIAL MED RADIATION PHYSICS CONSULTATION","33300018","CDM","333","RC","77370","HCPCS","facility","both","","","","496.49","496.49","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC SPECIAL MED RADIATION PHYSICS CONSULTATION","33300018","CDM","333","RC","77370","HCPCS","facility","both","","","","2238","2238","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD TX DELIVERY SINGLE AREA 6-10 MEV","33300019","CDM","333","RC","77403","HCPCS","facility","both","","","","649","649","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD TX DELIVERY SINGLE AREA 11-19 MEV","33300020","CDM","333","RC","77404","HCPCS","facility","both","","","","671","671","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD TX DELIVERY 3+ AREAS 11-19 MEV","33300022","CDM","333","RC","77414","HCPCS","facility","both","","","","881","881","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD TX DELIVERY 3+ AREAS 20+ MEV","33300023","CDM","333","RC","77416","HCPCS","facility","both","","","","901","901","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPEUTIC RADIOLOGY PORT FILM(S)","33300024","CDM","333","RC","77417","HCPCS","facility","both","","","","648","648","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPEUTIC RADIOLOGY PORT FILM(S)","33300024","CDM","333","RC","77417","HCPCS","facility","both","","","","46.51","46.51","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC SPECIAL RADIATION TREATMENT","33300026","CDM","333","RC","77470","HCPCS","facility","both","","","","3058","3058","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECIAL RADIATION TREATMENT","33300026","CDM","333","RC","77470","HCPCS","facility","both","","","","201.7","201.7","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC INFUSION/INSTILLATION RADIOELEMENT SOLUTION","33300027","CDM","333","RC","77750","HCPCS","facility","both","","","","480.99","480.99","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC INFUSION/INSTILLATION RADIOELEMENT SOLUTION","33300027","CDM","333","RC","77750","HCPCS","facility","both","","","","1726","1726","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRACAVITARY RAD SOURCE APPLICAT INTERMED","33300028","CDM","333","RC","77762","HCPCS","facility","both","","","","946.36","946.36","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC INTRACAVITARY RAD SOURCE APPLICAT COMPLEX","33300029","CDM","333","RC","77763","HCPCS","facility","both","","","","7228","7228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRACAVITARY RAD SOURCE APPLICAT COMPLEX","33300029","CDM","333","RC","77763","HCPCS","facility","both","","","","1225.65","1225.65","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC INTERSTITIAL RAD SOURCE APPLICATION COMPLEX","33300030","CDM","333","RC","77778","HCPCS","facility","both","","","","6829","6829","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTERSTITIAL RAD SOURCE APPLICATION COMPLEX","33300030","CDM","333","RC","77778","HCPCS","facility","both","","","","1241.12","1241.12","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC HDR RADIONUCLIDE BRACHYTX 1 CHANNEL","33300031","CDM","333","RC","77785","HCPCS","facility","both","","","","3747","3747","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HDR RADIONUCLIDE BRACHYTX 2-12 CHANNELS","33300032","CDM","333","RC","77786","HCPCS","facility","both","","","","3747","3747","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HDR RADIONUCLIDE BRACHYTX OVER 12 CHANNEL","33300033","CDM","333","RC","77787","HCPCS","facility","both","","","","4684","4684","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SUPERVISION, HANDLING, LOADING - RAD SOURCE","33300034","CDM","333","RC","77790","HCPCS","facility","both","","","","186.18","186.18","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC SUPERVISION, HANDLING, LOADING - RAD SOURCE","33300034","CDM","333","RC","77790","HCPCS","facility","both","","","","1198","1198","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STEREOTACTIC RADIOSURGERY, MAX 5 SESSIONS","33300036","CDM","333","RC","","","facility","both","","","","3605","3605","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SIMULATION; INTERMEDIATE","33300050","CDM","333","RC","77285","HCPCS","facility","both","","","","1613.5","1613.5","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC SIMULATION; INTERMEDIATE","33300050","CDM","333","RC","77285","HCPCS","facility","both","","","","4353","4353","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMIBODY PARTICLES TOTAL BODY","33300052","CDM","333","RC","77321","HCPCS","facility","both","","","","2512","2512","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMIBODY PARTICLES TOTAL BODY","33300052","CDM","333","RC","77321","HCPCS","facility","both","","","","186.18","186.18","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC RADIATION TX DELIVERY 6-10 MEV","33300053","CDM","333","RC","77408","HCPCS","facility","both","","","","752","752","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIATION TX DELIVERY 11-19 MEV","33300055","CDM","333","RC","77409","HCPCS","facility","both","","","","777","777","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIATION TX DELIVERY 3+ AREAS <= 5 MEV","33300057","CDM","333","RC","77412","HCPCS","facility","both","","","","860","860","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIATION TX DELIVERY 3+ AREAS <= 5 MEV","33300057","CDM","333","RC","77412","HCPCS","facility","both","","","","860","860","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC STEREOSCOPIC X-RAY GUIDANCE","33300058","CDM","333","RC","77421","HCPCS","facility","both","","","","155","155","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROBOT LNR SRS COMPL/1ST FRACT","33300060","CDM","333","RC","","","facility","both","","","","15870","15870","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROBOT LIN-RADSURG FRACTX 2-5","33300061","CDM","333","RC","","","facility","both","","","","10741","10741","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SRS LINEAR BASED, 1 SESSION","33300073","CDM","333","RC","77372","HCPCS","facility","both","","","","46308","46308","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SRS LINEAR BASED, 1 SESSION","33300073","CDM","333","RC","77372","HCPCS","facility","both","","","","4607.69","4607.69","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC SBRT DELIVERY PER FRACTION","33300074","CDM","333","RC","77373","HCPCS","facility","both","","","","5848.87","5848.87","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC SBRT DELIVERY PER FRACTION","33300074","CDM","333","RC","77373","HCPCS","facility","both","","","","18656","18656","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GUIDANCE FOR RADIATION TX","33300076","CDM","333","RC","77387","HCPCS","facility","both","","","","310.25","310.25","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC GUIDANCE FOR RADIATION TX","33300076","CDM","333","RC","77387","HCPCS","facility","both","","","","486","486","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GUIDANCE FOR RADIATION TX","33300076","CDM","333","RC","77387","HCPCS","facility","both","","","","486","486","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TELETHERAPY ISODOSE PLAN, COMPLEX","33300077","CDM","333","RC","77307","HCPCS","facility","both","","","","3865","3865","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TELETHERAPY ISODOSE PLAN, COMPLEX","33300077","CDM","333","RC","77307","HCPCS","facility","both","","","","3865","3865","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TELETHERAPY ISODOSE PLAN, COMPLEX","33300077","CDM","333","RC","77307","HCPCS","facility","both","","","","574.09","574.09","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC BRACHYTHERAPY ISODOSE PLAN, SIMPLE","33300078","CDM","333","RC","77316","HCPCS","facility","both","","","","496.49","496.49","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC BRACHYTHERAPY ISODOSE PLAN, SIMPLE","33300078","CDM","333","RC","77316","HCPCS","facility","both","","","","2387","2387","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRACHYTHERAPY ISODOSE PLAN, INTERMEDIATE","33300079","CDM","333","RC","77317","HCPCS","facility","both","","","","2837","2837","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRACHYTHERAPY ISODOSE PLAN, INTERMEDIATE","33300079","CDM","333","RC","77317","HCPCS","facility","both","","","","636.12","636.12","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC BRACHYTHERAPY ISODOSE PLAN, COMPLEX","33300080","CDM","333","RC","77318","HCPCS","facility","both","","","","868.81","868.81","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC BRACHYTHERAPY ISODOSE PLAN, COMPLEX","33300080","CDM","333","RC","77318","HCPCS","facility","both","","","","3361","3361","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTENSITY MODULATED RAD TX DELIVERY (IMRT), SIMPLE","33300081","CDM","333","RC","77385","HCPCS","facility","both","","","","1737.63","1737.63","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC INTENSITY MODULATED RAD TX DELIVERY (IMRT), SIMPLE","33300081","CDM","333","RC","77385","HCPCS","facility","both","","","","3722","3722","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INTENSITY MODULATED RAD TX DELIVERY (IMRT), SIMPLE","33300081","CDM","333","RC","77385","HCPCS","facility","both","","","","3722","3722","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTENSITY MODULATED RAD TX DELIVERY (IMRT), COMPLEX","33300082","CDM","333","RC","77386","HCPCS","facility","both","","","","3729","3729","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC INTENSITY MODULATED RAD TX DELIVERY (IMRT), COMPLEX","33300082","CDM","333","RC","77386","HCPCS","facility","both","","","","1737.63","1737.63","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC INTENSITY MODULATED RAD TX DELIVERY (IMRT), COMPLEX","33300082","CDM","333","RC","77386","HCPCS","facility","both","","","","3729","3729","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TELETHERAPY ISODOSE PLAN, SIMPLE","33300083","CDM","333","RC","77306","HCPCS","facility","both","","","","2767","2767","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TELETHERAPY ISODOSE PLAN, SIMPLE","33300083","CDM","333","RC","77306","HCPCS","facility","both","","","","2767","2767","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC TELETHERAPY ISODOSE PLAN, SIMPLE","33300083","CDM","333","RC","77306","HCPCS","facility","both","","","","310.25","310.25","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC RADIATION TREATMENT DELIVERY, =>1 MEV; SIMPLE","33300084","CDM","333","RC","77402","HCPCS","facility","both","","","","698.13","698.13","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC RADIATION TREATMENT DELIVERY, =>1 MEV; SIMPLE","33300084","CDM","333","RC","77402","HCPCS","facility","both","","","","1257","1257","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIATION TREATMENT DELIVERY, =>1 MEV; INTERMEDIATE","33300085","CDM","333","RC","77407","HCPCS","facility","both","","","","1817","1817","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIATION TREATMENT DELIVERY, =>1 MEV; INTERMEDIATE","33300085","CDM","333","RC","77407","HCPCS","facility","both","","","","1117.02","1117.02","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC RADIATION TREATMENT DELIVERY,=>1 MEV; COMPLEX","33300086","CDM","333","RC","77412","HCPCS","facility","both","","","","1194.62","1194.62","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC RADIATION TREATMENT DELIVERY,=>1 MEV; COMPLEX","33300086","CDM","333","RC","77412","HCPCS","facility","both","","","","1537","1537","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HDR RDNCL INTERSTITIAL/INTRACAV BRCHTX, 1 CHANNEL","33300087","CDM","333","RC","77770","HCPCS","facility","both","","","","7155","7155","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HDR RDNCL INTERSTITIAL/INTRACAV BRCHTX, 1 CHANNEL","33300087","CDM","333","RC","77770","HCPCS","facility","both","","","","713.69","713.69","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC HDR RDNCL INTERSTITIAL/INTRACAV BRCHTX, 2-12 CHANNELS","33300088","CDM","333","RC","77771","HCPCS","facility","both","","","","7155","7155","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HDR RDNCL INTERSTITIAL/INTRACAV BRCHTX, 2-12 CHANNELS","33300088","CDM","333","RC","77771","HCPCS","facility","both","","","","1396.26","1396.26","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC HDR RDNCL INTERSTITIAL/INTRACAV BRCHTX, OVER 12 CHANNELS","33300089","CDM","333","RC","77772","HCPCS","facility","both","","","","7902","7902","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HDR RDNCL INTERSTITIAL/INTRACAV BRCHTX, OVER 12 CHANNELS","33300089","CDM","333","RC","77772","HCPCS","facility","both","","","","2280.63","2280.63","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC TRANSPERINEAL PLMT OF BIODEGRADABLE MATRL W/IMAGE","33300091","CDM","333","RC","","","facility","both","","","","219.33","219.33","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC TRNSPERNEAL PLCMNT BDGRDABL MATRL, PERI-PROSTATIC,  1+  INJ, W/IMAG","33300092","CDM","333","RC","55874","HCPCS","facility","both","","","","341.34","341.34","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC TRNSPERNEAL PLCMNT BDGRDABL MATRL, PERI-PROSTATIC,  1+  INJ, W/IMAG","33300092","CDM","333","RC","55874","HCPCS","facility","both","","","","18323","18323","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTON TX DELIVERY SIMPLE W/O COMPENSATION","33300093","CDM","333","RC","77520","HCPCS","facility","both","","","","4472","4472","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTON TX DELIVERY SIMPLE W/COMPENSATION","33300094","CDM","333","RC","77522","HCPCS","facility","both","","","","7423","7423","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTON TX DELIVERY INTERMEDIATE","33300095","CDM","333","RC","77523","HCPCS","facility","both","","","","7548","7548","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROTON TX DELIVERY COMPLEX","33300096","CDM","333","RC","77525","HCPCS","facility","both","","","","7555","7555","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SURFACE APPLICATION OF LOW DOSE RATE RADIONUCLIDE SOURCE","33300097","CDM","333","RC","77789","HCPCS","facility","both","","","","263.77","263.77","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC SURFACE APPLICATION OF LOW DOSE RATE RADIONUCLIDE SOURCE","33300097","CDM","333","RC","77789","HCPCS","facility","both","","","","1076","1076","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RESPIRATORY MOTION MGMT SIMULATION","33300098","CDM","333","RC","77293","HCPCS","facility","both","","","","1046","1046","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RESPIRATORY MOTION MGMT SIMULATION","33300098","CDM","333","RC","77293","HCPCS","facility","both","","","","1566.41","1566.41","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC RAD TX, BRACHYTHERAPY, LESION UP TO 2.0 CM/1 CHANNEL","33300099","CDM","333","RC","77767","HCPCS","facility","both","","","","657","657","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD TX, BRACHYTHERAPY, LESION UP TO 2.0 CM/1 CHANNEL","33300099","CDM","333","RC","77767","HCPCS","facility","both","","","","713.41","713.41","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC RAD TX, BRACHYTHERAPY, LESION > 2.0 CM & 2 + CHANNELS/MULT LESION","33300100","CDM","333","RC","77768","HCPCS","facility","both","","","","983","983","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD TX, BRACHYTHERAPY, LESION > 2.0 CM & 2 + CHANNELS/MULT LESION","33300100","CDM","333","RC","77768","HCPCS","facility","both","","","","713.41","713.41","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC TRANSPERINEAL PROSTATE PLACEMENT NEEDLES/CATHETERS FOR BRACHYTHERAPY","33300101","CDM","333","RC","55875","HCPCS","facility","both","","","","11000","11000","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLMT ENDORECTAL INTRACAVITARY APPLICATOR","33300102","CDM","333","RC","","","facility","both","","","","1900","1900","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THERAPY ANAL, TC","33390001","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THERAPY BLADDER, TC","33390002","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THER BONE METS, TC","33390003","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THER BRAIN METS, TC","33390004","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THERAPY BREAST, TC","33390005","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THERAPY CERVICAL, TC","33390006","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THERAPY CNS, TC","33390007","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THER COLORECTAL, TC","33390008","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THER HEAD/NECK, TC","33390009","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THERAPY LUNG, TC","33390010","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THERAPY LYMPHOMA, TC","33390011","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THERAPY PANCREAS, TC","33390012","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THERAPY PROSTATE, TC","33390013","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THERAPY GI, TC","33390014","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ROM RAD THERAPY UTERUS, TC","33390015","CDM","333","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD TX DELIVERY 3+ AREAS 6-10 MEV","33391101","CDM","333","RC","77413","HCPCS","facility","both","","","","856","856","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD TX DELIVERY 3+ AREAS 6-10 MEV","33391102","CDM","333","RC","77413","HCPCS","facility","both","","","","856","856","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTENSITY MODULATED TX DELIVERY/TX SESSION","33391103","CDM","333","RC","77418","HCPCS","facility","both","","","","2124","2124","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTENSITY MODULATED TX DELIVERY/TX SESSION","33391104","CDM","333","RC","77418","HCPCS","facility","both","","","","2124","2124","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD DELIVERY SINGLE AREA ; UP TO 5 MEV","33391105","CDM","333","RC","77402","HCPCS","facility","both","","","","658","658","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RAD DELIVERY SINGLE AREA ; UP TO 5 MEV","33391105","CDM","333","RC","77402","HCPCS","facility","both","","","","658","658","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RAD TX DELIVERY SINGLE AREA 20 MEV/>","33391106","CDM","333","RC","77406","HCPCS","facility","both","","","","694","694","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIATION TX DELIVERY <= 5 MEV","33391107","CDM","333","RC","77407","HCPCS","facility","both","","","","769","769","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RADIATION TX DELIVERY <= 5 MEV","33391107","CDM","333","RC","77407","HCPCS","facility","both","","","","769","769","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIATION TX DELIVERY 20+ MEV","33391108","CDM","333","RC","77411","HCPCS","facility","both","","","","800","800","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY IV INFUSION, 1ST HR","33500001","CDM","335","RC","96413","HCPCS","facility","both","","","","1424","1424","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY IV INFUSION, 1ST HR","33500001","CDM","335","RC","96413","HCPCS","facility","both","","","","584.55","584.55","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC CHEMOTHERAPY IV INFUSION, 1ST HR","33500001","CDM","335","RC","96413","HCPCS","facility","both","","","","1159.41","1159.41","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CHEMOTHERAPY IV INFUSION, 1ST HR","33500001","CDM","335","RC","96413","HCPCS","facility","both","","","","668.95","668.95","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMOTHERAPY IV INFUSION, 1ST HR","33500001","CDM","335","RC","96413","HCPCS","facility","both","","","","433.7","433.7","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CHEMOTHERAPY IV INFUSION, EA ADDL HR","33500002","CDM","335","RC","96415","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CHEMOTHERAPY IV INFUSION, EA ADDL HR","33500002","CDM","335","RC","96415","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMOTHERAPY IV INFUSION, EA ADDL HR","33500002","CDM","335","RC","96415","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CHEMOTHERAPY IV INFUSION, EA ADDL HR","33500002","CDM","335","RC","96415","HCPCS","facility","both","","","","521","521","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY IV INFUSION, EA ADDL HR","33500002","CDM","335","RC","96415","HCPCS","facility","both","","","","292.28","292.28","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC CHEMOTHERAPY IV INFUSION, EA ADDL SEQ","33500003","CDM","335","RC","96417","HCPCS","facility","both","","","","24.07","24.07","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CHEMOTHERAPY IV INFUSION, EA ADDL SEQ","33500003","CDM","335","RC","96417","HCPCS","facility","both","","","","64.43","64.43","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CHEMOTHERAPY IV INFUSION, EA ADDL SEQ","33500003","CDM","335","RC","96417","HCPCS","facility","both","","","","292.28","292.28","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC CHEMOTHERAPY IV INFUSION, EA ADDL SEQ","33500003","CDM","335","RC","96417","HCPCS","facility","both","","","","442","442","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY IV INFUSION, EA ADDL SEQ","33500003","CDM","335","RC","96417","HCPCS","facility","both","","","","37.16","37.16","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, PERITONEAL VIA INDWELLING PORT OR CATH","33500004","CDM","335","RC","96446","HCPCS","facility","both","","","","1237","1237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY ADMIN, PERITONEAL VIA INDWELLING PORT OR CATH","33500004","CDM","335","RC","96446","HCPCS","facility","both","","","","1461.38","1461.38","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC CHEMOTHERAPY ADMIN, PERITONEAL VIA INDWELLING PORT OR CATH","33500004","CDM","335","RC","96446","HCPCS","facility","both","","","","2617.58","2617.58","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CHEMOTHERAPY ADMIN, PERITONEAL VIA INDWELLING PORT OR CATH","33500004","CDM","335","RC","96446","HCPCS","facility","both","","","","1672.22","1672.22","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMO PROLONG 8+ HRS INFUSE W/PUMP","33500005","CDM","335","RC","96416","HCPCS","facility","both","","","","4460","4460","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMO PROLONG 8+ HRS INFUSE W/PUMP","33500005","CDM","335","RC","96416","HCPCS","facility","both","","","","668.96","668.96","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMO PROLONG 8+ HRS INFUSE W/PUMP","33500005","CDM","335","RC","96416","HCPCS","facility","both","","","","941.72","941.72","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"DEAC 09/24/2022 HC CHEMOTHERAPY ADM, EXTENDED,  IV INFUSION W/PORTABLE PUMP","33500006","CDM","335","RC","","","facility","both","","","","995.26","995.26","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"DEAC 09/24/2022 HC CHEMOTHERAPY ADM, EXTENDED,  IV INFUSION W/PORTABLE PUMP","33500006","CDM","335","RC","","","facility","both","","","","856","856","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHER, IA INFUSION TECH >8 HOURS","33500007","CDM","335","RC","96425","HCPCS","facility","both","","","","1318","1318","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHER, IA INFUSION TECH >8 HOURS","33500007","CDM","335","RC","96425","HCPCS","facility","both","","","","222.96","222.96","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC CHEMOTHERAPY IV INFUSION, 1ST HR","33591101","CDM","335","RC","96413","HCPCS","facility","both","","","","638","638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY IV INFUSION, 1ST 0.5 HR","33591102","CDM","335","RC","96413","HCPCS","facility","both","","","","582","582","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY IV INFUSION, 1ST HR","33591103","CDM","335","RC","96413","HCPCS","facility","both","","","","678","678","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY IV INFUSION, EA ADDL HR","33591104","CDM","335","RC","96415","HCPCS","facility","both","","","","194","194","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMOTHERAPY IV INFUSION, EA ADDL HR","33591105","CDM","335","RC","96415","HCPCS","facility","both","","","","194","194","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THYROID UPTAKE MULTIPLE DETERMINATIONS","34100001","CDM","341","RC","78001","HCPCS","facility","both","","","","566","566","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THYROID IMAGING ONLY","34100003","CDM","341","RC","78010","HCPCS","facility","both","","","","957","957","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THYROID CARCINOMA METAST IMAG WHOLE BODY","34100004","CDM","341","RC","78018","HCPCS","facility","both","","","","2940","2940","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THYROID CARCINOMA METAST IMAG WHOLE BODY","34100004","CDM","341","RC","78018","HCPCS","facility","both","","","","853.58","853.58","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC PARATHYROID IMAGING","34100005","CDM","341","RC","78070","HCPCS","facility","both","","","","821.11","821.11","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC PARATHYROID IMAGING","34100005","CDM","341","RC","78070","HCPCS","facility","both","","","","800","800","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADRENAL IMAGING CORTEX AND/OR MEDULLA","34100006","CDM","341","RC","78075","HCPCS","facility","both","","","","1285.72","1285.72","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC ADRENAL IMAGING CORTEX AND/OR MEDULLA","34100006","CDM","341","RC","78075","HCPCS","facility","both","","","","5330","5330","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLASMA VOL RADPHARM VOL-DIL TECHN, MULTI","34100007","CDM","341","RC","78111","HCPCS","facility","both","","","","259.28","259.28","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC RED CELL VOLUME DETERMINATION MULTI SAMPLE","34100008","CDM","341","RC","78121","HCPCS","facility","both","","","","280.92","280.92","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC LYMPHATICS AND LYMPH NODE IMAGING","34100009","CDM","341","RC","78195","HCPCS","facility","both","","","","1954","1954","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYMPHATICS AND LYMPH NODE IMAGING","34100009","CDM","341","RC","78195","HCPCS","facility","both","","","","939.99","939.99","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC LIVER IMAGING W VASCULAR FLOW","34100010","CDM","341","RC","78202","HCPCS","facility","both","","","","2567","2567","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIVER IMAGING W VASCULAR FLOW","34100010","CDM","341","RC","78202","HCPCS","facility","both","","","","561.82","561.82","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC LIVER IMAGING (SPECT)","34100011","CDM","341","RC","78205","HCPCS","facility","both","","","","598.98","598.98","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC LIVER IMAGING (SPECT)","34100011","CDM","341","RC","78205","HCPCS","facility","both","","","","2218","2218","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIVER IMAGING (SPECT) W/VASCULAR FLOW","34100012","CDM","341","RC","78206","HCPCS","facility","both","","","","2218","2218","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIVER IMAGING (SPECT) W/VASCULAR FLOW","34100012","CDM","341","RC","78206","HCPCS","facility","both","","","","990.62","990.62","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC HEPATOBILIARY SYSTEM IMAG INC GALLBLADDER","34100013","CDM","341","RC","78226","HCPCS","facility","both","","","","929.16","929.16","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC HEPATOBILIARY SYSTEM IMAG INC GALLBLADDER","34100013","CDM","341","RC","78226","HCPCS","facility","both","","","","1896","1896","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASTROESOPHAGEAL REFLUX SCAN","34100014","CDM","341","RC","78262","HCPCS","facility","both","","","","1191","1191","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASTROESOPHAGEAL REFLUX SCAN","34100014","CDM","341","RC","78262","HCPCS","facility","both","","","","659.06","659.06","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC GASTRIC EMPTYING STUDY, SOLID","34100015","CDM","341","RC","78264","HCPCS","facility","both","","","","1274","1274","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASTRIC EMPTYING STUDY, SOLID","34100015","CDM","341","RC","78264","HCPCS","facility","both","","","","789.04","789.04","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC UREA BREATH TEST C-14 (ISOTOPIC), ACQUISTION","34100016","CDM","341","RC","78267","HCPCS","facility","both","","","","106","106","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UREA BREATH TEST C-14 (ISOTOPIC), ACQUISTION","34100016","CDM","341","RC","78267","HCPCS","facility","both","","","","280.92","280.92","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC UREA BREATH TEST C-14 (ISOTOPIC), ANALYSIS","34100017","CDM","341","RC","78268","HCPCS","facility","both","","","","140.41","140.41","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC UREA BREATH TEST C-14 (ISOTOPIC), ANALYSIS","34100017","CDM","341","RC","78268","HCPCS","facility","both","","","","467","467","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING","34100018","CDM","341","RC","78278","HCPCS","facility","both","","","","1725","1725","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING","34100018","CDM","341","RC","78278","HCPCS","facility","both","","","","950.79","950.79","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC INTESTINE IMAGING E.G. MECKEL'S LOCALIZATION","34100019","CDM","341","RC","78290","HCPCS","facility","both","","","","939.99","939.99","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC INTESTINE IMAGING E.G. MECKEL'S LOCALIZATION","34100019","CDM","341","RC","78290","HCPCS","facility","both","","","","1889","1889","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERITONEAL-VENOUS SHUNT PATENCY TEST","34100020","CDM","341","RC","78291","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC PERITONEAL-VENOUS SHUNT PATENCY TEST","34100020","CDM","341","RC","78291","HCPCS","facility","both","","","","1409","1409","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERITONEAL-VENOUS SHUNT PATENCY TEST","34100020","CDM","341","RC","78291","HCPCS","facility","both","","","","669.85","669.85","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC BONE AND/OR JOINT IMAGING, LIMITED AREA","34100021","CDM","341","RC","78300","HCPCS","facility","both","","","","475.4","475.4","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC BONE AND/OR JOINT IMAGING, LIMITED AREA","34100021","CDM","341","RC","78300","HCPCS","facility","both","","","","3213","3213","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE AND/OR JOINT IMAGING, WHOLE BODY","34100022","CDM","341","RC","78306","HCPCS","facility","both","","","","2949","2949","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE AND/OR JOINT IMAGING, WHOLE BODY","34100022","CDM","341","RC","78306","HCPCS","facility","both","","","","659.06","659.06","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC BONE AND/OR JOINT IMAGING , 3 PHASE STUDY","34100023","CDM","341","RC","78315","HCPCS","facility","both","","","","939.99","939.99","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC BONE AND/OR JOINT IMAGING , 3 PHASE STUDY","34100023","CDM","341","RC","78315","HCPCS","facility","both","","","","1737","1737","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDIAC SHUNT DETECTION","34100025","CDM","341","RC","78428","HCPCS","facility","both","","","","453.83","453.83","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC MYOCARD PERF IMAG SPECT SGL AT REST/STRESS","34100026","CDM","341","RC","78451","HCPCS","facility","both","","","","864.32","864.32","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC MYOCARD PERF IMAG SPECT MULTI  REST/STRESS","34100027","CDM","341","RC","78452","HCPCS","facility","both","","","","5860","5860","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYOCARD PERF IMAG SPECT MULTI  REST/STRESS","34100027","CDM","341","RC","78452","HCPCS","facility","both","","","","1242.46","1242.46","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC MYOCARD PERF IMAG PLANAR SGL REST/STRESS","34100028","CDM","341","RC","78453","HCPCS","facility","both","","","","799.52","799.52","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC MYOCARD PERF IMAG PLANAR SGL REST/STRESS","34100028","CDM","341","RC","78453","HCPCS","facility","both","","","","1394","1394","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDO BLD POOL IMAG PLANAR SNG REST/STRESS","34100029","CDM","341","RC","78472","HCPCS","facility","both","","","","572.61","572.61","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC CARDO BLD POOL IMAG PLANAR SNG REST/STRESS","34100029","CDM","341","RC","78472","HCPCS","facility","both","","","","1831","1831","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PULMONARY VENTILATION IMAG (AEROSOL/GAS)","34100030","CDM","341","RC","78579","HCPCS","facility","both","","","","507.81","507.81","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC PULMONARY VENTILATION IMAG (AEROSOL/GAS)","34100030","CDM","341","RC","78579","HCPCS","facility","both","","","","1911","1911","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PULMONARY PERFUSION IMAGING PARTICULATE","34100031","CDM","341","RC","78580","HCPCS","facility","both","","","","637.47","637.47","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC PULMONARY PERFUSION IMAGING PARTICULATE","34100031","CDM","341","RC","78580","HCPCS","facility","both","","","","1971","1971","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PULMONARY VENTILATION & PERFUSION IMAGING","34100032","CDM","341","RC","78582","HCPCS","facility","both","","","","885.97","885.97","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC PULMONARY VENTILATION & PERFUSION IMAGING","34100032","CDM","341","RC","78582","HCPCS","facility","both","","","","2251","2251","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRAIN IMAGING TOMOGRAPHIC (SPECT)","34100033","CDM","341","RC","78607","HCPCS","facility","both","","","","2464","2464","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRAIN IMAGING TOMOGRAPHIC (SPECT)","34100033","CDM","341","RC","78607","HCPCS","facility","both","","","","990.62","990.62","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC BRAIN IMAGING VASCULAR FLOW ONLY","34100034","CDM","341","RC","78610","HCPCS","facility","both","","","","507.81","507.81","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC CEREBROSPINAL FLUID FLOW IMG CISTERNOGRAM","34100035","CDM","341","RC","78630","HCPCS","facility","both","","","","961.59","961.59","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC CEREBROSPINAL FLUID FLOW IMG CISTERNOGRAM","34100035","CDM","341","RC","78630","HCPCS","facility","both","","","","2579","2579","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CEREBROSPINAL FLUID FLOW IMG SHUNT EVAL","34100036","CDM","341","RC","78645","HCPCS","facility","both","","","","2018","2018","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CEREBROSPINAL FLUID FLOW IMG SHUNT EVAL","34100036","CDM","341","RC","78645","HCPCS","facility","both","","","","939.99","939.99","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC CEREBROSPINAL FLUID LEAKAGE IMAGING","34100037","CDM","341","RC","78650","HCPCS","facility","both","","","","950.79","950.79","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC CEREBROSPINAL FLUID LEAKAGE IMAGING","34100037","CDM","341","RC","78650","HCPCS","facility","both","","","","2841","2841","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KIDNEY IMAGING W/VASC FLOW & FUNCTION","34100038","CDM","341","RC","78707","HCPCS","facility","both","","","","583.42","583.42","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC KIDNEY IMAGING W/VASC FLOW & FUNCTION","34100038","CDM","341","RC","78707","HCPCS","facility","both","","","","1710","1710","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KIDNEY IMAGING W/VASC FLOW & FUNC W/DRUG","34100039","CDM","341","RC","78708","HCPCS","facility","both","","","","2636","2636","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KIDNEY IMAGING W/VASC FLOW & FUNC W/DRUG","34100039","CDM","341","RC","78708","HCPCS","facility","both","","","","367.34","367.34","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC KIDNEY IMAGING TOMOGRAPHIC (SPECT)","34100040","CDM","341","RC","78710","HCPCS","facility","both","","","","575.95","575.95","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC KIDNEY IMAGING TOMOGRAPHIC (SPECT)","34100040","CDM","341","RC","78710","HCPCS","facility","both","","","","2567","2567","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KIDNEY STUDY NON-IMAGING RADIOISOTOPIC","34100041","CDM","341","RC","78725","HCPCS","facility","both","","","","280.92","280.92","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC URETER REFLUX STUDY RADIOPHARM CYSTOGRAM","34100042","CDM","341","RC","78740","HCPCS","facility","both","","","","605.05","605.05","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC UNLISTED GU PROCEDURE DIAGNOSTIC NM","34100043","CDM","341","RC","78799","HCPCS","facility","both","","","","939.99","939.99","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC UNLISTED GU PROCEDURE DIAGNOSTIC NM","34100043","CDM","341","RC","78799","HCPCS","facility","both","","","","2636","2636","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOPHARM LOCAL TUMOR; PLANAR, SINGLE AREA, SINGLE DAY IMG","34100044","CDM","341","RC","78800","HCPCS","facility","both","","","","1645","1645","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOPHARM LOCAL TUMOR; PLANAR, SINGLE AREA, SINGLE DAY IMG","34100044","CDM","341","RC","78800","HCPCS","facility","both","","","","702.51","702.51","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC RADIOPHARM LOCAL TUMOR ; PLANAR, WHOLE BODY, SINGLE DAY IMG","34100045","CDM","341","RC","78802","HCPCS","facility","both","","","","2857","2857","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOPHARM LOCAL TUMOR ; PLANAR, WHOLE BODY, SINGLE DAY IMG","34100045","CDM","341","RC","78802","HCPCS","facility","both","","","","885.97","885.97","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC RADIOPHARM LOCAL TUMOR,  SPECT; SINGLE AREA , SINGLE DAY IMG","34100046","CDM","341","RC","78803","HCPCS","facility","both","","","","907.86","907.86","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC RADIOPHARM LOCAL TUMOR,  SPECT; SINGLE AREA , SINGLE DAY IMG","34100046","CDM","341","RC","78803","HCPCS","facility","both","","","","2857","2857","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOPHARM LOCALIZE ABSCESS, WHOLE BODY","34100047","CDM","341","RC","78806","HCPCS","facility","both","","","","4750","4750","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOPHARM LOCALIZE ABSCESS, WHOLE BODY","34100047","CDM","341","RC","78806","HCPCS","facility","both","","","","979.12","979.12","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC UNLISTED MISC PROC DIAGNOSTIC NUCLEAR MED","34100048","CDM","341","RC","78999","HCPCS","facility","both","","","","440.13","440.13","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC THYROID UPTAKE; SINGLE","34100060","CDM","341","RC","78000","HCPCS","facility","both","","","","425","425","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THYROID XR W UPTAKE; MULTIPLE","34100061","CDM","341","RC","78007","HCPCS","facility","both","","","","1270","1270","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIVER & SPLEEN; STATIC ONLY","34100063","CDM","341","RC","78215","HCPCS","facility","both","","","","1652","1652","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIVER & SPLEEN; STATIC ONLY","34100063","CDM","341","RC","78215","HCPCS","facility","both","","","","540.22","540.22","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC LIVER & SPLEEN; W VASC FLOW","34100064","CDM","341","RC","78216","HCPCS","facility","both","","","","2567","2567","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPATOBIL SYST IMAGE W/DRUG","34100065","CDM","341","RC","78227","HCPCS","facility","both","","","","2250","2250","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPATOBIL SYST IMAGE W/DRUG","34100065","CDM","341","RC","78227","HCPCS","facility","both","","","","1274.9","1274.9","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC ESOPHAGEAL MOTILITY","34100066","CDM","341","RC","78258","HCPCS","facility","both","","","","1268","1268","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESOPHAGEAL MOTILITY","34100066","CDM","341","RC","78258","HCPCS","facility","both","","","","594.25","594.25","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC UNLISTED GI PROCEDURE DX NM","34100067","CDM","341","RC","78299","HCPCS","facility","both","","","","1673","1673","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE/JOINT; MULTI AREAS","34100068","CDM","341","RC","78305","HCPCS","facility","both","","","","3213","3213","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE/JOINT; SPECT (3D)","34100070","CDM","341","RC","78320","HCPCS","facility","both","","","","598.98","598.98","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC BONE/JOINT; SPECT (3D)","34100070","CDM","341","RC","78320","HCPCS","facility","both","","","","2775","2775","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NON-CARDIAC VASC FLOW","34100072","CDM","341","RC","78445","HCPCS","facility","both","","","","1159","1159","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRAIN IMAGE W/FLOW 4 + VIEWS","34100073","CDM","341","RC","78606","HCPCS","facility","both","","","","939.99","939.99","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC BRAIN IMAGE W/FLOW 4 + VIEWS","34100073","CDM","341","RC","78606","HCPCS","facility","both","","","","2251","2251","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TESTICULAR IMAGING W/FLOW","34100074","CDM","341","RC","78761","HCPCS","facility","both","","","","561.82","561.82","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC TESTICULAR IMAGING W/FLOW","34100074","CDM","341","RC","78761","HCPCS","facility","both","","","","1407","1407","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TUMOR LOCAL; PLANAR, 2 + AREAS, 1+ DAYS IMG/SNGL AREA IMG 2+ DAYS","34100075","CDM","341","RC","78801","HCPCS","facility","both","","","","767.41","767.41","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC TUMOR LOCAL; PLANAR, 2 + AREAS, 1+ DAYS IMG/SNGL AREA IMG 2+ DAYS","34100075","CDM","341","RC","78801","HCPCS","facility","both","","","","2337","2337","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Radiopharmaceutical Localization, Tomographic (SPECT)","34100077","CDM","341","RC","78807","HCPCS","facility","both","","","","3112","3112","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Radiopharmaceutical Localization, Tomographic (SPECT)","34100077","CDM","341","RC","78807","HCPCS","facility","both","","","","979.12","979.12","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC MYOCARDIAL IMAGE, PLANAR; QUAL/QUAN","34100078","CDM","341","RC","78466","HCPCS","facility","both","","","","1938","1938","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SALIVARY GLAND; W SERIAL IMAGES","34100080","CDM","341","RC","78231","HCPCS","facility","both","","","","324.13","324.13","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC SALIVARY GLAND; W SERIAL IMAGES","34100080","CDM","341","RC","78231","HCPCS","facility","both","","","","1725","1725","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LUNG PERFUSION DIFFERENTIAL","34100085","CDM","341","RC","78597","HCPCS","facility","both","","","","2168","2168","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LUNG PERFUSION DIFFERENTIAL","34100085","CDM","341","RC","78597","HCPCS","facility","both","","","","529.4","529.4","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC BONE MARROW IMAGING; MULTIPLE AREAS","34100095","CDM","341","RC","78103","HCPCS","facility","both","","","","5330","5330","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIVER IMAGE; STATIC ONLY","34100105","CDM","341","RC","78201","HCPCS","facility","both","","","","2567","2567","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LUNG VENTILATION & PERFUSION IMAGING","34100110","CDM","341","RC","78582","HCPCS","facility","both","","","","1040.29","1040.29","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC LUNG PERFUSION & VENTILATION DIFFERENTIAL","34100115","CDM","341","RC","78598","HCPCS","facility","both","","","","831.94","831.94","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC LUNG PERFUSION & VENTILATION DIFFERENTIAL","34100115","CDM","341","RC","78598","HCPCS","facility","both","","","","2829","2829","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KIDNEY IMAGING MORPHOLOGY","34100120","CDM","341","RC","78700","HCPCS","facility","both","","","","1477","1477","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KIDNEY IMAGING MORPHOLOGY","34100120","CDM","341","RC","78700","HCPCS","facility","both","","","","475.4","475.4","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC KIDNEY FLOW/FUNCT IMAGE-MULT W & W/O PHARM INTERV","34100125","CDM","341","RC","78709","HCPCS","facility","both","","","","2636","2636","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC KIDNEY FLOW/FUNCT IMAGE-MULT W & W/O PHARM INTERV","34100125","CDM","341","RC","78709","HCPCS","facility","both","","","","939.99","939.99","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC TUMOR IMAGING WHOLE BODY 2+ DAYS","34100130","CDM","341","RC","78804","HCPCS","facility","both","","","","1620.66","1620.66","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC TUMOR IMAGING WHOLE BODY 2+ DAYS","34100130","CDM","341","RC","78804","HCPCS","facility","both","","","","4995","4995","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LOCALIZATION OF INFLAMMATORY PROCESS; LIMIT AREA","34100135","CDM","341","RC","78805","HCPCS","facility","both","","","","4750","4750","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE MARROW IMAGING; WHOLE BODY","34100136","CDM","341","RC","78104","HCPCS","facility","both","","","","5330","5330","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE MARROW IMAGING; WHOLE BODY","34100136","CDM","341","RC","78104","HCPCS","facility","both","","","","659.06","659.06","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC THYROID UPTAKE MEASUREMENT","34100140","CDM","341","RC","78012","HCPCS","facility","both","","","","226.88","226.88","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC THYROID UPTAKE MEASUREMENT","34100140","CDM","341","RC","78012","HCPCS","facility","both","","","","759","759","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THYROID IMAGING W/BLOOD FLOW","34100141","CDM","341","RC","78013","HCPCS","facility","both","","","","970","970","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THYROID IMAGING W/BLOOD FLOW","34100141","CDM","341","RC","78013","HCPCS","facility","both","","","","540.22","540.22","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC THYROID IMAGING W/BLOOD FLOW & 1+ UPTAKES","34100142","CDM","341","RC","78014","HCPCS","facility","both","","","","680.68","680.68","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC THYROID IMAGING W/BLOOD FLOW & 1+ UPTAKES","34100142","CDM","341","RC","78014","HCPCS","facility","both","","","","1704","1704","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARTHYROID PLANAR IMAGING W/ SPECT","34100144","CDM","341","RC","78071","HCPCS","facility","both","","","","2066","2066","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HT MUSC IMAGE PLANAR MULT","34100150","CDM","341","RC","78454","HCPCS","facility","both","","","","1166.89","1166.89","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC MI PLANAR; SPECT (3D)","34100151","CDM","341","RC","78469","HCPCS","facility","both","","","","572.61","572.61","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC BM IMAGING; LIMITED","34100152","CDM","341","RC","78102","HCPCS","facility","both","","","","453.92","453.92","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC SALIVARY GLAND IMAGE;","34100153","CDM","341","RC","78230","HCPCS","facility","both","","","","475.4","475.4","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC SALIVARY GLAND FUNCTION","34100154","CDM","341","RC","78232","HCPCS","facility","both","","","","248.48","248.48","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC BRAIN IMAGE 4+ VIEWS","34100155","CDM","341","RC","78605","HCPCS","facility","both","","","","551","551","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC THYROID CARCINOMA METASTASES UPTAKE","34100156","CDM","341","RC","78020","HCPCS","facility","both","","","","172.86","172.86","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC RADIOPHARM LOCALIZE TUMOR, SPECT, W/CT 1 AREA 1 DAY IMAGE","34100157","CDM","341","RC","78830","HCPCS","facility","both","","","","5918","5918","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOPHARM LOCALIZE TUMOR, SPECT, W/CT 1 AREA 1 DAY IMAGE","34100157","CDM","341","RC","78830","HCPCS","facility","both","","","","1296.44","1296.44","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC RADIOPHARM LOCAL TUMOR, SPECT, 2 AREA 1 DAY IMG OR 1 AREA IMG 2+ DAYS","34100158","CDM","341","RC","78831","HCPCS","facility","both","","","","5918","5918","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOPHARM LOCAL TUMOR, SPECT, 2 AREA 1 DAY IMG OR 1 AREA IMG 2+ DAYS","34100158","CDM","341","RC","78831","HCPCS","facility","both","","","","1923.07","1923.07","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC RADIOPHARM LOCAL TUMOR, SPECT, MIN 2 AREA 1 DAY IMG /1 AREA OR IMG 2+ DAYS","34100159","CDM","341","RC","78832","HCPCS","facility","both","","","","2538.89","2538.89","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC RADIOPHARM LOCAL TUMOR, SPECT, MIN 2 AREA 1 DAY IMG /1 AREA OR IMG 2+ DAYS","34100159","CDM","341","RC","78832","HCPCS","facility","both","","","","6715","6715","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOPHARMACEUTICAL QUANTIFICATION MEASUREMENT(S), 1 AREA","34100160","CDM","341","RC","78835","HCPCS","facility","both","","","","1714","1714","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOPHARMACEUTICAL QUANTIFICATION MEASUREMENT(S), 1 AREA","34100160","CDM","341","RC","78835","HCPCS","facility","both","","","","248.48","248.48","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC GASTRIC EMPTYING STUDY - LIQUID","34100200","CDM","341","RC","78264","HCPCS","facility","both","","","","789.04","789.04","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC MRA WO CONTRAST, PELVIS","34100201","CDM","618","RC","","","facility","both","","","","1444.51","1444.51","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA WO CONTRAST, PELVIS","34100201","CDM","618","RC","","","facility","both","","","","4530","4530","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CEREBROSPINAL FLUID FLOW; TOMOGRAPHIC (SPECT)","34100202","CDM","341","RC","78647","HCPCS","facility","both","","","","1147.12","1147.12","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC PARATHYRD PLANAR W/SPECT&CT","34100203","CDM","341","RC","78072","HCPCS","facility","both","","","","1058.79","1058.79","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC GASTRIC EMPTYING IMAGING STUDY  (SOLID, LIQUID OR BOTH)","34100205","CDM","341","RC","78264","HCPCS","facility","both","","","","939.99","939.99","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC GASTRIC EMPTYING IMAGING STUDY  (SOLID, LIQUID OR BOTH)","34100205","CDM","341","RC","78264","HCPCS","facility","both","","","","1709","1709","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASTRIC EMPTYING IMAGING STUDY; W/SMALL BOWEL TRANSIT","34100206","CDM","341","RC","78265","HCPCS","facility","both","","","","1709","1709","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASTRIC EMPTYING IMAGING STUDY; W/SMALL BOWEL TRANSIT","34100206","CDM","341","RC","78265","HCPCS","facility","both","","","","1102.02","1102.02","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC GASTRIC EMPTYING IMAG STUDY W/SMALL BOWEL & COLON TRANSIT, MULT DAY","34100207","CDM","341","RC","78266","HCPCS","facility","both","","","","1328.93","1328.93","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC GASTRIC EMPTYING IMAG STUDY W/SMALL BOWEL & COLON TRANSIT, MULT DAY","34100207","CDM","341","RC","78266","HCPCS","facility","both","","","","2562","2562","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOPHARM THERAPY, BY ORAL ADMINISTRATION","34200001","CDM","342","RC","79005","HCPCS","facility","both","","","","151.26","151.26","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC RADIOPHARM THERAPY, BY ORAL ADMINISTRATION","34200001","CDM","342","RC","79005","HCPCS","facility","both","","","","2244","2244","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOPHARM THERAPY, BY IV ADMINISTRATION","34200002","CDM","342","RC","79101","HCPCS","facility","both","","","","2870","2870","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOPHARM THERAPY, BY IV ADMINISTRATION","34200002","CDM","342","RC","79101","HCPCS","facility","both","","","","151.26","151.26","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC RADIOPHARM THERAPY, BY IV ADMINISTRATION","34200002","CDM","342","RC","79101","HCPCS","facility","both","","","","217.21","217.21","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC INTERST COLLOID RPHARM RX","34200050","CDM","342","RC","79300","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC RADIOPHARM THERAPY, INTRA-ARTERIAL","34200051","CDM","342","RC","79445","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC DEAC 05/05/2021 F18 FDG =< 45 MCI","34341115","CDM","343","RC","","","facility","both","","","","348","348","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC XOFIGO, RADIUM RA223, PER MICROCURIE","34446002","CDM","636","RC","","","facility","both","","","","284.68","284.68","","","","","","","","","","","","","Gross Charge Type: JHH 67 MEDICATIONS EAP CONVERTING TO ERX IN WILLOW IN 2017 OPTIMIZATION"
"HC SM-153 LEXIDRONAM, =< 150 MCI, PER TX DOSE","34446003","CDM","344","RC","","","facility","both","","","","33645.84","33645.84","","","","","","","","","","","","","Gross Charge Type: JHH 67 MEDICATIONS EAP CONVERTING TO ERX IN WILLOW IN 2017 OPTIMIZATION"
"HC CT SOFT TISSUE NECK W/O CONTRAST","35000001","CDM","350","RC","70490","HCPCS","facility","both","","","","254.95","254.95","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT SOFT TISSUE NECK W/O CONTRAST","35000001","CDM","350","RC","70490","HCPCS","facility","both","","","","2324","2324","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT SOFT TISSUE NECK W/CONTRAST","35000002","CDM","350","RC","70491","HCPCS","facility","both","","","","2776","2776","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT SOFT TISSUE NECK W/CONTRAST","35000002","CDM","350","RC","70491","HCPCS","facility","both","","","","332.84","332.84","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT SOFT TISSUE NECK W/O & W/CONTRAST","35000003","CDM","350","RC","70492","HCPCS","facility","both","","","","3340","3340","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT SOFT TISSUE NECK W/O & W/CONTRAST","35000003","CDM","350","RC","70492","HCPCS","facility","both","","","","410.72","410.72","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ANGIO NECK W/CONTRAST MATERIAL(S)","35000004","CDM","350","RC","70498","HCPCS","facility","both","","","","403.69","403.69","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ANGIO NECK W/CONTRAST MATERIAL(S)","35000004","CDM","350","RC","70498","HCPCS","facility","both","","","","3340","3340","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT HEART W/O CONTRAST W/CALCIUM QUANT","35000005","CDM","350","RC","75571","HCPCS","facility","both","","","","141.64","141.64","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT HEART W/O CONTRAST W/CALCIUM QUANT","35000005","CDM","350","RC","75571","HCPCS","facility","both","","","","688","688","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT HEART W/CONTRAST INC W/3 D POSTPROC","35000006","CDM","350","RC","75572","HCPCS","facility","both","","","","389.51","389.51","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT HEART W/CONTRAST INC W/3 D POSTPROC","35000006","CDM","350","RC","75572","HCPCS","facility","both","","","","1534","1534","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT HEART W/CON FOR CONGENTIAL HEART DIS","35000007","CDM","350","RC","75573","HCPCS","facility","both","","","","524.03","524.03","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CTA HEART W/CON W/3D IMAGE POSTPROCESS","35000008","CDM","350","RC","75574","HCPCS","facility","both","","","","1534","1534","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CTA HEART W/CON W/3D IMAGE POSTPROCESS","35000008","CDM","350","RC","75574","HCPCS","facility","both","","","","601.95","601.95","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC 3D RENDERING W/O POSTPROCESS","35000009","CDM","350","RC","76376","HCPCS","facility","both","","","","28.32","28.32","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC 3D RENDERING W/O POSTPROCESS","35000009","CDM","350","RC","76376","HCPCS","facility","both","","","","32.8","32.8","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC 3D RENDERING W/O POSTPROCESS","35000009","CDM","350","RC","76376","HCPCS","facility","both","","","","1597","1597","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC 3D RENDERING W/O POSTPROCESS","35000009","CDM","350","RC","76376","HCPCS","facility","both","","","","81.65","81.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC 3D RENDERING W POSTPROCESS","35000010","CDM","350","RC","76377","HCPCS","facility","both","","","","82.13","82.13","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC 3D RENDERING W POSTPROCESS","35000010","CDM","350","RC","76377","HCPCS","facility","both","","","","63.75","63.75","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC 3D RENDERING W POSTPROCESS","35000010","CDM","350","RC","76377","HCPCS","facility","both","","","","204.12","204.12","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC 3D RENDERING W POSTPROCESS","35000010","CDM","350","RC","76377","HCPCS","facility","both","","","","1597","1597","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC 3D RENDERING W POSTPROCESS","35000010","CDM","350","RC","76377","HCPCS","facility","both","","","","45.41","45.41","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC CT LIMITED OR LOCALIZED FOLLOW-UP STUDY","35000011","CDM","350","RC","76380","HCPCS","facility","both","","","","1128","1128","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT LIMITED OR LOCALIZED FOLLOW-UP STUDY","35000011","CDM","350","RC","76380","HCPCS","facility","both","","","","191.24","191.24","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC UNLISTED CT PROCEDURE","35000012","CDM","350","RC","76497","HCPCS","facility","both","","","","283.28","283.28","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT SCAN FOR NEEDLE BIOPSY","35000013","CDM","350","RC","77012","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC CT SCAN FOR NEEDLE BIOPSY","35000013","CDM","350","RC","77012","HCPCS","facility","both","","","","405.48","405.48","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT SCAN FOR NEEDLE BIOPSY","35000013","CDM","350","RC","77012","HCPCS","facility","both","","","","3884","3884","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT GUIDANCE TISSUE ABLATION","35000014","CDM","350","RC","77013","HCPCS","facility","both","","","","3884","3884","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT GUIDANCE TISSUE ABLATION","35000014","CDM","350","RC","77013","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC CT GUIDANCE PLCMNT RAD THERAPY FIELDS","35000015","CDM","350","RC","77014","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC CT GUIDANCE PLCMNT RAD THERAPY FIELDS","35000015","CDM","350","RC","77014","HCPCS","facility","both","","","","310.25","310.25","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC CT GUIDANCE PLCMNT RAD THERAPY FIELDS","35000015","CDM","350","RC","77014","HCPCS","facility","both","","","","542","542","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC (SMH MOSAIQ) CT GUIDANCE PLCMNT RAD THERAPY FIELDS","35091115","CDM","350","RC","77014","HCPCS","facility","both","","","","448","448","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT HEAD OR BRAIN, W/O CONTRAST","35100001","CDM","351","RC","70450","HCPCS","facility","both","","","","2250","2250","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT HEAD OR BRAIN, W/O CONTRAST","35100001","CDM","351","RC","70450","HCPCS","facility","both","","","","148.72","148.72","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT HEAD OR BRAIN, W CONTRAST","35100002","CDM","351","RC","70460","HCPCS","facility","both","","","","2480","2480","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT HEAD OR BRAIN, W CONTRAST","35100002","CDM","351","RC","70460","HCPCS","facility","both","","","","212.48","212.48","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT HEAD OR BRAIN, W & W/O CONTRAST","35100003","CDM","351","RC","70470","HCPCS","facility","both","","","","3357","3357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT HEAD OR BRAIN, W & W/O CONTRAST","35100003","CDM","351","RC","70470","HCPCS","facility","both","","","","254.95","254.95","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ORBIT, SELLA, POSTERIOR FOSSA W/O CONTRAST","35100004","CDM","351","RC","70480","HCPCS","facility","both","","","","332.84","332.84","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ORBIT, SELLA, POSTERIOR FOSSA W/O CONTRAST","35100004","CDM","351","RC","70480","HCPCS","facility","both","","","","2541","2541","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT ORBIT, SELLA, POSTERIOR FOSSA W CONTRAST","35100005","CDM","351","RC","70481","HCPCS","facility","both","","","","2696","2696","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT ORBIT, SELLA, POSTERIOR FOSSA W CONTRAST","35100005","CDM","351","RC","70481","HCPCS","facility","both","","","","410.72","410.72","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ORBIT, SELLA, P. FOSSA W/O & W CONTRAST","35100006","CDM","351","RC","70482","HCPCS","facility","both","","","","3357","3357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT ORBIT, SELLA, P. FOSSA W/O & W CONTRAST","35100006","CDM","351","RC","70482","HCPCS","facility","both","","","","453.27","453.27","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT MAXILLOFACIAL W/O CONTRAST","35100007","CDM","351","RC","70486","HCPCS","facility","both","","","","191.24","191.24","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT MAXILLOFACIAL W/O CONTRAST","35100007","CDM","351","RC","70486","HCPCS","facility","both","","","","791","791","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT MAXILLOFACIAL W/O CONTRAST","35100007","CDM","351","RC","70486","HCPCS","facility","both","","","","2250","2250","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT MAXILLOFACIAL W/CONTRAST","35100008","CDM","351","RC","70487","HCPCS","facility","both","","","","2696","2696","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT MAXILLOFACIAL W/CONTRAST","35100008","CDM","351","RC","70487","HCPCS","facility","both","","","","219.57","219.57","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT MAXILLOFACIAL W/O & W/CONTRAST","35100009","CDM","351","RC","70488","HCPCS","facility","both","","","","3357","3357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT MAXILLOFACIAL W/O & W/CONTRAST","35100009","CDM","351","RC","70488","HCPCS","facility","both","","","","283.28","283.28","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ANGIO HEAD W/CONTRAST MATERIAL(S)","35100010","CDM","351","RC","70496","HCPCS","facility","both","","","","3357","3357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT ANGIO HEAD W/CONTRAST MATERIAL(S)","35100010","CDM","351","RC","70496","HCPCS","facility","both","","","","410.72","410.72","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC DX CT THORAX W/O CONTRAST","35200001","CDM","352","RC","71250","HCPCS","facility","both","","","","2798","2798","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DX CT THORAX W/O CONTRAST","35200001","CDM","352","RC","71250","HCPCS","facility","both","","","","254.95","254.95","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC DX CT THORAX W/O CONTRAST","35200001","CDM","352","RC","71250","HCPCS","facility","both","","","","1402","1402","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DX CT THORAX W CONTRAST","35200002","CDM","352","RC","71260","HCPCS","facility","both","","","","332.84","332.84","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC DX CT THORAX W CONTRAST","35200002","CDM","352","RC","71260","HCPCS","facility","both","","","","3359","3359","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DX CT THORAX W & W/O CONTRAST","35200003","CDM","352","RC","71270","HCPCS","facility","both","","","","4210","4210","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DX CT THORAX W & W/O CONTRAST","35200003","CDM","352","RC","71270","HCPCS","facility","both","","","","410.72","410.72","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CTA CHEST W CONTRAST","35200004","CDM","352","RC","71275","HCPCS","facility","both","","","","417.84","417.84","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CTA CHEST W CONTRAST","35200004","CDM","352","RC","71275","HCPCS","facility","both","","","","2798","2798","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT CERVICAL SPINE, W/O CONTRAST","35200005","CDM","352","RC","72125","HCPCS","facility","both","","","","262.06","262.06","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT CERVICAL SPINE, W/O CONTRAST","35200005","CDM","352","RC","72125","HCPCS","facility","both","","","","2564","2564","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT CERVICAL SPINE, W CONTRAST","35200006","CDM","352","RC","72126","HCPCS","facility","both","","","","2488","2488","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT CERVICAL SPINE, W CONTRAST","35200006","CDM","352","RC","72126","HCPCS","facility","both","","","","332.84","332.84","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT CERVICAL SPINE, W & W/O CONTRAST","35200007","CDM","352","RC","72127","HCPCS","facility","both","","","","410.72","410.72","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT CERVICAL SPINE, W & W/O CONTRAST","35200007","CDM","352","RC","72127","HCPCS","facility","both","","","","4210","4210","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT  THORACIC SPINE, W/O CONTRAST","35200008","CDM","352","RC","72128","HCPCS","facility","both","","","","2798","2798","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT  THORACIC SPINE, W/O CONTRAST","35200008","CDM","352","RC","72128","HCPCS","facility","both","","","","254.95","254.95","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT THORACIC SPINE, W CONTRAST","35200009","CDM","352","RC","72129","HCPCS","facility","both","","","","332.84","332.84","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT THORACIC SPINE, W CONTRAST","35200009","CDM","352","RC","72129","HCPCS","facility","both","","","","3357","3357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT THORACIC SPINE, W & W/O CONTRAST","35200010","CDM","352","RC","72130","HCPCS","facility","both","","","","4210","4210","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT THORACIC SPINE, W & W/O CONTRAST","35200010","CDM","352","RC","72130","HCPCS","facility","both","","","","410.72","410.72","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT LUMBAR SPINE, W/O CONTRAST","35200011","CDM","352","RC","72131","HCPCS","facility","both","","","","2891","2891","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT LUMBAR SPINE, W/O CONTRAST","35200011","CDM","352","RC","72131","HCPCS","facility","both","","","","254.95","254.95","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT  LUMBAR SPINE, W CONTRAST","35200012","CDM","352","RC","72132","HCPCS","facility","both","","","","3357","3357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT  LUMBAR SPINE, W CONTRAST","35200012","CDM","352","RC","72132","HCPCS","facility","both","","","","332.84","332.84","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT LUMBAR SPINE, W & W/O CONTRAST","35200013","CDM","352","RC","72133","HCPCS","facility","both","","","","410.72","410.72","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT LUMBAR SPINE, W & W/O CONTRAST","35200013","CDM","352","RC","72133","HCPCS","facility","both","","","","4686","4686","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CTA PELVIS W & W/O CONTRAST","35200014","CDM","352","RC","72191","HCPCS","facility","both","","","","4210","4210","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CTA PELVIS W & W/O CONTRAST","35200014","CDM","352","RC","72191","HCPCS","facility","both","","","","424.92","424.92","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT PELVIS W/O CONTRAST","35200015","CDM","352","RC","72192","HCPCS","facility","both","","","","184.14","184.14","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT PELVIS W/O CONTRAST","35200015","CDM","352","RC","72192","HCPCS","facility","both","","","","2798","2798","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT PELVIS W CONTRAST","35200016","CDM","352","RC","72193","HCPCS","facility","both","","","","332.84","332.84","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT PELVIS W CONTRAST","35200016","CDM","352","RC","72193","HCPCS","facility","both","","","","3357","3357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT PELVIS W & W/O CONTRAST","35200017","CDM","352","RC","72194","HCPCS","facility","both","","","","4210","4210","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT PELVIS W & W/O CONTRAST","35200017","CDM","352","RC","72194","HCPCS","facility","both","","","","396.6","396.6","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC PERCUT VERTOPLASTY/SACROPLASTY W/CT GUID","35200018","CDM","352","RC","72292","HCPCS","facility","both","","","","656","656","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT UPPER EXT W/O CONTRAST","35200019","CDM","352","RC","73200","HCPCS","facility","both","","","","2805","2805","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT UPPER EXT W/O CONTRAST","35200019","CDM","352","RC","73200","HCPCS","facility","both","","","","254.95","254.95","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT UPPER EXT W/O CONTRAST","35200019","CDM","352","RC","73200","HCPCS","facility","both","","","","4350","4350","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT UPPER EXT W CONTRAST","35200020","CDM","352","RC","73201","HCPCS","facility","both","","","","5562","5562","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT UPPER EXT W CONTRAST","35200020","CDM","352","RC","73201","HCPCS","facility","both","","","","3357","3357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT UPPER EXT W CONTRAST","35200020","CDM","352","RC","73201","HCPCS","facility","both","","","","325.76","325.76","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CTA UPPER EXT W & W/O CONTRAST","35200021","CDM","352","RC","73206","HCPCS","facility","both","","","","6979","6979","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CTA UPPER EXT W & W/O CONTRAST","35200021","CDM","352","RC","73206","HCPCS","facility","both","","","","4210","4210","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CTA UPPER EXT W & W/O CONTRAST","35200021","CDM","352","RC","73206","HCPCS","facility","both","","","","474.49","474.49","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT LOWER EXT W/O CONTRAST","35200022","CDM","352","RC","73700","HCPCS","facility","both","","","","254.95","254.95","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT LOWER EXT W/O CONTRAST","35200022","CDM","352","RC","73700","HCPCS","facility","both","","","","2805","2805","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT LOWER EXT W/O CONTRAST","35200022","CDM","352","RC","73700","HCPCS","facility","both","","","","4655","4655","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT LOWER EXT W CONTRAST","35200023","CDM","352","RC","73701","HCPCS","facility","both","","","","332.84","332.84","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT LOWER EXT W CONTRAST","35200023","CDM","352","RC","73701","HCPCS","facility","both","","","","3357","3357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT LOWER EXT W CONTRAST","35200023","CDM","352","RC","73701","HCPCS","facility","both","","","","5562","5562","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT LOWER EXT W & W/O CONTRAST","35200024","CDM","352","RC","73702","HCPCS","facility","both","","","","4210","4210","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT LOWER EXT W & W/O CONTRAST","35200024","CDM","352","RC","73702","HCPCS","facility","both","","","","424.92","424.92","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT LOWER EXT W & W/O CONTRAST","35200024","CDM","352","RC","73702","HCPCS","facility","both","","","","6979","6979","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CTA LOWER EXT W/O & W CONTRAST","35200025","CDM","352","RC","73706","HCPCS","facility","both","","","","4210","4210","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CTA LOWER EXT W/O & W CONTRAST","35200025","CDM","352","RC","73706","HCPCS","facility","both","","","","6979","6979","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CTA LOWER EXT W/O & W CONTRAST","35200025","CDM","352","RC","73706","HCPCS","facility","both","","","","517","517","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ABDOMEN W/O CONTRAST","35200026","CDM","352","RC","74150","HCPCS","facility","both","","","","1727","1727","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT ABDOMEN W/O CONTRAST","35200026","CDM","352","RC","74150","HCPCS","facility","both","","","","177.05","177.05","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ABDOMEN W CONTRAST","35200027","CDM","352","RC","74160","HCPCS","facility","both","","","","332.84","332.84","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ABDOMEN W CONTRAST","35200027","CDM","352","RC","74160","HCPCS","facility","both","","","","3256","3256","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT ABDOMEN W & W/O CONTRAST","35200028","CDM","352","RC","74170","HCPCS","facility","both","","","","382.43","382.43","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ABDOMEN W & W/O CONTRAST","35200028","CDM","352","RC","74170","HCPCS","facility","both","","","","4036","4036","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CTA ABDOMEN W/O AND W CONTRAST","35200029","CDM","352","RC","74175","HCPCS","facility","both","","","","5012","5012","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CTA ABDOMEN W/O AND W CONTRAST","35200029","CDM","352","RC","74175","HCPCS","facility","both","","","","432","432","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ABDOMEN AND PELVIS W/O CONTRAST","35200030","CDM","352","RC","74176","HCPCS","facility","both","","","","226.63","226.63","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ABDOMEN AND PELVIS W/O CONTRAST","35200030","CDM","352","RC","74176","HCPCS","facility","both","","","","4523","4523","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT ABDOMEN AND PELVIS W CONTRAST","35200031","CDM","352","RC","74177","HCPCS","facility","both","","","","6610","6610","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT ABDOMEN AND PELVIS W CONTRAST","35200031","CDM","352","RC","74177","HCPCS","facility","both","","","","439.1","439.1","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ABDOMEN AND PELVIS W & W/O CONTRAST","35200032","CDM","352","RC","74178","HCPCS","facility","both","","","","8244","8244","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT ABDOMEN AND PELVIS W & W/O CONTRAST","35200032","CDM","352","RC","74178","HCPCS","facility","both","","","","502.81","502.81","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT COLONOGRAPHY, DX W/2D, 3D W/O CON","35200033","CDM","352","RC","74261","HCPCS","facility","both","","","","729.44","729.44","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT COLONOGRAPHY, DX W/2D, 3D W/O CON","35200033","CDM","352","RC","74261","HCPCS","facility","both","","","","2798","2798","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT COLONOGRAPHY, DX W/2D, 3D W/CONTRAST","35200034","CDM","352","RC","74262","HCPCS","facility","both","","","","835.67","835.67","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT COLONOGRAPHY, DX W/2D, 3D W/CONTRAST","35200034","CDM","352","RC","74262","HCPCS","facility","both","","","","2798","2798","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT COLONOGRAPHY, SCREENING W/2D, 3D","35200035","CDM","352","RC","74263","HCPCS","facility","both","","","","761","761","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT COLONOGRAPHY, SCREENING W/2D, 3D","35200035","CDM","352","RC","74263","HCPCS","facility","both","","","","1274.71","1274.71","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ANGIO ABDOMINAL ARTERIES","35200040","CDM","352","RC","75635","HCPCS","facility","both","","","","524.03","524.03","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT ANGIO ABDOMINAL ARTERIES","35200040","CDM","352","RC","75635","HCPCS","facility","both","","","","3557","3557","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT UPR EXTREMITY W/WO CONTRAST","35200041","CDM","352","RC","73202","HCPCS","facility","both","","","","6979","6979","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT UPR EXTREMITY W/WO CONTRAST","35200041","CDM","352","RC","73202","HCPCS","facility","both","","","","432","432","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT UPR EXTREMITY W/WO CONTRAST","35200041","CDM","352","RC","73202","HCPCS","facility","both","","","","4210","4210","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT ANGIO ABD&PELV W/O&W/DYE","35200050","CDM","352","RC","74174","HCPCS","facility","both","","","","8244","8244","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT ANGIO ABD&PELV W/O&W/DYE","35200050","CDM","352","RC","74174","HCPCS","facility","both","","","","552.15","552.15","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC CT THORAX, LOW DOSE LUNG CANCER SCREENING, W/O CONTRAST","35200051","CDM","352","RC","71271","HCPCS","facility","both","","","","1128","1128","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT THORAX, LOW DOSE LUNG CANCER SCREENING, W/O CONTRAST","35200051","CDM","352","RC","71271","HCPCS","facility","both","","","","254.79","254.79","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC OR PROCEDURE PRICE PER MINUTE","36000001","CDM","360","RC","","","facility","both","","","","40.63","40.63","","","","","","","","","","","","","Gross Charge Type: JHH 40 OR"
"HC SAME DAY SURGERY FEE","36000002","CDM","360","RC","","","facility","both","","","","534","534","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SDS - MINOR < 2 HOURS","36000010","CDM","360","RC","","","facility","both","","","","813.35","813.35","","","","","","","","","","","","","Gross Charge Type: JHH 33 SAME DAY SURGERY"
"HC SDS - MODERATE > 2 HRS AND <= 4 HRS","36000011","CDM","360","RC","","","facility","both","","","","1361.25","1361.25","","","","","","","","","","","","","Gross Charge Type: JHH 33 SAME DAY SURGERY"
"HC SDS - MAJOR > 4 HOURS","36000012","CDM","360","RC","","","facility","both","","","","1961.99","1961.99","","","","","","","","","","","","","Gross Charge Type: JHH 33 SAME DAY SURGERY"
"HC SDS - MAJOR DIAG. PROCEDURE > 6 HOURS","36000013","CDM","361","RC","","","facility","both","","","","1866.8","1866.8","","","","","","","","","","","","","Gross Charge Type: JHH 33 SAME DAY SURGERY"
"HC PROCEDURE LEVEL 1 FIRST 30 MINUTES","36000014","CDM","360","RC","","","facility","both","","","","5083","5083","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE LEVEL 2 FIRST 30 MINUTES","36000015","CDM","360","RC","","","facility","both","","","","5816","5816","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE LEVEL 3 FIRST 30 MINUTES","36000016","CDM","360","RC","","","facility","both","","","","6547","6547","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE LEVEL 4 FIRST 30 MINUTES","36000017","CDM","360","RC","","","facility","both","","","","7273","7273","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE LEVEL 5 FIRST 30 MINUTES","36000018","CDM","360","RC","","","facility","both","","","","6547","6547","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE LEVEL 6 FIRST 30 MINUTES","36000019","CDM","360","RC","","","facility","both","","","","5816","5816","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRE-OP CHARGE","36000024","CDM","360","RC","","","facility","both","","","","946","946","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE LEVEL 1 EA ADDL 30 MIN","36000114","CDM","360","RC","","","facility","both","","","","2567","2567","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE LEVEL 2 EA ADDL 30 MIN","36000115","CDM","360","RC","","","facility","both","","","","3021","3021","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE LEVEL 3 EA ADDL 30 MIN","36000116","CDM","360","RC","","","facility","both","","","","3477","3477","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE LEVEL 4 EA ADDL 30 MIN","36000117","CDM","360","RC","","","facility","both","","","","3931","3931","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE LEVEL 5 EA ADDL 30 MIN","36000118","CDM","360","RC","","","facility","both","","","","3477","3477","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE LEVEL 6 PER 30 MINUTE","36000119","CDM","360","RC","","","facility","both","","","","3021","3021","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OR FLAT RATE BLOCK ROOM CHARGE","36013001","CDM","360","RC","","","facility","both","","","","2020","2020","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"Operating Room Clinical Minutes","36100001","CDM","361","RC","","","facility","both","","","","785.51","785.51","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"Operating Room Clinical Minutes","36100001","CDM","361","RC","","","facility","both","","","","14.16","14.16","","","","","","","","","","","","","Gross Charge Type: JHH 79 CLINIC ORC"
"HC IRC SURGICAL PRICE PER MINUTE","36100002","CDM","361","RC","","","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"DEAC 7/1/2017 HC RADIOLOGY SURGICAL COMPONENT","36100004","CDM","361","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"DEAC 7/1/2017 HC RADIOLOGY SURGICAL COMPONENT","36100004","CDM","361","RC","","","facility","both","","","","194","194","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2017 HC BREAST DEVICE LOC OR BX, STEREOTACTIC GUIDANCE","36100006","CDM","361","RC","","","facility","both","","","","1449.72","1449.72","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"DEAC 7/1/2017 HC BREAST DEVICE LOC, PERCUTANEOUS, MAMMOGRAPHIC GUIDANCE","36100007","CDM","361","RC","","","facility","both","","","","906.07","906.07","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"DEAC 7/1/2017 HC BREAST DEVICE LOC OR BX, MAGNETIC RESONANCE GUIDANCE","36100008","CDM","361","RC","36100008","HCPCS","facility","both","","","","765.99","765.99","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"DEAC 7/1/2017 HC BREAST DEVICE LOC OR BX, ULTRASOUND GUIDANCE","36100009","CDM","361","RC","","","facility","both","","","","906.07","906.07","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"DEAC 7/1/2017 HC BREAST DEVICE LOC OR BX, FLUOROSCOPIC GUIDANCE","36100010","CDM","361","RC","36100010","HCPCS","facility","both","","","","1449.72","1449.72","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"DEAC 7/1/2017 HC BREAST RAD EXAM, SURGICAL SPECIMEN","36100012","CDM","361","RC","","","facility","both","","","","181.24","181.24","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC FINE NEEDLE ASPIRATION BIOPSY; W/O IMAGE GUIDANCE, 1ST LESION","36100050","CDM","761","RC","10021","HCPCS","facility","both","","","","518","518","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION FOR MAMMARY DUCTOGRAM OR GALACTOGRAM","36100051","CDM","761","RC","19030","HCPCS","facility","both","","","","1399","1399","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Incision and drainage of soft tissue abscess, subfascial","36100052","CDM","761","RC","20005","HCPCS","facility","both","","","","1232","1232","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION OF SINUS TRACT; THERAPEUTIC","36100053","CDM","761","RC","20500","HCPCS","facility","both","","","","2615","2615","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE FOREIGN BODY, MUSCLE OR TENDON; COMPLICATED","36100054","CDM","761","RC","20525","HCPCS","facility","both","","","","4964","4964","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION; SINGLE TENDON SHEATH/LIGAMENT","36100055","CDM","761","RC","20550","HCPCS","facility","both","","","","659","659","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION; TRIGGER POINTS, 1 OR 2 MUSCLES","36100056","CDM","761","RC","20552","HCPCS","facility","both","","","","856","856","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ARTHROCENTESIS, SMALL JOINT OR BURSA","36100057","CDM","761","RC","20600","HCPCS","facility","both","","","","754","754","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ARTHROCENTESIS, INTERMEDIATE JOINT OR BURSA","36100058","CDM","761","RC","20605","HCPCS","facility","both","","","","826","826","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS VERTEBROPLASTY; THORACIC","36100059","CDM","361","RC","22520","HCPCS","facility","both","","","","4662","4662","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS VERTEBROPLASTY; LUMBAR","36100060","CDM","361","RC","22521","HCPCS","facility","both","","","","2670","2670","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS VERTEBROPLASTY; ADDL","36100061","CDM","361","RC","22522","HCPCS","facility","both","","","","2670","2670","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS KYPHOPLASTY; THORACIC","36100062","CDM","361","RC","22523","HCPCS","facility","both","","","","4921","4921","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS KYPHOPLASTY; LUMBAR","36100063","CDM","361","RC","22524","HCPCS","facility","both","","","","4921","4921","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS KYPHOPLASTY ADD-ON","36100064","CDM","361","RC","22525","HCPCS","facility","both","","","","4921","4921","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION FOR SHOULDER X-RAY","36100065","CDM","761","RC","23350","HCPCS","facility","both","","","","1247","1247","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION FOR SHOULDER X-RAY","36100065","CDM","761","RC","23350","HCPCS","facility","both","","","","759","759","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION FOR ELBOW ARTHROGRAPHY","36100066","CDM","761","RC","24220","HCPCS","facility","both","","","","985","985","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION FOR ELBOW ARTHROGRAPHY","36100066","CDM","761","RC","24220","HCPCS","facility","both","","","","1627","1627","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION FOR WRIST ARTHROGRAPHY","36100067","CDM","761","RC","25246","HCPCS","facility","both","","","","1070","1070","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION FOR WRIST ARTHROGRAPHY","36100067","CDM","761","RC","25246","HCPCS","facility","both","","","","1771","1771","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION HIP ARTHROGRAPHY; WO ANESTHESIA","36100068","CDM","761","RC","27093","HCPCS","facility","both","","","","1026","1026","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION HIP ARTHROGRAPHY; WO ANESTHESIA","36100068","CDM","761","RC","27093","HCPCS","facility","both","","","","1696","1696","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Injection knee arthrography","36100069","CDM","761","RC","27370","HCPCS","facility","both","","","","496","496","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Injection knee arthrography","36100069","CDM","761","RC","27370","HCPCS","facility","both","","","","809","809","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THORACENTESIS W TUBE INSERTION","36100070","CDM","361","RC","32422","HCPCS","facility","both","","","","1138","1138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT PLEURAL CATHETER WITH CUFF","36100071","CDM","761","RC","32550","HCPCS","facility","both","","","","12125","12125","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Percutaneous transluminal angioplasty, venous","36100072","CDM","361","RC","35476","HCPCS","facility","both","","","","3517","3517","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXTEMITY VENOGRAPHY INJECTION","36100073","CDM","761","RC","36005","HCPCS","facility","both","","","","361","361","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NONSELECTIVE CATH, SUPERIOR/INFERIOR VENA CAVA","36100074","CDM","761","RC","36010","HCPCS","facility","both","","","","2386","2386","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELECTIVE CATHETER, FIRST ORDER FAMILY","36100075","CDM","761","RC","36011","HCPCS","facility","both","","","","3600","3600","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELECTIVE CATHETER, SECOND ORDER FAMILY","36100076","CDM","761","RC","36012","HCPCS","facility","both","","","","4193","4193","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Access AV dialysis graft for eval","36100077","CDM","361","RC","36147","HCPCS","facility","both","","","","1379","1379","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELECTIVE CATH ARTERY, BRACH-CEPH, FIRST ORDER","36100078","CDM","761","RC","36215","HCPCS","facility","both","","","","6709.5","6709.5","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC SELECTIVE CATH ARTERY, BRACH-CEPH, FIRST ORDER","36100078","CDM","761","RC","36215","HCPCS","facility","both","","","","4116","4116","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT CATHETER ABD/L-EXT ARTERY 1ST","36100079","CDM","761","RC","36245","HCPCS","facility","both","","","","4173","4173","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT CATHETER ABD/L-EXT ART 2ND","36100080","CDM","761","RC","36246","HCPCS","facility","both","","","","4173","4173","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT CATHETER ABD/L-EXT ART 3RD","36100081","CDM","761","RC","36247","HCPCS","facility","both","","","","5415","5415","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION(S) OF SCLEROSANT FOR  SPIDER VEINS, LIMB OR TRUNK","36100082","CDM","761","RC","36468","HCPCS","facility","both","","","","1143","1143","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDOVENOUS ABLATION, RADIOFREQ, 1ST VEIN","36100083","CDM","761","RC","36475","HCPCS","facility","both","","","","15871","15871","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDOVENOUS ABLATION, RADIOFREQ, VEIN ADD ON","36100084","CDM","761","RC","36476","HCPCS","facility","both","","","","8551","8551","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT NON-TUNNELED CV CATHETER, AGE 5 OR OLDER","36100085","CDM","761","RC","36556","HCPCS","facility","both","","","","3963","3963","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT TUNNELED CV CATHETER, AGE 5 OR OLDER","36100086","CDM","761","RC","36558","HCPCS","facility","both","","","","7436","7436","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT TUNNELED CVAD W/PORT, 5YRS OR OLDER","36100087","CDM","761","RC","36561","HCPCS","facility","both","","","","17043","17043","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPLACE TUNNELED CV CATHETER, SAME VENOUS","36100088","CDM","761","RC","36581","HCPCS","facility","both","","","","7334","7334","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPLACE TUNNELED CVAD WITH PORT","36100089","CDM","761","RC","36582","HCPCS","facility","both","","","","14707","14707","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPLACE PICC CATHETER, INCL IMAGE GUIDE","36100090","CDM","761","RC","36584","HCPCS","facility","both","","","","4006","4006","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE TUNNELED CV CATHETER, WO PORT","36100091","CDM","761","RC","36589","HCPCS","facility","both","","","","1232","1232","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE TUNNELED CVAD, WITH PORT OR PUMP","36100092","CDM","761","RC","36590","HCPCS","facility","both","","","","3552","3552","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Thrombectomy, percutaneous, av fistula","36100093","CDM","361","RC","36870","HCPCS","facility","both","","","","3632","3632","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT ENDOVASCULAR VENA CAVA FILTER","36100094","CDM","761","RC","37191","HCPCS","facility","both","","","","8589","8589","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE ENDOVASCULAR VENA CAVE FILTER","36100095","CDM","761","RC","37193","HCPCS","facility","both","","","","9727","9727","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSCATHETER BIOPSY","36100096","CDM","761","RC","37200","HCPCS","facility","both","","","","4695","4695","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSCATHETER RETRIEVAL, PERCUT, FOREIGN BODY","36100097","CDM","361","RC","37197","HCPCS","facility","both","","","","2848","2848","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSCATHETER OCCLUSION OR EMBOLIZATION","36100098","CDM","361","RC","37204","HCPCS","facility","both","","","","9238","9238","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSCATHETER PLACEMENT, IV STENT, INITIAL VESSEL","36100099","CDM","361","RC","37205","HCPCS","facility","both","","","","4570","4570","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UTERINE FIBROID EMBOLIZATION","36100100","CDM","361","RC","37210","HCPCS","facility","both","","","","9238","9238","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REVASC, ILIAC ARTERY, UNIL, 1ST VESSEL; W STENT","36100101","CDM","761","RC","37221","HCPCS","facility","both","","","","8873","8873","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REVASC, OPEN/PERCUT, FEMORAL/POPLITEAL W/TLA; UNIL","36100102","CDM","761","RC","37224","HCPCS","facility","both","","","","9266","9266","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STAB PHLEBECTOMY, VEINS, 1 EXT, 10-20","36100103","CDM","761","RC","37765","HCPCS","facility","both","","","","14219","14219","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STAB PHLEBECTOMY, VEINS, 1 EXT, MORE THAN 20","36100104","CDM","761","RC","37766","HCPCS","facility","both","","","","14219","14219","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED VASCULAR SURGERY PROCEDURE","36100105","CDM","761","RC","37799","HCPCS","facility","both","","","","14219","14219","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOACTIVE TRACER ID SENTINEL NODE","36100106","CDM","761","RC","38792","HCPCS","facility","both","","","","64.82","64.82","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC RADIOACTIVE TRACER ID SENTINEL NODE","36100106","CDM","761","RC","38792","HCPCS","facility","both","","","","1593","1593","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RADIOACTIVE TRACER ID SENTINEL NODE","36100106","CDM","761","RC","38792","HCPCS","facility","both","","","","1061","1061","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED PROCEDURE, HEMIC OR LYMPHATIC SYSTEM","36100107","CDM","761","RC","38999","HCPCS","facility","both","","","","1333","1333","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED PROCEDURE, HEMIC OR LYMPHATIC SYSTEM","36100107","CDM","761","RC","38999","HCPCS","facility","both","","","","99.39","99.39","","","","","","","","","","","","","Gross Charge Type: HB JHH DONOR BILLING CLIENT FSC"
"HC REPOSITION GASTROSTOMY TUBE","36100108","CDM","761","RC","43761","HCPCS","facility","both","","","","2004","2004","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEPATOTOMY; PERCUT DRAIN ABSCESS, 1 OR 2 STAGES","36100109","CDM","361","RC","47011","HCPCS","facility","both","","","","3433","3433","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION PERCUT TRANSHEPATIC CHOLANGIOGRAPHY","36100110","CDM","361","RC","47500","HCPCS","facility","both","","","","908","908","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION CHOLANGIOGRAPHY THRU EXISTING CATH","36100111","CDM","361","RC","47505","HCPCS","facility","both","","","","386","386","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUT BILIARY DRAINAGE INTERNAL AND EXTERNAL","36100112","CDM","361","RC","47511","HCPCS","facility","both","","","","13353","13353","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHANGE OF PERCUT BILIARY DRAINAGE CATH","36100113","CDM","361","RC","47525","HCPCS","facility","both","","","","3039","3039","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUT DILATION BILARY STRICTURE WO STENT","36100114","CDM","761","RC","47555","HCPCS","facility","both","","","","4678","4678","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUT DILATION BILARY STRICTURE WITH STENT","36100115","CDM","761","RC","47556","HCPCS","facility","both","","","","5519","5519","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN PERITONEAL ABSCESS OR CYST, PERCUTANEOUS","36100116","CDM","361","RC","49021","HCPCS","facility","both","","","","3344","3344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT TUNNELED IP CATH FOR DIALYSIS, OPEN","36100117","CDM","761","RC","49421","HCPCS","facility","both","","","","3409","3409","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONTRAST INJECTION, ASSESS CYST VIA EXIST CATH","36100118","CDM","761","RC","49424","HCPCS","facility","both","","","","779","779","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE GASTROSTOMY TUBE, PERCUT, UNDER FLUORO GUIDE","36100119","CDM","761","RC","49440","HCPCS","facility","both","","","","5131","5131","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN RENAL ABSCESS; PERCUTANEOUS","36100120","CDM","361","RC","50021","HCPCS","facility","both","","","","3745","3745","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEPHROSTOMY, NEPHROTOMY WITH DRAINAGE","36100121","CDM","761","RC","50040","HCPCS","facility","both","","","","3552","3552","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHANGE EXT/INT URETER STENT","36100122","CDM","761","RC","50387","HCPCS","facility","both","","","","5173","5173","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHANGE EXT/INT URETER STENT","36100122","CDM","761","RC","50387","HCPCS","facility","both","","","","3449","3449","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE RENAL TUBE W/FLUORO","36100123","CDM","761","RC","50389","HCPCS","facility","both","","","","1570","1570","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE RENAL TUBE W/FLUORO","36100123","CDM","761","RC","50389","HCPCS","facility","both","","","","1050","1050","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUT DRAIN OR INJECT RENAL PELVIS","36100124","CDM","361","RC","50392","HCPCS","facility","both","","","","1759","1759","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUT DRAIN OR STENT PLACEMENT URETER","36100125","CDM","361","RC","50393","HCPCS","facility","both","","","","2110","2110","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION PROCEDURE FOR PYELOGRAPHY","36100126","CDM","361","RC","50394","HCPCS","facility","both","","","","365","365","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Dilation for nephrostomy tract, percut","36100127","CDM","761","RC","50395","HCPCS","facility","both","","","","1966","1966","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHANGE OF NEPHROSTOMY OR PYELOSTOMY TUBE","36100128","CDM","361","RC","50398","HCPCS","facility","both","","","","899","899","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECT ILEAL CONDUIT/URETEROPYELOGRAM","36100129","CDM","761","RC","50690","HCPCS","facility","both","","","","873","873","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION CYSTOGRAPHY OR VOIDING URETHROCYSTOGRAPHY","36100130","CDM","761","RC","51600","HCPCS","facility","both","","","","662","662","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYSTOURETHROSCOPY, WITH URETEROSCOPY, DX","36100131","CDM","761","RC","52351","HCPCS","facility","both","","","","3912","3912","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CATHETER FOR HYSTEROGRAPHY","36100132","CDM","761","RC","58340","HCPCS","facility","both","","","","707","707","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYELOGRAM INJECT, SPINAL NOT C1-C2","36100133","CDM","761","RC","62284","HCPCS","facility","both","","","","1433","1433","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS DISKECTOMY","36100134","CDM","761","RC","62287","HCPCS","facility","both","","","","10085","10085","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION DISCOGRAPHY, EACH LEVEL; LUMBAR","36100135","CDM","761","RC","62290","HCPCS","facility","both","","","","481","481","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Inject spine, cervical or thoracic","36100136","CDM","361","RC","62310","HCPCS","facility","both","","","","755","755","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Inject spine, lumbar or sacral","36100137","CDM","361","RC","62311","HCPCS","facility","both","","","","755","755","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LAMINOTOMY, ONE INTERSPACE, LUMBAR","36100138","CDM","761","RC","63030","HCPCS","facility","both","","","","6812","6812","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LAMINOTOMY, EA ADDL INTERSPACE, CERVICAL OR LUMBAR","36100139","CDM","761","RC","63035","HCPCS","facility","both","","","","3258","3258","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS IMPLANT NEURO ELECTRODES, EPIDURAL","36100140","CDM","761","RC","63650","HCPCS","facility","both","","","","18774","18774","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE NEURO ELECTRODE PERCUT, W/FLUORO","36100141","CDM","761","RC","63661","HCPCS","facility","both","","","","5772","5772","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REVIS/REMVL IMPL NSTIM GENERATOR/RCVR W/DETACH CONNECT E. ARRAY","36100142","CDM","761","RC","63688","HCPCS","facility","both","","","","8685","8685","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; TRIGEMINAL NERVE, EA BRCH","36100143","CDM","761","RC","64400","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; GREATER OCCIPITAL NERVE","36100144","CDM","761","RC","64405","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; INTERCOSTAL NERVE, SNGL LEVEL","36100145","CDM","761","RC","64420","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; INTERCOSTAL NERVE EA ADDL LEVEL","36100146","CDM","761","RC","64421","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), ANES AGENT(S)&/OR STERIOD; ILIOINGUINAL, ILIOHYPOGASTRIC  NERVES","36100147","CDM","761","RC","64425","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), TRANSFORAMINAL EPIDURAL, CERVICAL/THORACIC, 1 LEVEL","36100148","CDM","761","RC","64479","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), TRANSFORAMINAL EPIDURAL, CERVICAL/THORACIC, EA ADDL LEVEL","36100149","CDM","761","RC","64480","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), TRANSFORAMINAL EPIDURAL, LUMBAR/SACRAL, 1 LEVEL","36100150","CDM","761","RC","64483","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), TRANSFORAMINAL EPIDURAL, LUMBAR/SACRAL, 1 LEVEL","36100150","CDM","761","RC","64483","HCPCS","facility","both","","","","2284","2284","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), TRANSFORAMINAL EPIDURAL, LUMBAR/SACRAL, EA ADDL LEVEL","36100151","CDM","761","RC","64484","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), TRANSFORAMINAL EPIDURAL, LUMBAR/SACRAL, EA ADDL LEVEL","36100151","CDM","761","RC","64484","HCPCS","facility","both","","","","2284","2284","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PARAVERTEBRAL FACET, CERVICAL/THORARCIC, 1 LEVEL","36100152","CDM","761","RC","64490","HCPCS","facility","both","","","","2994","2994","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PARAVERTEBRAL FACET, CERVICAL/THORARCIC, 1 LEVEL","36100152","CDM","761","RC","64490","HCPCS","facility","both","","","","4483","4483","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PARAVERTEBRAL FACET, CERVICAL/THORARCIC, 2 LEVEL","36100153","CDM","761","RC","64491","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PARAVERTEBRAL FACET, CERVICAL/THORARCIC, 3 LEVEL","36100154","CDM","761","RC","64492","HCPCS","facility","both","","","","1078","1078","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 1 LEVEL","36100155","CDM","761","RC","64493","HCPCS","facility","both","","","","2533","2533","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 1 LEVEL","36100155","CDM","761","RC","64493","HCPCS","facility","both","","","","3383","3383","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 2 LEVEL","36100156","CDM","761","RC","64494","HCPCS","facility","both","","","","1617","1617","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 2 LEVEL","36100156","CDM","761","RC","64494","HCPCS","facility","both","","","","1215","1215","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 3 LEVEL","36100157","CDM","761","RC","64495","HCPCS","facility","both","","","","1816","1816","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PARAVERTEBRAL FACET, LUMBAR/SACRAL, 3 LEVEL","36100157","CDM","761","RC","64495","HCPCS","facility","both","","","","1215","1215","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NERVE BLOCK INJ, STELLATE GANGLION","36100158","CDM","761","RC","64510","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NERVE BLOCK INJ, SUPERIOR HYPOGASTRIC PLEXUS","36100159","CDM","761","RC","64517","HCPCS","facility","both","","","","2648","2648","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NERVE BLOCK INJ, SUPERIOR HYPOGASTRIC PLEXUS","36100159","CDM","761","RC","64517","HCPCS","facility","both","","","","3969","3969","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NERVE BLOCK INJ, LUMBAR OR THORACIC","36100160","CDM","761","RC","64520","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NERVE BLOCK INJ, CELIAC PLEXUS","36100161","CDM","761","RC","64530","HCPCS","facility","both","","","","2994","2994","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESTROY CERVICAL OR THORACIC, SINGLE FACET JOINT","36100162","CDM","761","RC","64633","HCPCS","facility","both","","","","3327","3327","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESTROY CERVICAL OR THORACIC, SINGLE FACET JOINT","36100162","CDM","761","RC","64633","HCPCS","facility","both","","","","4984","4984","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESTROY CERVICAL OR THORACIC, EA ADDL FACET JOINT","36100163","CDM","761","RC","64634","HCPCS","facility","both","","","","1756","1756","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESTROY CERVICAL OR THORACIC, EA ADDL FACET JOINT","36100163","CDM","761","RC","64634","HCPCS","facility","both","","","","2630","2630","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESTROY LUMBAR OR SACRAL, SINGLE FACET JOINT","36100164","CDM","761","RC","64635","HCPCS","facility","both","","","","4878","4878","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESTROY LUMBAR OR SACRAL, SINGLE FACET JOINT","36100164","CDM","761","RC","64635","HCPCS","facility","both","","","","3327","3327","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESTROY LUMBAR OR SACRAL, EA ADDL FACET JOINT","36100165","CDM","761","RC","64636","HCPCS","facility","both","","","","1665","1665","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESTROY LUMBAR OR SACRAL, EA ADDL FACET JOINT","36100165","CDM","761","RC","64636","HCPCS","facility","both","","","","2495","2495","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESTROY NEUROLYTIC, OTHER PERIPHERAL NERVE","36100166","CDM","761","RC","64640","HCPCS","facility","both","","","","2994","2994","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ARTERIAL BLOOD SAMPLING VIA PERC PUNCTURE","36100167","CDM","761","RC","36620","HCPCS","facility","both","","","","590","590","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ARTERIAL BLOOD SAMPLING VIA PERC PUNCTURE","36100167","CDM","761","RC","36620","HCPCS","facility","both","","","","107.36","107.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC PLACE NEEDLE INTRAOSSEOUS INFUSION","36100168","CDM","761","RC","36680","HCPCS","facility","both","","","","1309","1309","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PULMONARY EMBOLECTOMY; WO CPB","36100169","CDM","761","RC","33915","HCPCS","facility","both","","","","27451","27451","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THROMBOLYTIC ART THERAPY","36100200","CDM","761","RC","37211","HCPCS","facility","both","","","","3667","3667","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THROMBOLYTIC VENOUS THERAPY","36100201","CDM","761","RC","37212","HCPCS","facility","both","","","","3431","3431","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THROMBLYTIC ART/VEN THERAPY","36100202","CDM","761","RC","37213","HCPCS","facility","both","","","","7654","7654","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CESSJ THERAPY CATH REMOVAL","36100203","CDM","761","RC","37214","HCPCS","facility","both","","","","7654","7654","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRESS/DEBRID P-THICK BURN L","36100250","CDM","761","RC","16030","HCPCS","facility","both","","","","517","517","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CL TX ULNAR SHAFT FX; WO MANIP","36100251","CDM","761","RC","25530","HCPCS","facility","both","","","","339","339","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NONSELECTIVE CATH PLACEMENT IN VEIN","36100252","CDM","761","RC","36000","HCPCS","facility","both","","","","212.31","212.31","","","","","","","","","","","","","Gross Charge Type: JHH 79 CLINIC ORC"
"HC NONSELECTIVE CATH PLACEMENT IN VEIN","36100252","CDM","761","RC","36000","HCPCS","facility","both","","","","368","368","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANOSCOPY; DX","36100253","CDM","761","RC","46600","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPLACE NON-TUNNELED CV CATH","36100255","CDM","761","RC","","","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ (S), ANESTH AGENT(S) &/OR STERIOD; SCIATIC NERVE, INCL IMG GUIDANCE","36100256","CDM","761","RC","64445","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRONCHOSCOPY RESP COMPONENT","36100257","CDM","460","RC","94799","HCPCS","facility","both","","","","3351","3351","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRONCHOSCOPY ENDO COMPONENT","36100258","CDM","361","RC","","","facility","both","","","","2392","2392","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLEURAL CATH ENDO COMPONENT","36100259","CDM","361","RC","","","facility","both","","","","2064","2064","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLEURAL CATH RESP COMPONENT","36100260","CDM","361","RC","","","facility","both","","","","2055","2055","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPEN/PERQ PLACE STENT SAME INITIAL ARTERY","36100261","CDM","761","RC","37236","HCPCS","facility","both","","","","10883","10883","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPEN/PERQ PLACE STENT EACH ADDTL ARTERY","36100262","CDM","761","RC","37237","HCPCS","facility","both","","","","6302","6302","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPEN/PERQ PLACE STENT SAME INITIAL VEIN","36100263","CDM","761","RC","37238","HCPCS","facility","both","","","","10883","10883","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPEN/PERQ PLACE STENT EA ADD","36100264","CDM","761","RC","37239","HCPCS","facility","both","","","","6302","6302","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VASC EMBOLIZE/OCCLUDE VENOUS","36100265","CDM","761","RC","37241","HCPCS","facility","both","","","","16344","16344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VASC EMBOLIZE/OCCLUDE ARTERY","36100266","CDM","761","RC","37242","HCPCS","facility","both","","","","16344","16344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VASC EMBOLIZE/OCCLUDE ORGAN","36100267","CDM","761","RC","37243","HCPCS","facility","both","","","","16344","16344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VASC EMBOLIZE/OCCLUDE BLEED","36100268","CDM","761","RC","37244","HCPCS","facility","both","","","","16344","16344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMAGE CATH FLUID COLXN VISC","36100269","CDM","761","RC","49405","HCPCS","facility","both","","","","7137","7137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMAGE CATH FLUID PERI/RETRO","36100270","CDM","761","RC","49406","HCPCS","facility","both","","","","7228","7228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODENERV MUSC NECK DYSTON","36100271","CDM","761","RC","64616","HCPCS","facility","both","","","","1423","1423","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODENERV 1 EXTREMITY 1-4","36100272","CDM","761","RC","64642","HCPCS","facility","both","","","","1191","1191","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODENERV 1 EXTREM 1-4 EA","36100273","CDM","761","RC","64643","HCPCS","facility","both","","","","1191","1191","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODENERV 1 EXTREM 5/> MUS","36100274","CDM","761","RC","64644","HCPCS","facility","both","","","","1191","1191","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODENERV 1 EXTREM 5/> EA","36100275","CDM","761","RC","64645","HCPCS","facility","both","","","","1191","1191","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODENERV TRUNK MUSC 1-5","36100276","CDM","761","RC","64646","HCPCS","facility","both","","","","1191","1191","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODENERV TRUNK MUSC 6/>","36100277","CDM","761","RC","64647","HCPCS","facility","both","","","","1191","1191","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODENERV, MUSC(S); LARYNX UNI EMG","36100278","CDM","761","RC","64617","HCPCS","facility","both","","","","2488","2488","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABLATE BONE TUMOR PERQ","36100279","CDM","761","RC","20982","HCPCS","facility","both","","","","13757","13757","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMAGE GUIDED CATH ABSCESS TRANSVAGINAL","36100280","CDM","761","RC","49407","HCPCS","facility","both","","","","2373","2373","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE NEEDLE/CATH A-V DIALYSIS SHUNT, ADDTL ACCESS FOR THERAPY","36100281","CDM","361","RC","36148","HCPCS","facility","both","","","","690","690","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","36100282","CDM","761","RC","10030","HCPCS","facility","both","","","","775","775","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ & PLACEMENT OF CONTRAST CHAINS","36100283","CDM","761","RC","51605","HCPCS","facility","both","","","","662","662","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANESTHESIOLOGY PRICE PER MINUTE","37000001","CDM","370","RC","","","facility","both","","","","10.79","10.79","","","","","","","","","","","","","Gross Charge Type: JHH 41 ANESTHESIOLOGY"
"HC ANESTHESIOLOGY FLAT RATE","37000005","CDM","370","RC","","","facility","both","","","","1091","1091","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOD SEDATION SAME PHYS/QHP 5/>YRS; INITL 15 MIN","37000006","CDM","370","RC","99152","HCPCS","facility","both","","","","1131","1131","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOD SED SAME PHYS/QHP; EA ADDL 15 MIN","37000007","CDM","370","RC","99153","HCPCS","facility","both","","","","638","638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOD SED OTHER PHYS/QHP <5 YRS; INITL 15 MIN","37000008","CDM","370","RC","99155","HCPCS","facility","both","","","","1131","1131","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOD SED OTHER PHYS/QHP; EA ADDL 15 MIN","37000009","CDM","370","RC","99157","HCPCS","facility","both","","","","638","638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOD SED OTHER PHYS/QHP 5/>YRS; INITL 15 MIN","37000010","CDM","370","RC","99156","HCPCS","facility","both","","","","638","638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOD SED SAME PHYS/QHP <5 YRS; INITL 15 MIN","37000011","CDM","370","RC","99151","HCPCS","facility","both","","","","638","638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC L& D ANESTHESIA FLAT RATE","37000012","CDM","370","RC","","","facility","both","","","","216.23","216.23","","","","","","","","","","","","","Gross Charge Type: JHH 41 ANESTHESIOLOGY"
"HC RBC DEGLYCEROLIZED EACH UNIT","38100001","CDM","390","RC","","","facility","both","","","","520","520","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC DEGLYCEROLIZED EACH UNIT","38100001","CDM","390","RC","","","facility","both","","","","1199","1199","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC DEGLYCEROLIZED EACH UNIT","38100001","CDM","390","RC","","","facility","both","","","","544.29","544.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RBC DEGLYCEROLIZED EACH UNIT","38100001","CDM","390","RC","","","facility","both","","","","696.71","696.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RBC DEGLYCEROLIZED EACH UNIT","38100002","CDM","390","RC","","","facility","both","","","","1138","1138","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC LR IRRADIATED EACH UNIT","38100003","CDM","390","RC","","","facility","both","","","","471.02","471.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RBC LR IRRADIATED EACH UNIT","38100003","CDM","390","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC LR IRRADIATED EACH UNIT","38100003","CDM","390","RC","","","facility","both","","","","602.93","602.93","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RBC LR IRRADIATED EACH UNIT","38100003","CDM","390","RC","","","facility","both","","","","839","839","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC IRRADIATED EACH UNIT","38100005","CDM","390","RC","","","facility","both","","","","355.88","355.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RBC IRRADIATED EACH UNIT","38100005","CDM","390","RC","","","facility","both","","","","455.54","455.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC WSH LR FROZ DW WB/RBC EA UNIT","38100006","CDM","390","RC","","","facility","both","","","","630","630","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC WSH LR FROZ DW WB/RBC EA UNIT","38100006","CDM","390","RC","","","facility","both","","","","659.44","659.44","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC WSH LR FROZ DW WB/RBC EA UNIT","38100006","CDM","390","RC","","","facility","both","","","","1526","1526","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC WSH LR FROZ DW WB/RBC EA UNIT","38100006","CDM","390","RC","","","facility","both","","","","844.09","844.09","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RBC FROZ LEUK REDUC IRRAD EA UNIT","38100007","CDM","390","RC","","","facility","both","","","","790","790","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC FROZ LEUK REDUC IRRAD EA UNIT","38100007","CDM","390","RC","","","facility","both","","","","826.9","826.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RBC FROZ LEUK REDUC IRRAD EA UNIT","38100007","CDM","390","RC","","","facility","both","","","","1130","1130","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC FROZ LEUK REDUC IRRAD EA UNIT","38100007","CDM","390","RC","","","facility","both","","","","1058.47","1058.47","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RBC FROZ LEUK REDUC IRRAD EA UNIT","38100007","CDM","390","RC","","","facility","both","","","","1130","1130","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CMV-NEG LR IRRAD RBC EA UNIT","38100008","CDM","390","RC","","","facility","both","","","","656.51","656.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CMV-NEG LR IRRAD RBC EA UNIT","38100008","CDM","390","RC","","","facility","both","","","","1514","1514","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CMV-NEG LR IRRAD RBC EA UNIT","38100008","CDM","390","RC","","","facility","both","","","","512.89","512.89","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CMV-NEG LR IRRAD RBC EA UNIT","38100008","CDM","390","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC DEGLYCEROLIZED EA UNIT (AUTOLOGOUS/DIRECTED)","38100201","CDM","390","RC","","","facility","both","","","","770","770","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC DEGLYCEROLIZED EA UNIT (AUTOLOGOUS/DIRECTED)","38100201","CDM","390","RC","","","facility","both","","","","805.97","805.97","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RBC DEGLYCEROLIZED EA UNIT (AUTOLOGOUS/DIRECTED)","38100201","CDM","390","RC","","","facility","both","","","","1456","1456","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC DEGLYCEROLIZED EA UNIT (AUTOLOGOUS/DIRECTED)","38100201","CDM","390","RC","","","facility","both","","","","1031.67","1031.67","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RBC LR IRRADIATED EA UNIT (AUTOLOGOUS/DIRECTED)","38100203","CDM","390","RC","","","facility","both","","","","732.7","732.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RBC LR IRRADIATED EA UNIT (AUTOLOGOUS/DIRECTED)","38100203","CDM","390","RC","","","facility","both","","","","700","700","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC LR IRRADIATED EA UNIT (AUTOLOGOUS/DIRECTED)","38100203","CDM","390","RC","","","facility","both","","","","1241","1241","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC LR IRRADIATED EA UNIT (AUTOLOGOUS/DIRECTED)","38100203","CDM","390","RC","","","facility","both","","","","937.88","937.88","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RBC, DEGLYCER, LEUKOREDUCED (AUTOLOGOUS/DIRECTED)","38100206","CDM","390","RC","","","facility","both","","","","921.12","921.12","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RBC, DEGLYCER, LEUKOREDUCED (AUTOLOGOUS/DIRECTED)","38100206","CDM","390","RC","","","facility","both","","","","630","630","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC, DEGLYCER, LEUKOREDUCED (AUTOLOGOUS/DIRECTED)","38100206","CDM","390","RC","","","facility","both","","","","1179.04","1179.04","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RBC, DEGLYCER, LEUKOREDUCED (AUTOLOGOUS/DIRECTED)","38100206","CDM","390","RC","","","facility","both","","","","1791","1791","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC FROZ LEUK REDUC IRRAD EA UNIT (AUTOLOGOUS/DIRECTED)","38100207","CDM","390","RC","","","facility","both","","","","1395","1395","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC FROZ LEUK REDUC IRRAD EA UNIT (AUTOLOGOUS/DIRECTED)","38100207","CDM","390","RC","","","facility","both","","","","790","790","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC WASHED RED BLOOD CELLS EA UNIT","38120004","CDM","390","RC","","","facility","both","","","","334.95","334.95","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC WASHED RED BLOOD CELLS EA UNIT","38120004","CDM","390","RC","","","facility","both","","","","912","912","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC WASHED RED BLOOD CELLS EA UNIT","38120004","CDM","390","RC","","","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC WASHED RED BLOOD CELLS EA UNIT","38120004","CDM","390","RC","","","facility","both","","","","428.74","428.74","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC WASHED RED BLOOD CELLS EA UNIT (AUTOLOGOUS/DIRECTED)","38120005","CDM","390","RC","","","facility","both","","","","570","570","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC WASHED RED BLOOD CELLS EA UNIT (AUTOLOGOUS/DIRECTED)","38120005","CDM","390","RC","","","facility","both","","","","3482","3482","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD SPLIT UNIT","38200001","CDM","390","RC","","","facility","both","","","","1223","1223","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC WHOLE BLD FOR TRANSFUSION/UNIT","38200002","CDM","390","RC","","","facility","both","","","","282.61","282.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC WHOLE BLD FOR TRANSFUSION/UNIT","38200002","CDM","390","RC","","","facility","both","","","","270","270","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC WHOLE BLD FOR TRANSFUSION/UNIT","38200002","CDM","390","RC","","","facility","both","","","","361.76","361.76","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC WHOLE BLD FOR TRANSFUSION/UNIT","38200002","CDM","390","RC","","","facility","both","","","","917","917","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC WHOLE BLD FOR TRANSFUSION/UNIT (AUTOLOGOUS/DIRECTED)","38200003","CDM","390","RC","","","facility","both","","","","520","520","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC WHOLE BLD FOR TRANSFUSION/UNIT (AUTOLOGOUS/DIRECTED)","38200003","CDM","390","RC","","","facility","both","","","","1362","1362","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC WHOLE BLD FOR TRANSFUSION/UNIT (AUTOLOGOUS/DIRECTED)","38200003","CDM","390","RC","","","facility","both","","","","544.29","544.29","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC WHOLE BLD FOR TRANSFUSION/UNIT (AUTOLOGOUS/DIRECTED)","38200003","CDM","390","RC","","","facility","both","","","","696.71","696.71","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LR IRRAD WHOLE BLD EA UNIT","38200004","CDM","390","RC","","","facility","both","","","","565.23","565.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LR IRRAD WHOLE BLD EA UNIT","38200004","CDM","390","RC","","","facility","both","","","","445","445","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LR IRRAD WHOLE BLD EA UNIT","38200004","CDM","390","RC","","","facility","both","","","","540","540","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LR IRRAD WHOLE BLD EA UNIT","38200004","CDM","390","RC","","","facility","both","","","","723.51","723.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC WHOLE BLOOD, IRRADIATED, LEUKOREDUCED (AUTOLOGOUS/DIRECTED)","38200204","CDM","390","RC","","","facility","both","","","","1058.47","1058.47","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC WHOLE BLOOD, IRRADIATED, LEUKOREDUCED (AUTOLOGOUS/DIRECTED)","38200204","CDM","390","RC","","","facility","both","","","","826.9","826.9","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC WHOLE BLOOD, IRRADIATED, LEUKOREDUCED (AUTOLOGOUS/DIRECTED)","38200204","CDM","390","RC","","","facility","both","","","","709","709","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"DEAC 3/14/2017 HC PLASMA 1 DONOR FRZ W/IN 8 HR","38300001","CDM","390","RC","","","facility","both","","","","131","131","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FFP 8-24 HRS OF COLLECT EA UNIT","38300002","CDM","390","RC","","","facility","both","","","","266","266","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FFP 8-24 HRS OF COLLECT EA UNIT","38300002","CDM","390","RC","","","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FFP 8-24 HRS OF COLLECT EA UNIT","38300002","CDM","390","RC","","","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FFP 8-24 HRS OF COLLECT EA UNIT","38300002","CDM","390","RC","","","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DETERGENT TX FROZEN PLASMA EA UNIT","38300003","CDM","390","RC","","","facility","both","","","","321.56","321.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC DETERGENT TX FROZEN PLASMA EA UNIT","38300003","CDM","390","RC","","","facility","both","","","","251.22","251.22","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC DETERGENT TX FROZEN PLASMA EA UNIT","38300003","CDM","390","RC","","","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC DETERGENT TX FROZEN PLASMA EA UNIT","38300003","CDM","390","RC","","","facility","both","","","","861","861","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FFP DONOR RETSTD EA UNIT","38300004","CDM","390","RC","","","facility","both","","","","223","223","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLATELETS PHERESIS EACH UNIT","38400001","CDM","390","RC","","","facility","both","","","","920","920","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PLATELETS PHERESIS EACH UNIT","38400001","CDM","390","RC","","","facility","both","","","","1232.64","1232.64","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PLATELETS PHERESIS EACH UNIT","38400001","CDM","390","RC","","","facility","both","","","","962.98","962.98","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PLATELETS PHERESIS EACH UNIT","38400001","CDM","390","RC","","","facility","both","","","","1352","1352","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLATELETS PHERESIS LR EA UNIT","38400002","CDM","390","RC","","","facility","both","","","","1352","1352","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLATELETS PHERESIS LR EA UNIT","38400002","CDM","390","RC","","","facility","both","","","","1046.72","1046.72","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PLATELETS PHERESIS LR EA UNIT","38400002","CDM","390","RC","","","facility","both","","","","1339.83","1339.83","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PLATELETS PHERESIS LR EA UNIT","38400002","CDM","390","RC","","","facility","both","","","","1000","1000","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PLATELETS PHERESIS LR EA UNIT","38400002","CDM","390","RC","","","facility","both","","","","130.8","130.8","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC PLATELETS PHERESIS LR IRRAD EA UNIT","38400003","CDM","390","RC","","","facility","both","","","","1160","1160","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PLATELETS PHERESIS LR IRRAD EA UNIT","38400003","CDM","390","RC","","","facility","both","","","","1554.2","1554.2","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PLATELETS PHERESIS LR IRRAD EA UNIT","38400003","CDM","390","RC","","","facility","both","","","","1214.19","1214.19","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PLATELETS PHERESIS LR IRRAD EA UNIT","38400003","CDM","390","RC","","","facility","both","","","","1587","1587","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IRRADIATED PLATELETS EA UNIT","38400006","CDM","390","RC","","","facility","both","","","","321","321","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC IRRADIATED PLATELETS EA UNIT","38400006","CDM","390","RC","","","facility","both","","","","136.07","136.07","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC IRRADIATED PLATELETS EA UNIT","38400006","CDM","390","RC","","","facility","both","","","","130","130","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC IRRADIATED PLATELETS EA UNIT","38400006","CDM","390","RC","","","facility","both","","","","174.17","174.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEUKOREDUCED IRRAD PLATELETS EA UNIT","38400007","CDM","390","RC","","","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LEUKOREDUCED IRRAD PLATELETS EA UNIT","38400007","CDM","390","RC","","","facility","both","","","","187.58","187.58","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEUKOREDUCED IRRAD PLATELETS EA UNIT","38400007","CDM","390","RC","","","facility","both","","","","146.54","146.54","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LEUKOREDUCED IRRAD PLATELETS EA UNIT","38400007","CDM","390","RC","","","facility","both","","","","372","372","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLTLT HLA-LR EA UNIT","38400008","CDM","390","RC","","","facility","both","","","","1674.79","1674.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PLTLT HLA-LR EA UNIT","38400008","CDM","390","RC","","","facility","both","","","","2239","2239","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLTLT HLA-LR EA UNIT","38400008","CDM","390","RC","","","facility","both","","","","1308.4","1308.4","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PLTLT HLA-LR EA UNIT","38400008","CDM","390","RC","","","facility","both","","","","1250","1250","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CMV-N LR IR PLTLT EA UNIT","38400009","CDM","390","RC","","","facility","both","","","","1664","1664","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CMV-N LR IR PLTLT EA UNIT","38400009","CDM","390","RC","","","facility","both","","","","1200","1200","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CMV-N LR IR PLTLT EA UNIT","38400009","CDM","390","RC","","","facility","both","","","","1607.79","1607.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CMV-N LR IR PLTLT EA UNIT","38400009","CDM","390","RC","","","facility","both","","","","1256.06","1256.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LR CMV-NEG PLATELETS EA UNIT","38400010","CDM","390","RC","","","facility","both","","","","1253","1253","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LR CMV-NEG PLATELETS EA UNIT","38400010","CDM","390","RC","","","facility","both","","","","1088.58","1088.58","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LR CMV-NEG PLATELETS EA UNIT","38400010","CDM","390","RC","","","facility","both","","","","163.5","163.5","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC LR CMV-NEG PLATELETS EA UNIT","38400010","CDM","390","RC","","","facility","both","","","","1393.43","1393.43","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LR CMV-NEG PLATELETS EA UNIT","38400010","CDM","390","RC","","","facility","both","","","","1040","1040","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PR PLASMA EA UNIT","38400011","CDM","390","RC","","","facility","both","","","","619","619","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEUKO REDUCED PLATELETS EA UNIT","38400012","CDM","390","RC","","","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LEUKO REDUCED PLATELETS EA UNIT","38400012","CDM","390","RC","","","facility","both","","","","160.78","160.78","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEUKO REDUCED PLATELETS EA UNIT","38400012","CDM","390","RC","","","facility","both","","","","247","247","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEUKO REDUCED PLATELETS EA UNIT","38400012","CDM","390","RC","","","facility","both","","","","125.61","125.61","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PRT PLATELETS","38460001","CDM","390","RC","","","facility","both","","","","937.88","937.88","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PRT PLATELETS","38460001","CDM","390","RC","","","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PRT PLATELETS","38460001","CDM","390","RC","","","facility","both","","","","732.7","732.7","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PRT PLATELETS","38460001","CDM","390","RC","","","facility","both","","","","1910","1910","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GRANULOCYTES PHERESIS UNIT","38600001","CDM","390","RC","","","facility","both","","","","1200","1200","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC GRANULOCYTES PHERESIS UNIT","38600001","CDM","390","RC","","","facility","both","","","","8905","8905","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC GRANULOCYTES PHERESIS UNIT","38600001","CDM","390","RC","","","facility","both","","","","1256.06","1256.06","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC GRANULOCYTES PHERESIS UNIT","38600001","CDM","390","RC","","","facility","both","","","","1700.4","1700.4","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC GRANULOCYTES PHERESIS UNIT","38600001","CDM","390","RC","","","facility","both","","","","1607.79","1607.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CRYOPRECIPITATE EA UNIT","38700001","CDM","390","RC","","","facility","both","","","","247","247","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPATIBILITY TEST SPIN","39000001","CDM","300","RC","86920","HCPCS","facility","both","","","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC COMPATIBILITY TEST SPIN","39000001","CDM","300","RC","86920","HCPCS","facility","both","","","","8","8","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC COMPATIBILITY TEST SPIN","39000001","CDM","300","RC","86920","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC COMPATIBILITY TEST SPIN","39000001","CDM","300","RC","86920","HCPCS","facility","both","","","","21.44","21.44","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC FROZEN BLOOD PREP","39000002","CDM","390","RC","86930","HCPCS","facility","both","","","","728","728","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD SPLIT UNIT","39000003","CDM","390","RC","","","facility","both","","","","1278","1278","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC BLOOD SPLIT UNIT","39000003","CDM","390","RC","","","facility","both","","","","230.28","230.28","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLOOD SPLIT UNIT","39000003","CDM","390","RC","","","facility","both","","","","294.77","294.77","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC BLOOD SPLIT UNIT","39000003","CDM","390","RC","","","facility","both","","","","220","220","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CRYOPRECIPITATE EA UNIT","39000004","CDM","390","RC","","","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CRYOPRECIPITATE EA UNIT","39000004","CDM","390","RC","","","facility","both","","","","93.79","93.79","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CRYOPRECIPITATE EA UNIT","39000004","CDM","390","RC","","","facility","both","","","","73.27","73.27","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CRYOPRECIPITATE EA UNIT","39000004","CDM","390","RC","","","facility","both","","","","247","247","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEUKOCYTE POOR BLOOD EA UNIT","39000005","CDM","390","RC","","","facility","both","","","","723","723","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEUKOCYTE POOR BLOOD EA UNIT","39000005","CDM","390","RC","","","facility","both","","","","290","290","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LEUKOCYTE POOR BLOOD EA UNIT","39000005","CDM","390","RC","","","facility","both","","","","388.56","388.56","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEUKOCYTE POOR BLOOD EA UNIT","39000005","CDM","390","RC","","","facility","both","","","","303.55","303.55","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PLASMA 1 DONOR FRZ W/IN 8 HR","39000006","CDM","390","RC","","","facility","both","","","","266","266","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLASMA 1 DONOR FRZ W/IN 8 HR","39000006","CDM","390","RC","","","facility","both","","","","107.19","107.19","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PLASMA 1 DONOR FRZ W/IN 8 HR","39000006","CDM","390","RC","","","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PLASMA 1 DONOR FRZ W/IN 8 HR","39000006","CDM","390","RC","","","facility","both","","","","83.74","83.74","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RED BLOOD CELLS EA UNIT","39000007","CDM","390","RC","","","facility","both","","","","188.41","188.41","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RED BLOOD CELLS EA UNIT","39000007","CDM","390","RC","","","facility","both","","","","723","723","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RED BLOOD CELLS EA UNIT","39000007","CDM","390","RC","","","facility","both","","","","241.17","241.17","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RED BLOOD CELLS EA UNIT","39000007","CDM","390","RC","","","facility","both","","","","180","180","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC CMV-N LR WB/RBC EA UNIT","39000008","CDM","390","RC","","","facility","both","","","","442.14","442.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CMV-N LR WB/RBC EA UNIT","39000008","CDM","390","RC","","","facility","both","","","","345.42","345.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CMV-N LR WB/RBC EA UNIT","39000008","CDM","390","RC","","","facility","both","","","","349","349","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC CMV-N LR WB/RBC EA UNIT","39000008","CDM","390","RC","","","facility","both","","","","330","330","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PLASMA, CRYOPRECIPITATE REDUCED, EA UNIT","39000009","CDM","390","RC","","","facility","both","","","","1086","1086","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLASMA, CRYOPRECIPITATE REDUCED, EA UNIT","39000009","CDM","390","RC","","","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PLASMA, CRYOPRECIPITATE REDUCED, EA UNIT","39000009","CDM","390","RC","","","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC PLASMA, CRYOPRECIPITATE REDUCED, EA UNIT","39000009","CDM","390","RC","","","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PLATELETS, EACH UNIT","39000010","CDM","390","RC","","","facility","both","","","","147.37","147.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PLATELETS, EACH UNIT","39000010","CDM","390","RC","","","facility","both","","","","115.14","115.14","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PLATELETS, EACH UNIT","39000010","CDM","390","RC","","","facility","both","","","","287","287","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLATELET PHERESIS IRRAD EA UNIT","39000011","CDM","390","RC","","","facility","both","","","","1130.45","1130.45","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PLATELET PHERESIS IRRAD EA UNIT","39000011","CDM","390","RC","","","facility","both","","","","1447.01","1447.01","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PLATELET PHERESIS IRRAD EA UNIT","39000011","CDM","390","RC","","","facility","both","","","","1587","1587","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PLATELET PHERESIS IRRAD EA UNIT","39000011","CDM","390","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC IRRADIATED EACH UNIT","39000012","CDM","390","RC","","","facility","both","","","","340","340","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC IRRADIATED EACH UNIT","39000012","CDM","390","RC","","","facility","both","","","","455.54","455.54","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RBC IRRADIATED EACH UNIT","39000012","CDM","390","RC","","","facility","both","","","","355.88","355.88","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RBC IRRADIATED EACH UNIT","39000012","CDM","390","RC","","","facility","both","","","","839","839","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC LR,CMV NEG, IRR A/D","39000013","CDM","390","RC","","","facility","both","","","","964.68","964.68","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RBC LR,CMV NEG, IRR A/D","39000013","CDM","390","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC LR,CMV NEG, IRR A/D","39000013","CDM","390","RC","","","facility","both","","","","753.64","753.64","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC BLOOD SPLIT UNIT  (AUTOLOGOUS/DIRECTED)","39000203","CDM","390","RC","","","facility","both","","","","1223","1223","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC LEUKOCYTE POOR BLOOD EA UNIT (AUTOLOGOUS/DIRECTED)","39000205","CDM","390","RC","","","facility","both","","","","723.51","723.51","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC LEUKOCYTE POOR BLOOD EA UNIT (AUTOLOGOUS/DIRECTED)","39000205","CDM","390","RC","","","facility","both","","","","565.23","565.23","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC LEUKOCYTE POOR BLOOD EA UNIT (AUTOLOGOUS/DIRECTED)","39000205","CDM","390","RC","","","facility","both","","","","540","540","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC LEUKOCYTE POOR BLOOD EA UNIT (AUTOLOGOUS/DIRECTED)","39000205","CDM","390","RC","","","facility","both","","","","1071","1071","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FFP (FROZ WITH 8 HRS) (AUTOLOGOUS/DIRECTED)","39000206","CDM","390","RC","","","facility","both","","","","532","532","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC FFP (FROZ WITH 8 HRS) (AUTOLOGOUS/DIRECTED)","39000206","CDM","390","RC","","","facility","both","","","","345.42","345.42","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FFP (FROZ WITH 8 HRS) (AUTOLOGOUS/DIRECTED)","39000206","CDM","390","RC","","","facility","both","","","","330","330","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FFP (FROZ WITH 8 HRS) (AUTOLOGOUS/DIRECTED)","39000206","CDM","390","RC","","","facility","both","","","","442.14","442.14","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RED BLOOD CELLS EA UNIT (AUTOLOGOUS/DIRECTED)","39000207","CDM","390","RC","","","facility","both","","","","978","978","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RED BLOOD CELLS EA UNIT (AUTOLOGOUS/DIRECTED)","39000207","CDM","390","RC","","","facility","both","","","","450.09","450.09","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC RED BLOOD CELLS EA UNIT (AUTOLOGOUS/DIRECTED)","39000207","CDM","390","RC","","","facility","both","","","","576.13","576.13","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RED BLOOD CELLS EA UNIT (AUTOLOGOUS/DIRECTED)","39000207","CDM","390","RC","","","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC, IRRADIATED  (AUTOLOGOUS/DIRECTED)","39000212","CDM","390","RC","","","facility","both","","","","1362","1362","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC RBC, IRRADIATED  (AUTOLOGOUS/DIRECTED)","39000212","CDM","390","RC","","","facility","both","","","","790.5","790.5","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC RBC, IRRADIATED  (AUTOLOGOUS/DIRECTED)","39000212","CDM","390","RC","","","facility","both","","","","340","340","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC RBC, IRRADIATED  (AUTOLOGOUS/DIRECTED)","39000212","CDM","390","RC","","","facility","both","","","","617.57","617.57","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CMV-N LR WB/RBC AUT/DIR","39000213","CDM","390","RC","","","facility","both","","","","607.1","607.1","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC CMV-N LR WB/RBC AUT/DIR","39000213","CDM","390","RC","","","facility","both","","","","777.1","777.1","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC CMV-N LR WB/RBC AUT/DIR","39000213","CDM","390","RC","","","facility","both","","","","330","330","","","","","","","","","","","","","Gross Charge Type: JHH CLIN CLIENT FEE SCHEDULE"
"HC FFP HIGH TITER COVID-19 CONVALESCENT, FROZEN - 8 HR COLLECT, EA UNIT (439)","39000216","CDM","390","RC","","","facility","both","","","","919.02","919.02","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC FFP HIGH TITER COVID-19 CONVALESCENT, FROZEN - 8 HR COLLECT, EA UNIT (439)","39000216","CDM","390","RC","","","facility","both","","","","2421","2421","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FFP HIGH TITER COVID-19 CONVALESCENT, FROZEN - 8 HR COLLECT, EA UNIT (439)","39000216","CDM","390","RC","","","facility","both","","","","1176.37","1176.37","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC TRANSFUSION BLOOD OR BLOOD COMPONENTS","39100001","CDM","391","RC","36430","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC TRANSFUSION BLOOD OR BLOOD COMPONENTS","39100001","CDM","391","RC","36430","HCPCS","facility","both","","","","352","352","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD OR BLOOD COMPONENTS","39100001","CDM","391","RC","36430","HCPCS","facility","both","","","","322.16","322.16","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC TRANSFUSION BLOOD OR BLOOD COMPONENTS","39100001","CDM","391","RC","36430","HCPCS","facility","both","","","","120.37","120.37","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC TRANSFUSION BLOOD OR BLOOD COMPONENTS","39100001","CDM","391","RC","36430","HCPCS","facility","both","","","","185.81","185.81","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC TRANSFUSION BLOOD OP ON IP UNIT","39191101","CDM","391","RC","36430","HCPCS","facility","both","","","","527","527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 0.5 HOURS","39191102","CDM","391","RC","36430","HCPCS","facility","both","","","","590","590","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 1.0 HOURS","39191103","CDM","391","RC","36430","HCPCS","facility","both","","","","653","653","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 1.5 HOURS","39191104","CDM","391","RC","36430","HCPCS","facility","both","","","","716","716","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 2.0 HOURS","39191105","CDM","391","RC","36430","HCPCS","facility","both","","","","779","779","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 2.5 HOURS","39191106","CDM","391","RC","36430","HCPCS","facility","both","","","","842","842","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 3.0 HOURS","39191107","CDM","391","RC","36430","HCPCS","facility","both","","","","905","905","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 3.5 HOURS","39191108","CDM","391","RC","36430","HCPCS","facility","both","","","","968","968","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 4.0 HOURS","39191109","CDM","391","RC","36430","HCPCS","facility","both","","","","1032","1032","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 4.5 HOURS","39191110","CDM","391","RC","36430","HCPCS","facility","both","","","","1095","1095","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 5.0 HOURS","39191111","CDM","391","RC","36430","HCPCS","facility","both","","","","1158","1158","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 5.5 HOURS","39191112","CDM","391","RC","36430","HCPCS","facility","both","","","","1221","1221","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 6.0 HOURS","39191113","CDM","391","RC","36430","HCPCS","facility","both","","","","1284","1284","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 6.5 HOURS","39191114","CDM","391","RC","36430","HCPCS","facility","both","","","","1347","1347","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 7.0 HOURS","39191115","CDM","391","RC","36430","HCPCS","facility","both","","","","1410","1410","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 7.5 HOURS","39191116","CDM","391","RC","36430","HCPCS","facility","both","","","","1473","1473","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 8.0 HOURS","39191117","CDM","391","RC","36430","HCPCS","facility","both","","","","1536","1536","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 9.0 HOURS","39191118","CDM","391","RC","36430","HCPCS","facility","both","","","","1662","1662","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSFUSION BLOOD 10.0 HOURS","39191119","CDM","391","RC","36430","HCPCS","facility","both","","","","1788","1788","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, BILAT","40100001","CDM","401","RC","","","facility","both","","","","370","370","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, BILAT","40100001","CDM","401","RC","","","facility","both","","","","548","548","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, BILAT","40100001","CDM","401","RC","","","facility","both","","","","244","244","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, BILAT","40100001","CDM","401","RC","","","facility","both","","","","370","370","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, BILAT","40100001","CDM","401","RC","","","facility","both","","","","394.2","394.2","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, UNILAT","40100002","CDM","401","RC","","","facility","both","","","","281.56","281.56","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, UNILAT","40100002","CDM","401","RC","","","facility","both","","","","482","482","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAGNOSTIC MAMMOGRAPHY, DIR DIGITAL, UNILAT","40100002","CDM","401","RC","","","facility","both","","","","166","166","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAG MAMMO, INCL CAD WHEN PERFORMED, BIL","40100003","CDM","401","RC","","","facility","both","","","","576","576","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAG MAMMO, INCL CAD WHEN PERFORMED, BIL","40100003","CDM","401","RC","","","facility","both","","","","256","256","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAG MAMMO, INCL CAD WHEN PERFORMED, BIL","40100003","CDM","401","RC","","","facility","both","","","","389","389","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAG MAMMO, INCL CAD WHEN PERFORMED, BIL","40100003","CDM","401","RC","","","facility","both","","","","1085.22","1085.22","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DIAG MAMMO, INCL CAD WHEN PERFORMED, BIL","40100003","CDM","401","RC","","","facility","both","","","","389","389","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAG  MAMMO, INCL CAD WHEN PERFORMED, UNIL","40100004","CDM","401","RC","","","facility","both","","","","829.88","829.88","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DIAG  MAMMO, INCL CAD WHEN PERFORMED, UNIL","40100004","CDM","401","RC","","","facility","both","","","","174","174","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAG  MAMMO, INCL CAD WHEN PERFORMED, UNIL","40100004","CDM","401","RC","","","facility","both","","","","507","507","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMPUTER DX MAMMOGRAM ADD-ON","40100010","CDM","401","RC","77051","HCPCS","facility","both","","","","56.3","56.3","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC COMPUTER DX MAMMOGRAM ADD-ON","40100010","CDM","401","RC","77051","HCPCS","facility","both","","","","61","61","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAMMOGRAM ONE BREAST","40100011","CDM","401","RC","77055","HCPCS","facility","both","","","","482","482","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL","40100014","CDM","401","RC","77061","HCPCS","facility","both","","","","172","172","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL","40100014","CDM","401","RC","77061","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DIGITAL BREAST TOMOSYNTHESIS; BILATERAL","40100015","CDM","401","RC","77062","HCPCS","facility","both","","","","172","172","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIGITAL BREAST TOMOSYNTHESIS; BILATERAL","40100015","CDM","401","RC","77062","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DX MAMMO INCL CAD; UNILAT","40100016","CDM","401","RC","77065","HCPCS","facility","both","","","","870","870","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DX MAMMO INCL CAD; UNILAT","40100016","CDM","401","RC","77065","HCPCS","facility","both","","","","1212.65","1212.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DX MAMMO INCL CAD; BILAT","40100017","CDM","401","RC","77066","HCPCS","facility","both","","","","989","989","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DX MAMMO INCL CAD; BILAT","40100017","CDM","401","RC","77066","HCPCS","facility","both","","","","1585.77","1585.77","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DIAGNOSTIC DIGITAL BREAST TOMOGRAPHY, UNILATERAL OR BILATERAL","40100018","CDM","401","RC","","","facility","both","","","","172","172","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAGNOSTIC DIGITAL BREAST TOMOGRAPHY, UNILATERAL OR BILATERAL","40100018","CDM","401","RC","","","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ECHOENCEPHALOGRAPHY OF NEONATAL","40200001","CDM","402","RC","76506","HCPCS","facility","both","","","","1119.39","1119.39","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ECHOENCEPHALOGRAPHY OF NEONATAL","40200001","CDM","402","RC","76506","HCPCS","facility","both","","","","1288","1288","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND, SOFT TISSUES HEAD & NECK","40200002","CDM","402","RC","76536","HCPCS","facility","both","","","","1166.04","1166.04","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND, SOFT TISSUES HEAD & NECK","40200002","CDM","402","RC","76536","HCPCS","facility","both","","","","1250","1250","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND CHEST INCLS MEDIASTINUM","40200003","CDM","402","RC","76604","HCPCS","facility","both","","","","1215","1215","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND CHEST INCLS MEDIASTINUM","40200003","CDM","402","RC","76604","HCPCS","facility","both","","","","792.88","792.88","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND BREAST(S) UNILAT OR BILAT","40200004","CDM","402","RC","76645","HCPCS","facility","both","","","","705","705","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND ABDOMEN COMPLETE","40200005","CDM","402","RC","76700","HCPCS","facility","both","","","","1756","1756","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND ABDOMEN COMPLETE","40200005","CDM","402","RC","76700","HCPCS","facility","both","","","","1072.73","1072.73","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND ABDOMEN LIMITED - 1 ORGAN, QUAD","40200006","CDM","402","RC","76705","HCPCS","facility","both","","","","839.53","839.53","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND ABDOMEN LIMITED - 1 ORGAN, QUAD","40200006","CDM","402","RC","76705","HCPCS","facility","both","","","","1221","1221","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND RETROPERITONEAL COMPLETE","40200007","CDM","402","RC","76770","HCPCS","facility","both","","","","1026.12","1026.12","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND RETROPERITONEAL COMPLETE","40200007","CDM","402","RC","76770","HCPCS","facility","both","","","","1712","1712","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND RETROPERITONEAL LIMITED","40200008","CDM","402","RC","76775","HCPCS","facility","both","","","","1288","1288","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND RETROPERITONEAL LIMITED","40200008","CDM","402","RC","76775","HCPCS","facility","both","","","","373.13","373.13","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND TRANSPLANTED KIDNEY W/DOPPLER","40200009","CDM","402","RC","76776","HCPCS","facility","both","","","","1585.77","1585.77","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND TRANSPLANTED KIDNEY W/DOPPLER","40200009","CDM","402","RC","76776","HCPCS","facility","both","","","","1288","1288","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND SPINAL CANAL AND CONTENTS","40200010","CDM","402","RC","76800","HCPCS","facility","both","","","","1072.73","1072.73","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND SPINAL CANAL AND CONTENTS","40200010","CDM","402","RC","76800","HCPCS","facility","both","","","","1524","1524","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US, SINGLE FETUS < 14 WKS, TRANSABD APPRCH","40200011","CDM","402","RC","76801","HCPCS","facility","both","","","","1016.77","1016.77","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US, SINGLE FETUS < 14 WKS, TRANSABD APPRCH","40200011","CDM","402","RC","76801","HCPCS","facility","both","","","","1524","1524","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US, FETUS < 14 WKS, EACH ADDTL FETUS","40200012","CDM","402","RC","76802","HCPCS","facility","both","","","","290.5","290.5","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US, FETUS < 14 WKS, EACH ADDTL FETUS","40200012","CDM","402","RC","76802","HCPCS","facility","both","","","","1524","1524","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US, SINGLE FETUS > = 14 WKS, TRANSABD APPRCH","40200013","CDM","402","RC","76805","HCPCS","facility","both","","","","1524","1524","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US, SINGLE FETUS > = 14 WKS, TRANSABD APPRCH","40200013","CDM","402","RC","76805","HCPCS","facility","both","","","","543.02","543.02","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC US, SINGLE FETUS > = 14 WKS, TRANSABD APPRCH","40200013","CDM","402","RC","76805","HCPCS","facility","both","","","","1061.42","1061.42","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US, FETUS > = 14 WKS, EACH ADDTL FETUS","40200014","CDM","402","RC","76810","HCPCS","facility","both","","","","489.89","489.89","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US, FETUS > = 14 WKS, EACH ADDTL FETUS","40200014","CDM","402","RC","76810","HCPCS","facility","both","","","","1524","1524","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US, DETAILED FETAL ANATOMIC EXM, SNGL FETUS","40200015","CDM","402","RC","76811","HCPCS","facility","both","","","","979.78","979.78","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US, DETAILED FETAL ANATOMIC EXM, SNGL FETUS","40200015","CDM","402","RC","76811","HCPCS","facility","both","","","","1654","1654","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US, DETAILED FETAL ANATOMIC EXM, ADDL FETUS","40200016","CDM","402","RC","76812","HCPCS","facility","both","","","","1306.37","1306.37","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US, DETAILED FETAL ANATOMIC EXM, ADDL FETUS","40200016","CDM","402","RC","76812","HCPCS","facility","both","","","","684","684","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US, NUCHAL TRANSLUCENCY MEASURE, 1 FETUS","40200017","CDM","402","RC","76813","HCPCS","facility","both","","","","684","684","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US, NUCHAL TRANSLUCENCY MEASURE, 1 FETUS","40200017","CDM","402","RC","76813","HCPCS","facility","both","","","","694.01","694.01","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US NUCHAL TRANSLUCENCY MEASURE,ADDL FETUS","40200018","CDM","402","RC","76814","HCPCS","facility","both","","","","326.59","326.59","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US NUCHAL TRANSLUCENCY MEASURE,ADDL FETUS","40200018","CDM","402","RC","76814","HCPCS","facility","both","","","","684","684","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US LIMITED 1 OR MORE FETUS(S)","40200019","CDM","402","RC","76815","HCPCS","facility","both","","","","612.36","612.36","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US LIMITED 1 OR MORE FETUS(S)","40200019","CDM","402","RC","76815","HCPCS","facility","both","","","","181.05","181.05","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC US LIMITED 1 OR MORE FETUS(S)","40200019","CDM","402","RC","76815","HCPCS","facility","both","","","","1276","1276","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US FOLLOW-UP PER FETUS","40200020","CDM","402","RC","76816","HCPCS","facility","both","","","","816.48","816.48","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US FOLLOW-UP PER FETUS","40200020","CDM","402","RC","76816","HCPCS","facility","both","","","","970","970","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US OB TRANSVAGINAL","40200021","CDM","402","RC","76817","HCPCS","facility","both","","","","694.01","694.01","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US OB TRANSVAGINAL","40200021","CDM","402","RC","76817","HCPCS","facility","both","","","","970","970","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FETAL BP PROFILE W/O NON-STRESS TEST","40200022","CDM","402","RC","76819","HCPCS","facility","both","","","","1823","1823","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FETAL BP PROFILE W/O NON-STRESS TEST","40200022","CDM","402","RC","76819","HCPCS","facility","both","","","","571.54","571.54","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC FETAL BP PROFILE W/O NON-STRESS TEST","40200022","CDM","402","RC","76819","HCPCS","facility","both","","","","723.95","723.95","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC DOPPLER VELOCIMETRY, FETAL UMB ARTERY","40200023","CDM","402","RC","76820","HCPCS","facility","both","","","","181.05","181.05","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC DOPPLER VELOCIMETRY, FETAL UMB ARTERY","40200023","CDM","402","RC","76820","HCPCS","facility","both","","","","244.94","244.94","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DOPPLER VELOCIMETRY, FETAL UMB ARTERY","40200023","CDM","402","RC","76820","HCPCS","facility","both","","","","1472","1472","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY","40200024","CDM","402","RC","76821","HCPCS","facility","both","","","","182.86","182.86","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY","40200024","CDM","402","RC","76821","HCPCS","facility","both","","","","653.18","653.18","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY","40200024","CDM","402","RC","76821","HCPCS","facility","both","","","","661","661","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ECHOCARDIO FETAL CARDIOVASCULAR W/2-D","40200025","CDM","483","RC","76825","HCPCS","facility","both","","","","2245.32","2245.32","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ECHOCARDIO FETAL CARDIOVASCULAR W/2-D","40200025","CDM","483","RC","76825","HCPCS","facility","both","","","","2253","2253","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ECHOCARDIO FETAL CARDIOVASCULAR F/U STUDY","40200026","CDM","483","RC","76826","HCPCS","facility","both","","","","2253","2253","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ECHOCARDIO FETAL CARDIOVASCULAR F/U STUDY","40200026","CDM","483","RC","76826","HCPCS","facility","both","","","","1428.84","1428.84","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DOPPLER ECHOCARDIOLOGY FETAL COMPLETE","40200027","CDM","483","RC","76827","HCPCS","facility","both","","","","684","684","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DOPPLER ECHOCARDIOLOGY FETAL COMPLETE","40200027","CDM","483","RC","76827","HCPCS","facility","both","","","","530.71","530.71","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DOPPLER ECHOCARDIOLOGY FETAL F/U","40200028","CDM","483","RC","76828","HCPCS","facility","both","","","","285.77","285.77","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DOPPLER ECHOCARDIOLOGY FETAL F/U","40200028","CDM","483","RC","76828","HCPCS","facility","both","","","","684","684","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND TRANSVAGINAL, NON OB","40200029","CDM","402","RC","76830","HCPCS","facility","both","","","","1606","1606","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND TRANSVAGINAL, NON OB","40200029","CDM","402","RC","76830","HCPCS","facility","both","","","","1020.6","1020.6","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND PELVIC EXAM COMPLETE NON OB","40200030","CDM","402","RC","76856","HCPCS","facility","both","","","","1420","1420","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND PELVIC EXAM COMPLETE NON OB","40200030","CDM","402","RC","76856","HCPCS","facility","both","","","","857.3","857.3","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND PELVIC EXAM LIMITED NON OB","40200031","CDM","402","RC","76857","HCPCS","facility","both","","","","285.77","285.77","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND PELVIC EXAM LIMITED NON OB","40200031","CDM","402","RC","76857","HCPCS","facility","both","","","","1218","1218","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND SCROTUM AND CONTRASTENTS","40200032","CDM","402","RC","76870","HCPCS","facility","both","","","","466.41","466.41","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND SCROTUM AND CONTRASTENTS","40200032","CDM","402","RC","76870","HCPCS","facility","both","","","","1094","1094","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND TRANSRECTAL","40200033","CDM","402","RC","76872","HCPCS","facility","both","","","","792.88","792.88","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND TRANSRECTAL","40200033","CDM","402","RC","76872","HCPCS","facility","both","","","","1606","1606","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US TRANSRECTAL-PROSTATE VOL STUDY, BRACHY","40200034","CDM","402","RC","76873","HCPCS","facility","both","","","","63.85","63.85","","","","","","","","","","","","","Gross Charge Type: JHH 48 CAT"
"HC US TRANSRECTAL-PROSTATE VOL STUDY, BRACHY","40200034","CDM","402","RC","76873","HCPCS","facility","both","","","","1719","1719","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US TRANSRECTAL-PROSTATE VOL STUDY, BRACHY","40200034","CDM","402","RC","76873","HCPCS","facility","both","","","","1212.65","1212.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US COMPLETE JOINT","40200035","CDM","402","RC","76881","HCPCS","facility","both","","","","2064","2064","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US COMPLETE JOINT","40200035","CDM","402","RC","76881","HCPCS","facility","both","","","","1254","1254","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US COMPLETE JOINT","40200035","CDM","402","RC","76881","HCPCS","facility","both","","","","1166.04","1166.04","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US LIMITED, JOINT OR FOCAL EVAL OF OTHER NONVASCULAR EXTREMITY STRUCTURE(S)","40200036","CDM","402","RC","76882","HCPCS","facility","both","","","","139.91","139.91","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US LIMITED, JOINT OR FOCAL EVAL OF OTHER NONVASCULAR EXTREMITY STRUCTURE(S)","40200036","CDM","402","RC","76882","HCPCS","facility","both","","","","1254","1254","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US INFANT HIPS; LIMITED/STATIC","40200037","CDM","402","RC","76886","HCPCS","facility","both","","","","1021","1021","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US INFANT HIPS; LIMITED/STATIC","40200037","CDM","402","RC","76886","HCPCS","facility","both","","","","1026.12","1026.12","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US GUIDANCE PERICARDIOCENTESIS","40200038","CDM","402","RC","76930","HCPCS","facility","both","","","","1208.11","1208.11","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US GUIDANCE PERICARDIOCENTESIS","40200038","CDM","402","RC","76930","HCPCS","facility","both","","","","43.61","43.61","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC US GUIDANCE PERICARDIOCENTESIS","40200038","CDM","402","RC","76930","HCPCS","facility","both","","","","250","250","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US GUIDANCE VASCULAR ACCESS","40200039","CDM","402","RC","76937","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC US GUIDANCE VASCULAR ACCESS","40200039","CDM","402","RC","76937","HCPCS","facility","both","","","","1560","1560","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US GUIDANCE TISSUE ABLATION","40200040","CDM","402","RC","76940","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC US GUIDANCE TISSUE ABLATION","40200040","CDM","402","RC","76940","HCPCS","facility","both","","","","483.28","483.28","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US GUIDED FETAL TRANSFUSION/CORDOCENTESIS","40200041","CDM","402","RC","76941","HCPCS","facility","both","","","","1208.11","1208.11","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US GUIDED FETAL TRANSFUSION/CORDOCENTESIS","40200041","CDM","402","RC","76941","HCPCS","facility","both","","","","397","397","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US GUIDED FETAL TRANSFUSION/CORDOCENTESIS","40200041","CDM","402","RC","76941","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC US GUIDED NEEDLE PLACEMENT","40200042","CDM","402","RC","76942","HCPCS","facility","both","","","","2","2","","","","","","","","","","","","","Gross Charge Type: JHH 79 CLINIC ORC"
"HC US GUIDED NEEDLE PLACEMENT","40200042","CDM","402","RC","76942","HCPCS","facility","both","","","","906.07","906.07","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US GUIDED NEEDLE PLACEMENT","40200042","CDM","402","RC","76942","HCPCS","facility","both","","","","2140","2140","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US GUIDED NEEDLE PLACEMENT","40200042","CDM","402","RC","76942","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC US GUIDED CHORIONIC VILLUS SAMPLING","40200043","CDM","402","RC","76945","HCPCS","facility","both","","","","1208.11","1208.11","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US GUIDED CHORIONIC VILLUS SAMPLING","40200043","CDM","402","RC","76945","HCPCS","facility","both","","","","1446","1446","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US GUIDED CHORIONIC VILLUS SAMPLING","40200043","CDM","402","RC","76945","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC US GUIDED AMNIOCENTESIS","40200044","CDM","402","RC","76946","HCPCS","facility","both","","","","724.85","724.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US GUIDED AMNIOCENTESIS","40200044","CDM","402","RC","76946","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC US GUIDED AMNIOCENTESIS","40200044","CDM","402","RC","76946","HCPCS","facility","both","","","","1183","1183","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US GUIDED INTERSTITIAL RADIOELEMENT APPLIC","40200046","CDM","402","RC","76965","HCPCS","facility","both","","","","1505","1505","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US GUIDED INTERSTITIAL RADIOELEMENT APPLIC","40200046","CDM","402","RC","76965","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC US GUIDANCE INTRAOPERATIVE","40200047","CDM","402","RC","76998","HCPCS","facility","both","","","","1056","1056","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US GUIDANCE INTRAOPERATIVE","40200047","CDM","402","RC","76998","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC US GUIDANCE INTRAOPERATIVE","40200047","CDM","402","RC","76998","HCPCS","facility","both","","","","540.03","540.03","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC UNLISTED ULTRASOUND PROCEDURE","40200048","CDM","402","RC","76999","HCPCS","facility","both","","","","302.01","302.01","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC UNLISTED ULTRASOUND PROCEDURE","40200048","CDM","402","RC","76999","HCPCS","facility","both","","","","586","586","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FETAL BP PROFILE W NON-STRESS TEST","40200049","CDM","402","RC","76818","HCPCS","facility","both","","","","904.96","904.96","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC FETAL BP PROFILE W NON-STRESS TEST","40200049","CDM","402","RC","76818","HCPCS","facility","both","","","","981.87","981.87","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC FETAL BP PROFILE W NON-STRESS TEST","40200049","CDM","402","RC","76818","HCPCS","facility","both","","","","1823","1823","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SALINE INFUSED SONOHYSTEROGRAM","40200050","CDM","402","RC","76831","HCPCS","facility","both","","","","518","518","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SALINE INFUSED SONOHYSTEROGRAM","40200050","CDM","402","RC","76831","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC SALINE INFUSED SONOHYSTEROGRAM","40200050","CDM","402","RC","76831","HCPCS","facility","both","","","","724.85","724.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US INFANT HIPS; DYNAMIC","40200051","CDM","402","RC","76885","HCPCS","facility","both","","","","1139","1139","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US INFANT HIPS; DYNAMIC","40200051","CDM","402","RC","76885","HCPCS","facility","both","","","","1445.85","1445.85","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US GUIDED PSA/AVF COMPRESSION REPAIR","40200053","CDM","402","RC","76936","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC US GUIDED PSA/AVF COMPRESSION REPAIR","40200053","CDM","402","RC","76936","HCPCS","facility","both","","","","1026.88","1026.88","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US GUIDED PSA/AVF COMPRESSION REPAIR","40200053","CDM","402","RC","76936","HCPCS","facility","both","","","","1507","1507","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DX OPHTHAL B-SCAN US","40200056","CDM","402","RC","76512","HCPCS","facility","both","","","","513.04","513.04","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND EXAM AAA SCREEN","40200060","CDM","402","RC","","","facility","both","","","","619.45","619.45","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US GUIDE -  ENDOMYOCARDIAL BX","40200061","CDM","402","RC","76932","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC US GUIDE -  ENDOMYOCARDIAL BX","40200061","CDM","402","RC","76932","HCPCS","facility","both","","","","1208.11","1208.11","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND BREAST UNILAT, COMPLETE","40200062","CDM","402","RC","76641","HCPCS","facility","both","","","","932.79","932.79","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND BREAST UNILAT, COMPLETE","40200062","CDM","402","RC","76641","HCPCS","facility","both","","","","1187","1187","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND BREAST UNILAT, LIMITED","40200063","CDM","402","RC","76642","HCPCS","facility","both","","","","1187","1187","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND BREAST UNILAT, LIMITED","40200063","CDM","402","RC","76642","HCPCS","facility","both","","","","699.63","699.63","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC US ABDOMINAL AORTA SCREEN AAA","40200066","CDM","402","RC","76706","HCPCS","facility","both","","","","692","692","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US ABDOMINAL AORTA SCREEN AAA","40200066","CDM","402","RC","76706","HCPCS","facility","both","","","","886.19","886.19","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND, ABDOMINAL, W/CONTRAST","40200067","CDM","402","RC","","","facility","both","","","","1219.65","1219.65","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND, ELASTOGRAPHY; PARENCHYMA (EG, ORGAN)","40200068","CDM","402","RC","76981","HCPCS","facility","both","","","","1265","1265","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND, ELASTOGRAPHY; PARENCHYMA (EG, ORGAN)","40200068","CDM","402","RC","76981","HCPCS","facility","both","","","","839.53","839.53","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND, TARGET DYNAMIC MICROBUBBLE; 1ST LESION","40200069","CDM","402","RC","76978","HCPCS","facility","both","","","","1678.89","1678.89","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES","40200070","CDM","402","RC","76979","HCPCS","facility","both","","","","839.53","839.53","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND, ELASTOGRAPHY; FIRST TARGET LESION","40200071","CDM","402","RC","76982","HCPCS","facility","both","","","","1072.73","1072.73","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ULTRASOUND, ELASTOGRAPHY; FIRST TARGET LESION","40200071","CDM","402","RC","76982","HCPCS","facility","both","","","","655","655","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ULTRASOUND, ELASTOGRAPHY; EA ADDL TARGET LESION","40200072","CDM","402","RC","76983","HCPCS","facility","both","","","","839.53","839.53","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC HISTOTRIPSY OF MALIGNANT LIVER TISSUE, INCL IMG GUIDANCE","40200074","CDM","402","RC","","","facility","both","","","","22573.38","22573.38","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC HISTOTRIPSY, MALIG RENAL TISS W/ IMAG GUIDANCE","40200075","CDM","402","RC","","","facility","both","","","","22573.38","22573.38","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC SCREENING MAMMOGRAPHY, BILAT 2 V EA BREAST","40300001","CDM","403","RC","77057","HCPCS","facility","both","","","","281.56","281.56","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC COMP SCREEN MAMMOGRAM ADD-ON","40300005","CDM","403","RC","77052","HCPCS","facility","both","","","","56.32","56.32","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC COMP SCREEN MAMMOGRAM ADD-ON","40300005","CDM","403","RC","77052","HCPCS","facility","both","","","","61","61","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SCREENING MAMMOGRAPHY, DIGITAL, BILATERAL","40300006","CDM","403","RC","","","facility","both","","","","316","316","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SCREENING MAMMOGRAPHY, DIGITAL, BILATERAL","40300006","CDM","403","RC","","","facility","both","","","","281.56","281.56","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC SCREENING DIGITAL BREAST TOMOSYNTHESIS; BILATERAL","40300007","CDM","403","RC","77063","HCPCS","facility","both","","","","326.49","326.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC SCREENING DIGITAL BREAST TOMOSYNTHESIS; BILATERAL","40300007","CDM","403","RC","77063","HCPCS","facility","both","","","","172","172","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SCREEN MAMMO INCL CAD; BILAT","40300008","CDM","403","RC","77067","HCPCS","facility","both","","","","569","569","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SCREEN MAMMO INCL CAD; BILAT","40300008","CDM","403","RC","77067","HCPCS","facility","both","","","","1305.93","1305.93","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC SCREENING MAMMO, INCL CAD WHEN PERFORMED, BIL","40300009","CDM","403","RC","","","facility","both","","","","332","332","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SCREENING MAMMO, INCL CAD WHEN PERFORMED, BIL","40300009","CDM","403","RC","","","facility","both","","","","893.72","893.72","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC MYOCARD PERF IMAG PET, METABOLIC EVAL","40400001","CDM","404","RC","78459","HCPCS","facility","both","","","","7779.12","7779.12","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC MYCARDO IMAG PET PERF MULT REST/STRESS","40400002","CDM","404","RC","78492","HCPCS","facility","both","","","","4861.95","4861.95","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC BRAIN IMAGING, PET, METABOLIC EVALUATION","40400003","CDM","404","RC","78608","HCPCS","facility","both","","","","8878","8878","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRAIN IMAGING, PET, METABOLIC EVALUATION","40400003","CDM","404","RC","78608","HCPCS","facility","both","","","","3889.52","3889.52","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC PET IMAGING, WHOLE BODY","40400004","CDM","404","RC","78813","HCPCS","facility","both","","","","4861.95","4861.95","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC PET IMAGING W/CT SKULL BASE TO MID-THIGH","40400005","CDM","404","RC","78815","HCPCS","facility","both","","","","4699.89","4699.89","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC PET IMAGING W/CT SKULL BASE TO MID-THIGH","40400005","CDM","404","RC","78815","HCPCS","facility","both","","","","8878","8878","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PET IMAGING W/CT WHOLE BODY","40400006","CDM","404","RC","78816","HCPCS","facility","both","","","","8878","8878","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PET IMAGING W/CT WHOLE BODY","40400006","CDM","404","RC","78816","HCPCS","facility","both","","","","5348.13","5348.13","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC PET IMAGE W/CT LMTD AREA","40400007","CDM","404","RC","78814","HCPCS","facility","both","","","","3889.52","3889.52","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC PET IMAGE W/CT LMTD AREA","40400007","CDM","404","RC","78814","HCPCS","facility","both","","","","8878","8878","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARD PET PERFUS; SINGLE","40400016","CDM","404","RC","78491","HCPCS","facility","both","","","","2593.03","2593.03","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC PET IMAGING; LIMITED AREA (EG; CHEST, HEAD/NECK)","40400017","CDM","404","RC","78811","HCPCS","facility","both","","","","2917.15","2917.15","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC MYOCARDIAL IMG, PET, METABOLIC  EVAL, 1 STUDY CONCURRENT CT","40400018","CDM","404","RC","78429","HCPCS","facility","both","","","","6715","6715","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYOCARDIAL IMG, PET, METABOLIC  EVAL, 1 STUDY CONCURRENT CT","40400018","CDM","404","RC","78429","HCPCS","facility","both","","","","7778.68","7778.68","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC MYOCARDIAL IMG, PET, PERF STUDY, SINGLE, REST/STRESS, CNCRNT CT","40400019","CDM","404","RC","78430","HCPCS","facility","both","","","","2593.87","2593.87","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC MYOCARDIAL IMG, PET, PERF STUDY, MULTI, REST & STRESS, CNCRNT CT","40400020","CDM","404","RC","78431","HCPCS","facility","both","","","","4863.51","4863.51","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"HC MYOCARDIAL IMG, PET, COMB PERFUSION W/ METABOLIC EVAL STUDY; W/CT","40400021","CDM","404","RC","78433","HCPCS","facility","both","","","","10369.1","10369.1","","","","","","","","","","","","","Gross Charge Type: JHH 47 NUC MED"
"DEAC 4/1/2020 HC CDSM APPLIED PATHWAYS","40920000","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM EVICORE","40920001","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM MEDCURRENT","40920002","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM MEDICALIS","40920003","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM NATIONAL DECISION SUPPORT COMPANY","40920004","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"HC DEAC 01/01/2021 CDSM NATIONAL IMAGING ASSOCIATES","40920005","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"HC DEAC 01/01/2021  CDSM TEST APPROPRIATE","40920006","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM AIM SPECIALTY HEALTH","40920007","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM CRANBERRY PEAK","40920008","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 04/01/2022 HC CDSM SAGE HELATH MANAGEMENT SOLUTIONS","40920009","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM STANSON","40920010","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM QUALIFIED TOOL NOT OTHERWISE SPECIFIED","40920011","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM AGILEMD","40920012","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM EVIDENCE CARE","40920013","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM INVENI QA","40920014","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM RELIANT MEDICAL GROUP","40920015","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM SPEED OF CARE","40920016","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM HEALTH'S HELP","40920017","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM INFINIX","40920018","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"DEAC 06/11/2024 HC CDSM LOGICNETS AUC SOLUTION","40920019","CDM","409","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHM CORPORATE FROZEN ALL LOCATION SERVICE AREA 11"
"HC ENDOTRACHEAL, INTUBATION EMERGENCY","41000001","CDM","410","RC","31500","HCPCS","facility","both","","","","89.48","89.48","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC ENDOTRACHEAL, INTUBATION EMERGENCY","41000001","CDM","410","RC","31500","HCPCS","facility","both","","","","294","294","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CATHETER ASPIRATION: NASOTRACHEAL","41000002","CDM","410","RC","31720","HCPCS","facility","both","","","","53.68","53.68","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CATHETER ASPIRATION: NASOTRACHEAL","41000002","CDM","410","RC","31720","HCPCS","facility","both","","","","312","312","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ARTERIAL PUNCTURE BLOOD FOR DX","41000005","CDM","410","RC","36600","HCPCS","facility","both","","","","53.68","53.68","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC ARTERIAL PUNCTURE BLOOD FOR DX","41000005","CDM","410","RC","36600","HCPCS","facility","both","","","","236.2","236.2","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC ARTERIAL PUNCTURE BLOOD FOR DX","41000005","CDM","410","RC","36600","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HCVENTILATOR MGT, INITIAL DAY < 12 HRS","41000007","CDM","410","RC","94002","HCPCS","facility","both","","","","1054","1054","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HCVENTILATOR MGT, INITIAL DAY < 12 HRS","41000007","CDM","410","RC","94002","HCPCS","facility","both","","","","494.77","494.77","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HCVENTILATOR MGT, INITIAL DAY > 12 HRS","41000008","CDM","410","RC","94002","HCPCS","facility","both","","","","848.16","848.16","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HCVENTILATOR MGT, INITIAL DAY > 12 HRS","41000008","CDM","410","RC","94002","HCPCS","facility","both","","","","1054","1054","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC VENTILATOR MGT, INITIAL DAY NICU < 12 HRS","41000009","CDM","410","RC","94002","HCPCS","facility","both","","","","1054","1054","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC VENTILATOR MGT, INITIAL DAY NICU < 12 HRS","41000009","CDM","410","RC","94002","HCPCS","facility","both","","","","735.07","735.07","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018  HC VENTILATOR MGT, INITIAL DAY NICU > 12 HRS","41000010","CDM","410","RC","94002","HCPCS","facility","both","","","","1328.78","1328.78","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018  HC VENTILATOR MGT, INITIAL DAY NICU > 12 HRS","41000010","CDM","410","RC","94002","HCPCS","facility","both","","","","1054","1054","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY < 12 HRS","41000011","CDM","410","RC","94003","HCPCS","facility","both","","","","441.74","441.74","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY < 12 HRS","41000011","CDM","410","RC","94003","HCPCS","facility","both","","","","872","872","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018  HC VENTILATOR MGT, SUBSEQ DAY > 12 HRS","41000012","CDM","410","RC","94003","HCPCS","facility","both","","","","872","872","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018  HC VENTILATOR MGT, SUBSEQ DAY > 12 HRS","41000012","CDM","410","RC","94003","HCPCS","facility","both","","","","742.13","742.13","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY NICU < 12 HRS","41000013","CDM","410","RC","94003","HCPCS","facility","both","","","","735.07","735.07","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY NICU < 12 HRS","41000013","CDM","410","RC","94003","HCPCS","facility","both","","","","872","872","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY NICU > 12 HRS","41000014","CDM","410","RC","94003","HCPCS","facility","both","","","","1328.78","1328.78","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC VENTILATOR MGT, SUBSEQ DAY NICU > 12 HRS","41000014","CDM","410","RC","94003","HCPCS","facility","both","","","","872","872","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC INHALATION TX SPAG, INITIAL","41000015","CDM","410","RC","94640","HCPCS","facility","both","","","","109","109","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC INHALATION TX SPAG, INITIAL","41000015","CDM","410","RC","94640","HCPCS","facility","both","","","","247.36","247.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC INHALATION TX SPAG, SUBSEQ DAY","41000016","CDM","410","RC","94640","HCPCS","facility","both","","","","176.69","176.69","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC INHALATION TX SPAG, SUBSEQ DAY","41000016","CDM","410","RC","94640","HCPCS","facility","both","","","","91","91","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC INHALATION TX, CONT NEB W/BROCH, INITIAL DAY","41000017","CDM","410","RC","94640","HCPCS","facility","both","","","","109","109","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC INHALATION TX, CONT NEB W/BROCH, INITIAL DAY","41000017","CDM","410","RC","94640","HCPCS","facility","both","","","","169.64","169.64","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC INHALATION TX, CONT NEB W/BROCH, SUBSEQ DAY","41000018","CDM","410","RC","94640","HCPCS","facility","both","","","","53.01","53.01","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC INHALATION TX, HAND HELD NEB, INITIAL TREATMENT","41000019","CDM","410","RC","94640","HCPCS","facility","both","","","","109","109","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC INHALATION TX, HAND HELD NEB, INITIAL TREATMENT","41000019","CDM","410","RC","94640","HCPCS","facility","both","","","","106.02","106.02","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC INHALATION TX, HAND HELD NEB, SUBSEQ TREATMENT","41000020","CDM","410","RC","94640","HCPCS","facility","both","","","","53.01","53.01","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC INHALATION TX, HAND HELD NEB, SUBSEQ TREATMENT","41000020","CDM","410","RC","94640","HCPCS","facility","both","","","","109","109","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC INHALATION TX, IPPB, INITIAL DAY","41000021","CDM","410","RC","94640","HCPCS","facility","both","","","","123.69","123.69","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC INHALATION TX, IPPB, SUBSEQ DAY","41000022","CDM","410","RC","94640","HCPCS","facility","both","","","","70.68","70.68","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC INHALATION TX, MDI, INITIAL DAY","41000023","CDM","410","RC","94640","HCPCS","facility","both","","","","141.37","141.37","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC INHALATION TX, MDI, INITIAL DAY","41000023","CDM","410","RC","94640","HCPCS","facility","both","","","","109","109","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC INHALATION TX, MDI, SUBSEQ DAY","41000024","CDM","410","RC","94640","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC INHALATION TX, MDI, SUBSEQ DAY","41000024","CDM","410","RC","94640","HCPCS","facility","both","","","","88.34","88.34","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC INHALATION TX, ULTRASONIC NEB, INITIAL DAY","41000025","CDM","410","RC","94640","HCPCS","facility","both","","","","311","311","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AEROSOL PENTAMIDINE FOR P. CARINII","41000026","CDM","410","RC","94642","HCPCS","facility","both","","","","776","776","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AEROSOL PENTAMIDINE FOR P. CARINII","41000026","CDM","410","RC","94642","HCPCS","facility","both","","","","214.72","214.72","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, SUBSEQ DAY < 12 HRS","41000027","CDM","410","RC","94660","HCPCS","facility","both","","","","839","839","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, SUBSEQ DAY < 12 HRS","41000027","CDM","410","RC","94660","HCPCS","facility","both","","","","300.39","300.39","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, INITIAL DAY < 12 HRS","41000028","CDM","410","RC","94660","HCPCS","facility","both","","","","388.74","388.74","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, INITIAL DAY < 12 HRS","41000028","CDM","410","RC","94660","HCPCS","facility","both","","","","925","925","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, SUBSEQ DAY > 12 HRS","41000029","CDM","410","RC","94660","HCPCS","facility","both","","","","839","839","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, SUBSEQ DAY > 12 HRS","41000029","CDM","410","RC","94660","HCPCS","facility","both","","","","512.42","512.42","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, INITIAL DAY > 12 HRS","41000030","CDM","410","RC","94660","HCPCS","facility","both","","","","840","840","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC POS AIRWAY PRESSURE CPAP, INITIAL DAY > 12 HRS","41000030","CDM","410","RC","94660","HCPCS","facility","both","","","","600.77","600.77","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC EVALUATE PT USE OF INHALER/PER DAY","41000031","CDM","410","RC","94664","HCPCS","facility","both","","","","53.68","53.68","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC EVALUATE PT USE OF INHALER/PER DAY","41000031","CDM","410","RC","94664","HCPCS","facility","both","","","","236.2","236.2","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC EVALUATE PT USE OF INHALER/PER DAY","41000031","CDM","410","RC","94664","HCPCS","facility","both","","","","316","316","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC CHEST PT LIMITED, 2 POSITIONS, INITIAL TX","41000032","CDM","410","RC","94667","HCPCS","facility","both","","","","112","112","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC CHEST PT LIMITED, 2 POSITIONS, INITIAL TX","41000032","CDM","410","RC","94667","HCPCS","facility","both","","","","123.69","123.69","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC CHEST PT COMPREHENSIVE, 4 POSITIONS, INITIAL TX","41000033","CDM","410","RC","94667","HCPCS","facility","both","","","","212.04","212.04","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC CHEST PT COMPREHENSIVE, 4 POSITIONS, INITIAL TX","41000033","CDM","410","RC","94667","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC CHEST PT LIMITED, 2 POSITIONS, SUBSEQ TX","41000034","CDM","410","RC","94668","HCPCS","facility","both","","","","88.34","88.34","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC CHEST PT LIMITED, 2 POSITIONS, SUBSEQ TX","41000034","CDM","410","RC","94668","HCPCS","facility","both","","","","230","230","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC CHEST PT COMPREHENSIVE, 4 POSITIONS SUBSEQ TX","41000035","CDM","410","RC","94668","HCPCS","facility","both","","","","176.69","176.69","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC CHEST PT COMPREHENSIVE, 4 POSITIONS SUBSEQ TX","41000035","CDM","410","RC","94668","HCPCS","facility","both","","","","230","230","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MECHANICAL CHEST WALL OSCILLATION","41000037","CDM","410","RC","94669","HCPCS","facility","both","","","","107.36","107.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC ECMO/ECLS INITIATION VENOUS - DAILY MGMT","41000038","CDM","410","RC","33946","HCPCS","facility","both","","","","6512.5","6512.5","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC ECMO/ECLS INITIATION ARTERY - DAILY MGMT","41000039","CDM","410","RC","33947","HCPCS","facility","both","","","","6512.5","6512.5","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC ECMO/ECLS DAILY MGMT-VENOUS","41000040","CDM","410","RC","33948","HCPCS","facility","both","","","","5152.75","5152.75","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC ECMO/ECLS DAILY MGMT ARTERY","41000041","CDM","410","RC","33949","HCPCS","facility","both","","","","5152.75","5152.75","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC VENTILATOR MGT, INITIAL DAY - ADULT","41000042","CDM","410","RC","94002","HCPCS","facility","both","","","","1410","1410","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VENTILATOR MGT, INITIAL DAY - ADULT","41000042","CDM","410","RC","94002","HCPCS","facility","both","","","","894.59","894.59","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC VENTILATOR MGT, INITIAL DAY - NICU","41000043","CDM","410","RC","94002","HCPCS","facility","both","","","","1410","1410","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VENTILATOR MGT, INITIAL DAY - NICU","41000043","CDM","410","RC","94002","HCPCS","facility","both","","","","1073.5","1073.5","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC VENTILATOR MGT, SUBSEQ DAY - ADULT","41000044","CDM","410","RC","94003","HCPCS","facility","both","","","","894.59","894.59","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC VENTILATOR MGT, SUBSEQ DAY - ADULT","41000044","CDM","410","RC","94003","HCPCS","facility","both","","","","1168","1168","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VENTILATOR MGT, SUBSEQ DAY - NICU","41000045","CDM","410","RC","94003","HCPCS","facility","both","","","","1073.5","1073.5","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC VENTILATOR MGT, SUBSEQ DAY - NICU","41000045","CDM","410","RC","94003","HCPCS","facility","both","","","","1168","1168","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AIRWAY INHALATION TX - INPATIENT ADMISSION","41000046","CDM","410","RC","94640","HCPCS","facility","both","","","","1717.6","1717.6","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC AIRWAY INHALATION TX - INPATIENT ADMISSION","41000046","CDM","410","RC","94640","HCPCS","facility","both","","","","316","316","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AIRWAY INHALATION TX - OUTPATIENT ENCOUNTER","41000047","CDM","410","RC","94640","HCPCS","facility","both","","","","629.84","629.84","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC AIRWAY INHALATION TX - OUTPATIENT ENCOUNTER","41000047","CDM","410","RC","94640","HCPCS","facility","both","","","","143.17","143.17","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC AIRWAY INHALATION TX - OUTPATIENT ENCOUNTER","41000047","CDM","410","RC","94640","HCPCS","facility","both","","","","316","316","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POS AIRWAY PRESSURE CPAP, PER DAY","41000048","CDM","410","RC","94660","HCPCS","facility","both","","","","429.42","429.42","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC POS AIRWAY PRESSURE CPAP, PER DAY","41000048","CDM","410","RC","94660","HCPCS","facility","both","","","","1123","1123","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEST PT,  INITIAL TX","41000049","CDM","410","RC","94667","HCPCS","facility","both","","","","188","188","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEST PT,  INITIAL TX","41000049","CDM","410","RC","94667","HCPCS","facility","both","","","","472.39","472.39","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC CHEST PT,  INITIAL TX","41000049","CDM","410","RC","94667","HCPCS","facility","both","","","","107.36","107.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CHEST PT, SUBSEQ TX","41000050","CDM","410","RC","94668","HCPCS","facility","both","","","","393.6","393.6","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC CHEST PT, SUBSEQ TX","41000050","CDM","410","RC","94668","HCPCS","facility","both","","","","89.48","89.48","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CHEST PT, SUBSEQ TX","41000050","CDM","410","RC","94668","HCPCS","facility","both","","","","422","422","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRACHEOSTOMY TUBE CHANGE","41000051","CDM","410","RC","31502","HCPCS","facility","both","","","","78.72","78.72","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC TRACHEOSTOMY TUBE CHANGE","41000051","CDM","410","RC","31502","HCPCS","facility","both","","","","443","443","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONTINUOUS NEG PRESSURE VENTILATION/PER DAY","41000052","CDM","410","RC","94662","HCPCS","facility","both","","","","429.06","429.06","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC RESPIRATORY FUNCTION THERAPY EA 15 MINS","41000053","CDM","410","RC","","","facility","both","","","","53.68","53.68","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CONTINUOUS INHALATION TX, 1ST HOUR","41000200","CDM","410","RC","94644","HCPCS","facility","both","","","","214","214","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONTINUOUS INHALATION TX, 1ST HOUR","41000200","CDM","410","RC","94644","HCPCS","facility","both","","","","121.66","121.66","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CONTINUOUS INHALATION TX, EA ADD HOUR","41000201","CDM","410","RC","94645","HCPCS","facility","both","","","","214","214","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONTINUOUS INHALATION TX, EA ADD HOUR","41000201","CDM","410","RC","94645","HCPCS","facility","both","","","","100.19","100.19","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC RESPIRATORY MUSCLE THERAPY EA 15 MINS","41000202","CDM","410","RC","","","facility","both","","","","236.2","236.2","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC STRAPPING, UNNA BOOT","42000001","CDM","420","RC","29580","HCPCS","facility","both","","","","124.15","124.15","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC STRAPPING, UNNA BOOT","42000001","CDM","420","RC","29580","HCPCS","facility","both","","","","124.11","124.11","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC STRAPPING, UNNA BOOT","42000001","CDM","420","RC","29580","HCPCS","facility","both","","","","316","316","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLY SURFACE TENS","42000002","CDM","420","RC","64550","HCPCS","facility","both","","","","57.55","57.55","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC APPLY SURFACE TENS","42000002","CDM","420","RC","64550","HCPCS","facility","both","","","","87","87","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLY SURFACE TENS","42000002","CDM","420","RC","64550","HCPCS","facility","both","","","","47.72","47.72","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC MECHANICAL TRACTION THERAPY","42000003","CDM","420","RC","97012","HCPCS","facility","both","","","","204","204","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MECHANICAL TRACTION THERAPY","42000003","CDM","420","RC","97012","HCPCS","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC MECHANICAL TRACTION THERAPY","42000003","CDM","420","RC","97012","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ELECTRICAL STIMULATION EA 15 MINS","42000004","CDM","420","RC","97032","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ELECTRICAL STIMULATION EA 15 MINS","42000004","CDM","420","RC","97032","HCPCS","facility","both","","","","20.64","20.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ELECTRICAL STIMULATION EA 15 MINS","42000004","CDM","420","RC","97032","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTRICAL STIMULATION EA 15 MINS","42000004","CDM","420","RC","97032","HCPCS","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC IONTOPHORESIS THERAPY EA 15 MINS","42000005","CDM","420","RC","97033","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IONTOPHORESIS THERAPY EA 15 MINS","42000005","CDM","420","RC","97033","HCPCS","facility","both","","","","28.65","28.65","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC IONTOPHORESIS THERAPY EA 15 MINS","42000005","CDM","420","RC","97033","HCPCS","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC IONTOPHORESIS THERAPY EA 15 MINS","42000005","CDM","420","RC","97033","HCPCS","facility","both","","","","31","31","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ULTRASOUND THERAPY EA 15 MINS","42000006","CDM","420","RC","97035","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ULTRASOUND THERAPY EA 15 MINS","42000006","CDM","420","RC","97035","HCPCS","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ULTRASOUND THERAPY EA 15 MINS","42000006","CDM","420","RC","97035","HCPCS","facility","both","","","","20.64","20.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ULTRASOUND THERAPY EA 15 MINS","42000006","CDM","420","RC","97035","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPEUTIC EXERCISES EA 15 MINS","42000007","CDM","420","RC","97110","HCPCS","facility","both","","","","67","67","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC THERAPEUTIC EXERCISES EA 15 MINS","42000007","CDM","420","RC","97110","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPEUTIC EXERCISES EA 15 MINS","42000007","CDM","420","RC","97110","HCPCS","facility","both","","","","41.33","41.33","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC THERAPEUTIC EXERCISES EA 15 MINS","42000007","CDM","420","RC","97110","HCPCS","facility","both","","","","38.2","38.2","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC THERAPEUTIC EXERCISES EA 15 MINS","42000007","CDM","420","RC","97110","HCPCS","facility","both","","","","95.11","95.11","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC NEUROMUSCULAR REEDUCATION EA 15 MINS","42000008","CDM","420","RC","97112","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEUROMUSCULAR REEDUCATION EA 15 MINS","42000008","CDM","420","RC","97112","HCPCS","facility","both","","","","51.64","51.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC NEUROMUSCULAR REEDUCATION EA 15 MINS","42000008","CDM","420","RC","97112","HCPCS","facility","both","","","","47.74","47.74","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC NEUROMUSCULAR REEDUCATION EA 15 MINS","42000008","CDM","420","RC","97112","HCPCS","facility","both","","","","77","77","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC GAIT TRAINING THERAPY EA 15 MINS","42000009","CDM","420","RC","97116","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GAIT TRAINING THERAPY EA 15 MINS","42000009","CDM","420","RC","97116","HCPCS","facility","both","","","","38.2","38.2","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC GAIT TRAINING THERAPY EA 15 MINS","42000009","CDM","420","RC","97116","HCPCS","facility","both","","","","66","66","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC MASSAGE THERAPY EA 15 MINS","42000010","CDM","420","RC","97124","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC MASSAGE THERAPY EA 15 MINS","42000010","CDM","420","RC","97124","HCPCS","facility","both","","","","47.74","47.74","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC MASSAGE THERAPY EA 15 MINS","42000010","CDM","420","RC","97124","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MASSAGE THERAPY EA 15 MINS","42000010","CDM","420","RC","97124","HCPCS","facility","both","","","","51.64","51.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC MANUAL THERAPY EA 15 MINS","42000011","CDM","420","RC","97140","HCPCS","facility","both","","","","38.2","38.2","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC MANUAL THERAPY EA 15 MINS","42000011","CDM","420","RC","97140","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC MANUAL THERAPY EA 15 MINS","42000011","CDM","420","RC","97140","HCPCS","facility","both","","","","41.33","41.33","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC MANUAL THERAPY EA 15 MINS","42000011","CDM","420","RC","97140","HCPCS","facility","both","","","","271","271","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELECTIVE DEBRIDEMENT 20 SQ CM OR LESS","42000012","CDM","420","RC","97597","HCPCS","facility","both","","","","319","319","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELECTIVE DEBRIDEMENT 20 SQ CM OR LESS","42000012","CDM","420","RC","97597","HCPCS","facility","both","","","","240","240","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SELECTIVE DEBRIDEMENT 20 SQ CM OR LESS","42000012","CDM","420","RC","97597","HCPCS","facility","both","","","","227.21","227.21","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SELECTIVE DEBRIDEMENT 20 SQ CM OR LESS","42000012","CDM","420","RC","97597","HCPCS","facility","both","","","","210.02","210.02","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC SELECTIVE DEBRIDEMENT EA ADDL SQ CM","42000013","CDM","420","RC","97598","HCPCS","facility","both","","","","82.61","82.61","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SELECTIVE DEBRIDEMENT EA ADDL SQ CM","42000013","CDM","420","RC","97598","HCPCS","facility","both","","","","319","319","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELECTIVE DEBRIDEMENT EA ADDL SQ CM","42000013","CDM","420","RC","97598","HCPCS","facility","both","","","","54","54","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SELECTIVE DEBRIDEMENT EA ADDL SQ CM","42000013","CDM","420","RC","97598","HCPCS","facility","both","","","","76.37","76.37","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC NEG PRESSURE WOUND TX W/DME, LESS THAN 50 SQ CM","42000014","CDM","420","RC","97605","HCPCS","facility","both","","","","105","105","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC NEG PRESSURE WOUND TX W/DME, LESS THAN 50 SQ CM","42000014","CDM","420","RC","97605","HCPCS","facility","both","","","","333","333","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEG PRESSURE WOUND TX W/DME, GREATER THAN 50 SQ CM","42000015","CDM","420","RC","97606","HCPCS","facility","both","","","","518","518","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEG PRESSURE WOUND TX W/DME, GREATER THAN 50 SQ CM","42000015","CDM","420","RC","97606","HCPCS","facility","both","","","","114.58","114.58","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ORTHOTIC MGMT & TRAINING, INITIAL ENCOUNTER, EA 15 MINS","42000017","CDM","420","RC","97760","HCPCS","facility","both","","","","92.96","92.96","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ORTHOTIC MGMT & TRAINING, INITIAL ENCOUNTER, EA 15 MINS","42000017","CDM","420","RC","97760","HCPCS","facility","both","","","","108","108","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ORTHOTIC MGMT & TRAINING, INITIAL ENCOUNTER, EA 15 MINS","42000017","CDM","420","RC","97760","HCPCS","facility","both","","","","344","344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ORTHOTIC MGMT & TRAINING, INITIAL ENCOUNTER, EA 15 MINS","42000017","CDM","420","RC","97760","HCPCS","facility","both","","","","85.93","85.93","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC PROSTHETIC TRAINING, INITIAL ENCOUNTER,  EA 15 MINS","42000018","CDM","420","RC","97761","HCPCS","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC PROSTHETIC TRAINING, INITIAL ENCOUNTER,  EA 15 MINS","42000018","CDM","420","RC","97761","HCPCS","facility","both","","","","66.82","66.82","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC PROSTHETIC TRAINING, INITIAL ENCOUNTER,  EA 15 MINS","42000018","CDM","420","RC","97761","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC PROSTHETIC TRAINING, INITIAL ENCOUNTER,  EA 15 MINS","42000018","CDM","420","RC","97761","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C/O ORTHOTIC/PROSTH USE EA 15 MINS","42000019","CDM","420","RC","97762","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC C/O ORTHOTIC/PROSTH USE EA 15 MINS","42000019","CDM","420","RC","97762","HCPCS","facility","both","","","","54.08","54.08","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC C/O ORTHOTIC/PROSTH USE EA 15 MINS","42000019","CDM","420","RC","97762","HCPCS","facility","both","","","","174","174","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC C/O ORTHOTIC/PROSTH USE EA 15 MINS","42000019","CDM","420","RC","97762","HCPCS","facility","both","","","","60.42","60.42","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC NC ELECTRICAL STIMULATION UA (WOUND)","42000020","CDM","420","RC","","","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ELECTRICAL STIMULATION UA (NON-WOUND)","42000021","CDM","420","RC","","","facility","both","","","","259","259","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTRICAL STIMULATION UA (NON-WOUND)","42000021","CDM","420","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ELECTRICAL STIMULATION UA (NON-WOUND)","42000021","CDM","420","RC","","","facility","both","","","","20.64","20.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ELECTRICAL STIMULATION UA (NON-WOUND)","42000021","CDM","420","RC","","","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ASSISTIVE TECHNOLOGY ASSESSMENT EA 15 MIN","42000022","CDM","420","RC","97755","HCPCS","facility","both","","","","155.76","155.76","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC HOT OR COLD PACKS THERAPY","42000023","CDM","420","RC","97010","HCPCS","facility","both","","","","79","79","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HOT OR COLD PACKS THERAPY","42000023","CDM","420","RC","97010","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ELECTRIC STIMULATION THERAPY","42000024","CDM","420","RC","97014","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC VASOPNEUMATIC DEVICE THERAPY","42000050","CDM","420","RC","97016","HCPCS","facility","both","","","","20.64","20.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC VASOPNEUMATIC DEVICE THERAPY","42000050","CDM","420","RC","97016","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC VASOPNEUMATIC DEVICE THERAPY","42000050","CDM","420","RC","97016","HCPCS","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC VASOPNEUMATIC DEVICE THERAPY","42000050","CDM","420","RC","97016","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AQUATIC THERAPY/EXERCISE EA 15 MINS","42000051","CDM","420","RC","97113","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AQUATIC THERAPY/EXERCISE EA 15 MINS","42000051","CDM","420","RC","97113","HCPCS","facility","both","","","","105","105","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC WOUND CARE NON-SELECTIVE, WO ANES, PER SESSION","42000052","CDM","420","RC","97602","HCPCS","facility","both","","","","319","319","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHYSICAL PERFORMANCE TEST, EA 15 MINS","42000053","CDM","420","RC","97750","HCPCS","facility","both","","","","61.97","61.97","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC PHYSICAL PERFORMANCE TEST, EA 15 MINS","42000053","CDM","420","RC","97750","HCPCS","facility","both","","","","371","371","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHYSICAL PERFORMANCE TEST, EA 15 MINS","42000053","CDM","420","RC","97750","HCPCS","facility","both","","","","57.28","57.28","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC PHYSICAL PERFORMANCE TEST, EA 15 MINS","42000053","CDM","420","RC","97750","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC E STIM WOUND, STAGE 3-4 ULCERS","42000054","CDM","420","RC","","","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC INFRARED THERAPY","42000055","CDM","420","RC","97026","HCPCS","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEG PRESSURE WND TX NON DME < = 50 SQ CM","42000057","CDM","420","RC","97607","HCPCS","facility","both","","","","105","105","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC NEG PRESSURE WND TX NON DME < = 50 SQ CM","42000057","CDM","420","RC","97607","HCPCS","facility","both","","","","518","518","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEG PRESSURE WND TX NON DME > 50 SQ CM","42000058","CDM","420","RC","97608","HCPCS","facility","both","","","","114.58","114.58","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC NEG PRESSURE WND TX NON DME > 50 SQ CM","42000058","CDM","420","RC","97608","HCPCS","facility","both","","","","518","518","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLY RIGID  TOTAL CONTACT LEG CAST","42000059","CDM","420","RC","29445","HCPCS","facility","both","","","","873","873","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES)","42000060","CDM","420","RC","29405","HCPCS","facility","both","","","","185","185","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES)","42000060","CDM","420","RC","29405","HCPCS","facility","both","","","","143.21","143.21","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ORTH/PROST MGMT, UP/LOW EXT, AND/OR TRUNK, SUBSQ ENC, EA 15 MIN","42000061","CDM","420","RC","97763","HCPCS","facility","both","","","","113.61","113.61","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ORTH/PROST MGMT, UP/LOW EXT, AND/OR TRUNK, SUBSQ ENC, EA 15 MIN","42000061","CDM","420","RC","97763","HCPCS","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ORTH/PROST MGMT, UP/LOW EXT, AND/OR TRUNK, SUBSQ ENC, EA 15 MIN","42000061","CDM","420","RC","97763","HCPCS","facility","both","","","","228","228","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ORTH/PROST MGMT, UP/LOW EXT, AND/OR TRUNK, SUBSQ ENC, EA 15 MIN","42000061","CDM","420","RC","97763","HCPCS","facility","both","","","","105","105","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC MINDPOD SOLUTION- MPS01","42000062","CDM","420","RC","","","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC APPLY CAST, HAND AND LOWER FOREARM (GAUNTLET)","42000063","CDM","420","RC","29085","HCPCS","facility","both","","","","265","265","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC APPLY CAST, HAND AND LOWER FOREARM (GAUNTLET)","42000063","CDM","420","RC","29085","HCPCS","facility","both","","","","196.23","196.23","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC APPLY CAST, FINGER","42000064","CDM","420","RC","29086","HCPCS","facility","both","","","","144.6","144.6","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC APPLY CAST, FINGER","42000064","CDM","420","RC","29086","HCPCS","facility","both","","","","210","210","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC REMOTE THER MNTR TX MGMT PHYS/QHP; MNTHLY; 1ST 20 MIN","42000065","CDM","420","RC","98980","HCPCS","facility","both","","","","142","142","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC REMOTE THER MNTR TX MGMT PHYS/QHP;MNTHLY; EA ADDL 20 MIN","42000066","CDM","420","RC","98981","HCPCS","facility","both","","","","112","112","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC CANALITH REPOSITIONING PROCEDURE PER DAY","42000067","CDM","420","RC","95992","HCPCS","facility","both","","","","47.74","47.74","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC CANALITH REPOSITIONING PROCEDURE PER DAY","42000067","CDM","420","RC","95992","HCPCS","facility","both","","","","95","95","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC NEEDLE INSERTION(S  W/O INJECTION(S); 1 OR 2 MUSCLE(S)","42000069","CDM","420","RC","20560","HCPCS","facility","both","","","","38.21","38.21","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC NEEDLE INSERTION(S) W/O INJECTION(S); 3 OR MORE MUSCLES","42000070","CDM","420","RC","20561","HCPCS","facility","both","","","","57.3","57.3","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC MOBILITY CURRENT STATUS","42090000","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC MOBILITY CURRENT STATUS","42090000","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC MOBILITY CURRENT STATUS","42090000","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOBILITY CURRENT STATUS","42090000","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC MOBILITY CURRENT STATUS","42090000","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC MOBILITY GOAL STATUS","42090001","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC MOBILITY GOAL STATUS","42090001","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC MOBILITY GOAL STATUS","42090001","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOBILITY GOAL STATUS","42090001","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC MOBILITY GOAL STATUS","42090001","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC MOBILITY DISCHARGE STATUS","42090002","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC MOBILITY DISCHARGE STATUS","42090002","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC MOBILITY DISCHARGE STATUS","42090002","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOBILITY DISCHARGE STATUS","42090002","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC MOBILITY DISCHARGE STATUS","42090002","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC BODY POSITION CURRENT STATUS","42090003","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BODY POSITION CURRENT STATUS","42090003","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC BODY POSITION CURRENT STATUS","42090003","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC BODY POSITION CURRENT STATUS","42090003","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC BODY POSITION CURRENT STATUS","42090003","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC BODY POSITION GOAL STATUS","42090004","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BODY POSITION GOAL STATUS","42090004","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC BODY POSITION GOAL STATUS","42090004","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC BODY POSITION GOAL STATUS","42090004","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC BODY POSITION GOAL STATUS","42090004","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC BODY POSITION DISCHARGE STATUS","42090005","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BODY POSITION DISCHARGE STATUS","42090005","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC BODY POSITION DISCHARGE STATUS","42090005","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC BODY POSITION DISCHARGE STATUS","42090005","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC BODY POSITION DISCHARGE STATUS","42090005","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC CARRY CURRENT STATUS","42090006","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC CARRY CURRENT STATUS","42090006","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC CARRY CURRENT STATUS","42090006","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARRY CURRENT STATUS","42090006","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC CARRY CURRENT STATUS","42090006","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC CARRY GOAL STATUS","42090007","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC CARRY GOAL STATUS","42090007","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARRY GOAL STATUS","42090007","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC CARRY GOAL STATUS","42090007","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC CARRY GOAL STATUS","42090007","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC CARRY DISCHARGE STATUS","42090008","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARRY DISCHARGE STATUS","42090008","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC CARRY DISCHARGE STATUS","42090008","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC CARRY DISCHARGE STATUS","42090008","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC CARRY DISCHARGE STATUS","42090008","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SELF CARE CURRENT STATUS","42090009","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELF CARE CURRENT STATUS","42090009","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SELF CARE CURRENT STATUS","42090009","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC SELF CARE CURRENT STATUS","42090009","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SELF CARE CURRENT STATUS","42090009","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SELF CARE GOAL STATUS","42090010","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELF CARE GOAL STATUS","42090010","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC SELF CARE GOAL STATUS","42090010","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SELF CARE GOAL STATUS","42090010","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SELF CARE GOAL STATUS","42090010","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SELF CARE DISCHARGE STATUS","42090011","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELF CARE DISCHARGE STATUS","42090011","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SELF CARE DISCHARGE STATUS","42090011","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC SELF CARE DISCHARGE STATUS","42090011","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SELF CARE DISCHARGE STATUS","42090011","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC OTHER PT/OT CURRENT STATUS","42090012","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC OTHER PT/OT CURRENT STATUS","42090012","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OTHER PT/OT CURRENT STATUS","42090012","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC OTHER PT/OT CURRENT STATUS","42090012","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC OTHER PT/OT CURRENT STATUS","42090012","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC OTHER PT/OT GOAL STATUS","42090013","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC OTHER PT/OT GOAL STATUS","42090013","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC OTHER PT/OT GOAL STATUS","42090013","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OTHER PT/OT GOAL STATUS","42090013","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC OTHER PT/OT GOAL STATUS","42090013","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"DEAC 1/1/2020 HC OTHER PT/OT DISCHARGE STATUS","42090014","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"DEAC 1/1/2020 HC OTHER PT/OT DISCHARGE STATUS","42090014","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"DEAC 1/1/2020 HC OTHER PT/OT DISCHARGE STATUS","42090014","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"DEAC 1/1/2020 HC OTHER PT/OT DISCHARGE STATUS","42090014","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 1/1/2020 HC OTHER PT/OT DISCHARGE STATUS","42090014","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SUBSEQUENT PT/OT CURRENT STATUS","42090015","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SUBSEQUENT PT/OT CURRENT STATUS","42090015","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SUBSEQUENT PT/OT CURRENT STATUS","42090015","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC SUBSEQUENT PT/OT CURRENT STATUS","42090015","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SUBSEQUENT PT/OT CURRENT STATUS","42090015","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SUBSEQUENT PT/OT GOAL STATUS","42090016","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SUBSEQUENT PT/OT GOAL STATUS","42090016","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SUBSEQUENT PT/OT GOAL STATUS","42090016","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC SUBSEQUENT PT/OT GOAL STATUS","42090016","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SUBSEQUENT PT/OT GOAL STATUS","42090016","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SUBSEQUENT PT/OT DISCHARGE STATUS","42090017","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SUBSEQUENT PT/OT DISCHARGE STATUS","42090017","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SUBSEQUENT PT/OT DISCHARGE STATUS","42090017","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SUBSEQUENT PT/OT DISCHARGE STATUS","42090017","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC SUBSEQUENT PT/OT DISCHARGE STATUS","42090017","CDM","420","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"DEAC 1/1/2020 HC CANALITH REPOSITIONIONG PROCEDURE","42090018","CDM","420","RC","95992","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHYSICAL THERAPY EVALUATION","42400001","CDM","424","RC","97001","HCPCS","facility","both","","","","175","175","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC PHYSICAL THERAPY EVALUATION","42400001","CDM","424","RC","97001","HCPCS","facility","both","","","","137.74","137.74","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC PHYSICAL THERAPY RE-EVALUATION","42400002","CDM","424","RC","97002","HCPCS","facility","both","","","","103.31","103.31","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC PHYSICAL THERAPY RE-EVALUATION","42400002","CDM","424","RC","97002","HCPCS","facility","both","","","","463","463","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHYSICAL THERAPY RE-EVALUATION","42400002","CDM","424","RC","97002","HCPCS","facility","both","","","","87.5","87.5","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC PT EVAL LOW COMPLEXITY","42400003","CDM","424","RC","97161","HCPCS","facility","both","","","","76.37","76.37","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC PT EVAL LOW COMPLEXITY","42400003","CDM","424","RC","97161","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC PT EVAL LOW COMPLEXITY","42400003","CDM","424","RC","97161","HCPCS","facility","both","","","","380","380","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PT EVAL MODERATE COMPLEXITY","42400004","CDM","424","RC","97162","HCPCS","facility","both","","","","76.37","76.37","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC PT EVAL MODERATE COMPLEXITY","42400004","CDM","424","RC","97162","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC PT EVAL MODERATE COMPLEXITY","42400004","CDM","424","RC","97162","HCPCS","facility","both","","","","553","553","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PT EVAL HIGH COMPLEXITY","42400005","CDM","424","RC","97163","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC PT EVAL HIGH COMPLEXITY","42400005","CDM","424","RC","97163","HCPCS","facility","both","","","","729","729","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PT EVAL HIGH COMPLEXITY","42400005","CDM","424","RC","97163","HCPCS","facility","both","","","","76.37","76.37","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC PT RE-EVAL EST PLAN CARE","42400006","CDM","424","RC","97164","HCPCS","facility","both","","","","57.28","57.28","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC PT RE-EVAL EST PLAN CARE","42400006","CDM","424","RC","97164","HCPCS","facility","both","","","","150","150","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC PT RE-EVAL EST PLAN CARE","42400006","CDM","424","RC","97164","HCPCS","facility","both","","","","737","737","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLY LONG ARM SPLINT","43000001","CDM","430","RC","29105","HCPCS","facility","both","","","","723","723","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLY LONG ARM SPLINT","43000001","CDM","430","RC","29105","HCPCS","facility","both","","","","143.21","143.21","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC APPLY LONG ARM SPLINT","43000001","CDM","430","RC","29105","HCPCS","facility","both","","","","154.93","154.93","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC APPLY LONG ARM SPLINT","43000001","CDM","430","RC","29105","HCPCS","facility","both","","","","156","156","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC APPLY SHORT ARM SPLINT, STATIC","43000002","CDM","430","RC","29125","HCPCS","facility","both","","","","133.65","133.65","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC APPLY SHORT ARM SPLINT, STATIC","43000002","CDM","430","RC","29125","HCPCS","facility","both","","","","598","598","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLY SHORT ARM SPLINT, STATIC","43000002","CDM","430","RC","29125","HCPCS","facility","both","","","","117","117","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC APPLY SHORT ARM SPLINT, STATIC","43000002","CDM","430","RC","29125","HCPCS","facility","both","","","","144.6","144.6","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC APPLY SHORT ARM SPLINT, DYNAMIC","43000003","CDM","430","RC","29126","HCPCS","facility","both","","","","165.27","165.27","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC APPLY SHORT ARM SPLINT, DYNAMIC","43000003","CDM","430","RC","29126","HCPCS","facility","both","","","","148","148","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC APPLY SHORT ARM SPLINT, DYNAMIC","43000003","CDM","430","RC","29126","HCPCS","facility","both","","","","723","723","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLY FINGER SPLINT, STATIC","43000004","CDM","430","RC","29130","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC APPLY FINGER SPLINT, STATIC","43000004","CDM","430","RC","29130","HCPCS","facility","both","","","","485","485","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLY FINGER SPLINT, STATIC","43000004","CDM","430","RC","29130","HCPCS","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC APPLY FINGER SPLINT, DYNAMIC","43000005","CDM","430","RC","29131","HCPCS","facility","both","","","","528","528","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLY FINGER SPLINT, DYNAMIC","43000005","CDM","430","RC","29131","HCPCS","facility","both","","","","103.28","103.28","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC APPLY LONG LEG SPLINT","43000006","CDM","430","RC","29505","HCPCS","facility","both","","","","196.23","196.23","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC APPLY LONG LEG SPLINT","43000006","CDM","430","RC","29505","HCPCS","facility","both","","","","181.39","181.39","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC APPLY SHORT LEG SPLINT","43000007","CDM","430","RC","29515","HCPCS","facility","both","","","","124.11","124.11","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC APPLY SHORT LEG SPLINT","43000007","CDM","430","RC","29515","HCPCS","facility","both","","","","134.25","134.25","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC APPLY SHORT LEG SPLINT","43000007","CDM","430","RC","29515","HCPCS","facility","both","","","","598","598","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED CASTING OR STRAPPING","43000008","CDM","430","RC","29799","HCPCS","facility","both","","","","485","485","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEVELOPMENTAL TESTING","43000009","CDM","918","RC","96110","HCPCS","facility","both","","","","276.43","276.43","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC DEVELOPMENTAL TESTING","43000009","CDM","918","RC","96110","HCPCS","facility","both","","","","85.93","85.93","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC DEVELOPMENTAL TESTING","43000009","CDM","918","RC","96110","HCPCS","facility","both","","","","92.96","92.96","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC DEVELOPMENTAL TESTING","43000009","CDM","918","RC","96110","HCPCS","facility","both","","","","195.9","195.9","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC DEVELOPMENTAL TESTING","43000009","CDM","918","RC","96110","HCPCS","facility","both","","","","523.52","523.52","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC DEVELOPMENTAL TESTING","43000009","CDM","918","RC","96110","HCPCS","facility","both","","","","71.34","71.34","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC PARAFFIN BATH THERAPY","43000010","CDM","430","RC","97018","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC PARAFFIN BATH THERAPY","43000010","CDM","430","RC","97018","HCPCS","facility","both","","","","238","238","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARAFFIN BATH THERAPY","43000010","CDM","430","RC","97018","HCPCS","facility","both","","","","10.34","10.34","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC PARAFFIN BATH THERAPY","43000010","CDM","430","RC","97018","HCPCS","facility","both","","","","9.53","9.53","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC WHIRLPOOL THERAPY","43000011","CDM","430","RC","97022","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC WHIRLPOOL THERAPY","43000011","CDM","430","RC","97022","HCPCS","facility","both","","","","28.65","28.65","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC WHIRLPOOL THERAPY","43000011","CDM","430","RC","97022","HCPCS","facility","both","","","","31","31","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC WHIRLPOOL THERAPY","43000011","CDM","430","RC","97022","HCPCS","facility","both","","","","379","379","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2023 HC THERAPUETIC REHAB GROUP (2,3,4 PTS)","43000012","CDM","430","RC","97150","HCPCS","facility","both","","","","20.64","20.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"DEAC 7/1/2023 HC THERAPUETIC REHAB GROUP (2,3,4 PTS)","43000012","CDM","430","RC","97150","HCPCS","facility","both","","","","144.17","144.17","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2023 HC THERAPUETIC REHAB GROUP (2,3,4 PTS)","43000012","CDM","430","RC","97150","HCPCS","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"DEAC 7/1/2023 HC THERAPUETIC REHAB GROUP (5 OR MORE PTS)","43000013","CDM","430","RC","97150","HCPCS","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"DEAC 7/1/2023 HC THERAPUETIC REHAB GROUP (5 OR MORE PTS)","43000013","CDM","430","RC","97150","HCPCS","facility","both","","","","20.64","20.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC THERAPEUTIC ACTIVITY DIR EA 15 MINS","43000014","CDM","430","RC","97530","HCPCS","facility","both","","","","265","265","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPEUTIC ACTIVITY DIR EA 15 MINS","43000014","CDM","430","RC","97530","HCPCS","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC THERAPEUTIC ACTIVITY DIR EA 15 MINS","43000014","CDM","430","RC","97530","HCPCS","facility","both","","","","66.82","66.82","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC THERAPEUTIC ACTIVITY DIR EA 15 MINS","43000014","CDM","430","RC","97530","HCPCS","facility","both","","","","166.46","166.46","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC THERAPEUTIC ACTIVITY DIR EA 15 MINS","43000014","CDM","430","RC","97530","HCPCS","facility","both","","","","87","87","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC COGNITIVE SKILLS DEVELOPMENT EA 15 MINS","43000015","CDM","430","RC","97532","HCPCS","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC COGNITIVE SKILLS DEVELOPMENT EA 15 MINS","43000015","CDM","430","RC","97532","HCPCS","facility","both","","","","54.08","54.08","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC COGNITIVE SKILLS DEVELOPMENT EA 15 MINS","43000015","CDM","430","RC","97532","HCPCS","facility","both","","","","60.49","60.49","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC COGNITIVE SKILLS DEVELOPMENT EA 15 MINS","43000015","CDM","430","RC","97532","HCPCS","facility","both","","","","174","174","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COGNITIVE SKILLS DEVELOPMENT EA 15 MINS","43000015","CDM","430","RC","97532","HCPCS","facility","both","","","","60.42","60.42","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SENSORY INTEGRATION EA 15 MINS","43000016","CDM","430","RC","97533","HCPCS","facility","both","","","","265","265","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SENSORY INTEGRATION EA 15 MINS","43000016","CDM","430","RC","97533","HCPCS","facility","both","","","","133.65","133.65","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC SENSORY INTEGRATION EA 15 MINS","43000016","CDM","430","RC","97533","HCPCS","facility","both","","","","144.6","144.6","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ADL/SELF HOME MGMT EA 15 MINS","43000017","CDM","430","RC","97535","HCPCS","facility","both","","","","47.74","47.74","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ADL/SELF HOME MGMT EA 15 MINS","43000017","CDM","430","RC","97535","HCPCS","facility","both","","","","51.64","51.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ADL/SELF HOME MGMT EA 15 MINS","43000017","CDM","430","RC","97535","HCPCS","facility","both","","","","108","108","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ADL/SELF HOME MGMT EA 15 MINS","43000017","CDM","430","RC","97535","HCPCS","facility","both","","","","265","265","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COMMUNITY/WORK REINTEGRATION EA 15 MINS","43000018","CDM","430","RC","97537","HCPCS","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC COMMUNITY/WORK REINTEGRATION EA 15 MINS","43000018","CDM","430","RC","97537","HCPCS","facility","both","","","","51.64","51.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC COMMUNITY/WORK REINTEGRATION EA 15 MINS","43000018","CDM","430","RC","97537","HCPCS","facility","both","","","","47.74","47.74","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC WHEELCHAIR MGMT TRAINING EA 15 MINS","43000019","CDM","430","RC","97542","HCPCS","facility","both","","","","51.64","51.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC WHEELCHAIR MGMT TRAINING EA 15 MINS","43000019","CDM","430","RC","97542","HCPCS","facility","both","","","","265","265","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC WHEELCHAIR MGMT TRAINING EA 15 MINS","43000019","CDM","430","RC","97542","HCPCS","facility","both","","","","72","72","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC WHEELCHAIR MGMT TRAINING EA 15 MINS","43000019","CDM","430","RC","97542","HCPCS","facility","both","","","","47.74","47.74","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC THERAPEUTIC REHAB GROUP 2 OR MORE","43000020","CDM","430","RC","97150","HCPCS","facility","both","","","","20.64","20.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC THERAPEUTIC REHAB GROUP 2 OR MORE","43000020","CDM","430","RC","97150","HCPCS","facility","both","","","","159","159","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPEUTIC REHAB GROUP 2 OR MORE","43000020","CDM","430","RC","97150","HCPCS","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC COGNITIVE SKILLS DEVELOPMENT (INCLUDE COMPENSATORY TRAINING) EA 15 MINS","43000027","CDM","430","RC","","","facility","both","","","","71.22","71.22","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC COGNITIVE SKILLS DEVELOPMENT (INCLUDE COMPENSATORY TRAINING) EA 15 MINS","43000027","CDM","430","RC","","","facility","both","","","","192","192","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COGNITIVE SKILLS DEVELOPMENT (INCLUDE COMPENSATORY TRAINING) EA 15 MINS","43000027","CDM","430","RC","","","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC COGNITIVE SKILLS DEVELOPMENT (INCLUDE COMPENSATORY TRAINING) EA 15 MINS","43000027","CDM","430","RC","","","facility","both","","","","51.37","51.37","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC COGNITIVE SKILLS DEVELOPMENT (INCLUDE COMPENSATORY TRAINING) EA 15 MINS","43000027","CDM","430","RC","","","facility","both","","","","65.55","65.55","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; 1ST 15 MIN","43000028","CDM","430","RC","97129","HCPCS","facility","both","","","","38.2","38.2","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; 1ST 15 MIN","43000028","CDM","430","RC","97129","HCPCS","facility","both","","","","214","214","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; 1ST 15 MIN","43000028","CDM","430","RC","97129","HCPCS","facility","both","","","","95.11","95.11","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; 1ST 15 MIN","43000028","CDM","430","RC","97129","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; 1ST 15 MIN","43000028","CDM","430","RC","97129","HCPCS","facility","both","","","","41.33","41.33","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; EA ADDL 15 MIN","43000029","CDM","430","RC","97130","HCPCS","facility","both","","","","20.64","20.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; EA ADDL 15 MIN","43000029","CDM","430","RC","97130","HCPCS","facility","both","","","","65","65","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; EA ADDL 15 MIN","43000029","CDM","430","RC","97130","HCPCS","facility","both","","","","214","214","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; EA ADDL 15 MIN","43000029","CDM","430","RC","97130","HCPCS","facility","both","","","","38.2","38.2","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC THER INTERV COG FUNCT/COMP STRATG; DIR CONTACT; EA ADDL 15 MIN","43000029","CDM","430","RC","97130","HCPCS","facility","both","","","","95.11","95.11","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC CONTRAST BATH THERAPY EA 15 MINS","43000201","CDM","430","RC","97034","HCPCS","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC CONTRAST BATH THERAPY EA 15 MINS","43000201","CDM","430","RC","97034","HCPCS","facility","both","","","","265","265","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONTRAST BATH THERAPY EA 15 MINS","43000201","CDM","430","RC","97034","HCPCS","facility","both","","","","82.61","82.61","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC OCCUPATIONAL THERAPY EVALUATION","43400001","CDM","434","RC","97003","HCPCS","facility","both","","","","175","175","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC OCCUPATIONAL THERAPY EVALUATION","43400001","CDM","434","RC","97003","HCPCS","facility","both","","","","122.33","122.33","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC OCCUPATIONAL THERAPY RE -EVALUATION","43400002","CDM","434","RC","97004","HCPCS","facility","both","","","","463","463","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OCCUPATIONAL THERAPY RE -EVALUATION","43400002","CDM","434","RC","97004","HCPCS","facility","both","","","","91.74","91.74","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC OCCUPATIONAL THERAPY RE -EVALUATION","43400002","CDM","434","RC","97004","HCPCS","facility","both","","","","87.5","87.5","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC OT EVAL LOW COMPLEXITY","43400003","CDM","434","RC","97165","HCPCS","facility","both","","","","220","220","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC OT EVAL LOW COMPLEXITY","43400003","CDM","434","RC","97165","HCPCS","facility","both","","","","380","380","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OT EVAL LOW COMPLEXITY","43400003","CDM","434","RC","97165","HCPCS","facility","both","","","","82.61","82.61","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC OT EVAL MOD COMPLEXITY","43400004","CDM","434","RC","97166","HCPCS","facility","both","","","","220","220","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC OT EVAL MOD COMPLEXITY","43400004","CDM","434","RC","97166","HCPCS","facility","both","","","","553","553","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OT EVAL MOD COMPLEXITY","43400004","CDM","434","RC","97166","HCPCS","facility","both","","","","82.61","82.61","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC OT EVAL HIGH COMPLEXITY","43400005","CDM","434","RC","97167","HCPCS","facility","both","","","","220","220","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC OT EVAL HIGH COMPLEXITY","43400005","CDM","434","RC","97167","HCPCS","facility","both","","","","729","729","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OT EVAL HIGH COMPLEXITY","43400005","CDM","434","RC","97167","HCPCS","facility","both","","","","82.61","82.61","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC OT RE-EVAL EST PLAN CARE","43400006","CDM","434","RC","97168","HCPCS","facility","both","","","","737","737","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OT RE-EVAL EST PLAN CARE","43400006","CDM","434","RC","97168","HCPCS","facility","both","","","","152","152","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC OT RE-EVAL EST PLAN CARE","43400006","CDM","434","RC","97168","HCPCS","facility","both","","","","61.97","61.97","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SLV THERAPY, INDIVIDUAL","44000001","CDM","440","RC","92507","HCPCS","facility","both","","","","265","265","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SLV THERAPY, INDIVIDUAL","44000001","CDM","440","RC","92507","HCPCS","facility","both","","","","225","225","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SLV THERAPY, INDIVIDUAL","44000001","CDM","440","RC","92507","HCPCS","facility","both","","","","214.02","214.02","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC LARYNGEAL FUNCTION STUDY","44000002","CDM","440","RC","92520","HCPCS","facility","both","","","","428.05","428.05","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC LARYNGEAL FUNCTION STUDY","44000002","CDM","440","RC","92520","HCPCS","facility","both","","","","719","719","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TX SWALLOWING DYSFUNCTION","44000003","CDM","440","RC","92526","HCPCS","facility","both","","","","238","238","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC TX SWALLOWING DYSFUNCTION","44000003","CDM","440","RC","92526","HCPCS","facility","both","","","","285.34","285.34","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC TX SWALLOWING DYSFUNCTION","44000003","CDM","440","RC","92526","HCPCS","facility","both","","","","265","265","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVAL TO USE/FIT VOICE PROSTHETIC","44000004","CDM","440","RC","92597","HCPCS","facility","both","","","","652","652","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVAL TO USE/FIT VOICE PROSTHETIC","44000004","CDM","440","RC","92597","HCPCS","facility","both","","","","190.24","190.24","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC NON-SPEECH DEVICE TX","44000005","CDM","440","RC","92606","HCPCS","facility","both","","","","214.02","214.02","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC EVAL FOR SPEECH DEVICE RX, 1ST HR","44000006","CDM","440","RC","92607","HCPCS","facility","both","","","","527","527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVAL FOR SPEECH DEVICE RX, 1ST HR","44000006","CDM","440","RC","92607","HCPCS","facility","both","","","","386","386","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC EVAL FOR SPEECH DEVICE RX, 1ST HR","44000006","CDM","440","RC","92607","HCPCS","facility","both","","","","428.05","428.05","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC EVAL FOR SPEECH DEVICE RX, EA ADDL 30 MIN","44000007","CDM","440","RC","92608","HCPCS","facility","both","","","","225","225","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC EVAL FOR SPEECH DEVICE RX, EA ADDL 30 MIN","44000007","CDM","440","RC","92608","HCPCS","facility","both","","","","332","332","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVAL FOR SPEECH DEVICE RX, EA ADDL 30 MIN","44000007","CDM","440","RC","92608","HCPCS","facility","both","","","","166.46","166.46","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC THERAPEUTIC SP DEVICE SERVICE","44000008","CDM","440","RC","92609","HCPCS","facility","both","","","","356.71","356.71","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC THERAPEUTIC SP DEVICE SERVICE","44000008","CDM","440","RC","92609","HCPCS","facility","both","","","","325","325","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC THERAPEUTIC SP DEVICE SERVICE","44000008","CDM","440","RC","92609","HCPCS","facility","both","","","","435","435","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVALUATE SWALLOWING FUNCTION","44000009","CDM","444","RC","92610","HCPCS","facility","both","","","","285.34","285.34","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC EVALUATE SWALLOWING FUNCTION","44000009","CDM","444","RC","92610","HCPCS","facility","both","","","","238","238","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC EVALUATE SWALLOWING FUNCTION","44000009","CDM","444","RC","92610","HCPCS","facility","both","","","","809","809","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOTION FLUORO SWALLOW FCN, CINE/VIDEO","44000010","CDM","440","RC","92611","HCPCS","facility","both","","","","699","699","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOTION FLUORO SWALLOW FCN, CINE/VIDEO","44000010","CDM","440","RC","92611","HCPCS","facility","both","","","","546.94","546.94","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC FEES W CINE OR VIDEO","44000011","CDM","440","RC","92612","HCPCS","facility","both","","","","1093.89","1093.89","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC FEES W CINE OR VIDEO","44000011","CDM","440","RC","92612","HCPCS","facility","both","","","","699","699","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLEX ENDOSCOPIC EVAL, LARYNGEAL SENSORY TEST BY CINE/VIDEO","44000012","CDM","440","RC","92614","HCPCS","facility","both","","","","737.18","737.18","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC FEES & LARYNGEAL SENSORY TEST W CINE/VIDEO","44000013","CDM","440","RC","92616","HCPCS","facility","both","","","","1117.68","1117.68","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC EVAL AUDITORY FUNCTION, 1ST HR","44000014","CDM","440","RC","92626","HCPCS","facility","both","","","","209.07","209.07","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC EVAL AUDITORY FUNCTION, 1ST HR","44000014","CDM","440","RC","92626","HCPCS","facility","both","","","","484","484","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVAL AUDITORY FUNCTION, 1ST HR","44000014","CDM","440","RC","92626","HCPCS","facility","both","","","","108.71","108.71","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC EVAL AUDITORY FUNCTION, EA ADDL 15 MIN","44000015","CDM","440","RC","92627","HCPCS","facility","both","","","","27.17","27.17","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC EVAL AUDITORY FUNCTION, EA ADDL 15 MIN","44000015","CDM","440","RC","92627","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVAL AUDITORY FUNCTION, EA ADDL 15 MIN","44000015","CDM","440","RC","92627","HCPCS","facility","both","","","","52.27","52.27","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC AUD REHAB PRE-LING HEAR LOSS","44000016","CDM","440","RC","92630","HCPCS","facility","both","","","","108.71","108.71","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC AUD REHAB PRE-LING HEAR LOSS","44000016","CDM","440","RC","92630","HCPCS","facility","both","","","","209.07","209.07","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC AUD REHAB POSTLING HEAR LOSS","44000017","CDM","440","RC","92633","HCPCS","facility","both","","","","108.71","108.71","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC AUD REHAB POSTLING HEAR LOSS","44000017","CDM","440","RC","92633","HCPCS","facility","both","","","","209.07","209.07","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC APHASIA ASSESMENT EACH HR","44000018","CDM","440","RC","96105","HCPCS","facility","both","","","","280","280","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC APHASIA ASSESMENT EACH HR","44000018","CDM","440","RC","96105","HCPCS","facility","both","","","","368.57","368.57","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC APHASIA ASSESMENT EACH HR","44000018","CDM","440","RC","96105","HCPCS","facility","both","","","","261.2","261.2","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC APHASIA ASSESMENT EACH HR","44000018","CDM","440","RC","96105","HCPCS","facility","both","","","","261.58","261.58","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC APHASIA ASSESMENT EACH HR","44000018","CDM","440","RC","96105","HCPCS","facility","both","","","","698.02","698.02","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC APHASIA ASSESMENT EACH HR","44000018","CDM","440","RC","96105","HCPCS","facility","both","","","","924","924","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COGNITIVE ASSESSMENT BY HC PRO PER HR","44000019","CDM","440","RC","96125","HCPCS","facility","both","","","","309.14","309.14","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC COGNITIVE ASSESSMENT BY HC PRO PER HR","44000019","CDM","440","RC","96125","HCPCS","facility","both","","","","676","676","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COGNITIVE ASSESSMENT BY HC PRO PER HR","44000019","CDM","440","RC","96125","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC COGNITIVE ASSESSMENT BY HC PRO PER HR","44000019","CDM","440","RC","96125","HCPCS","facility","both","","","","134.23","134.23","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC EX FOR NONSPEECH DEVICE RX, 1ST HR","44000030","CDM","440","RC","92605","HCPCS","facility","both","","","","214.02","214.02","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC EX FOR NONSPEECH DEV RX EA ADD 30 MIN","44000035","CDM","440","RC","92618","HCPCS","facility","both","","","","71.34","71.34","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SLV TREATMENT GROUP, 2 OR MORE 2-4","44000050","CDM","440","RC","92508","HCPCS","facility","both","","","","280","280","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SLV TREATMENT GROUP, 2 OR MORE 2-4","44000050","CDM","440","RC","92508","HCPCS","facility","both","","","","95.11","95.11","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC UNLISTED ENT PROCEDURE/SERVICE","44000051","CDM","444","RC","92700","HCPCS","facility","both","","","","72.49","72.49","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"DEAC 07/01/2024 HC SLV TREATMENT GROUP 5 OR MORE","44000052","CDM","440","RC","92508","HCPCS","facility","both","","","","25.96","25.96","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC DIAGNOSTIC ANALYSIS, PROG, VERF OF AUD OSS SOUND PRCR, ANY TYPE; 1ST 60 MIN","44000053","CDM","471","RC","92622","HCPCS","facility","both","","","","99.66","99.66","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC DIAGNOSTIC ANALYSIS, PROG, VERF OF AUD OSS SOUND PRCR, ANY TYPE; EA ADD 15 M","44000054","CDM","471","RC","92623","HCPCS","facility","both","","","","27.17","27.17","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC SWALLOW CURRENT STATUS","44090000","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SWALLOW CURRENT STATUS","44090000","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SWALLOW CURRENT STATUS","44090000","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SWALLOW CURRENT STATUS","44090000","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SWALLOW GOAL STATUS","44090001","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SWALLOW GOAL STATUS","44090001","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SWALLOW GOAL STATUS","44090001","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SWALLOW GOAL STATUS","44090001","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SWALLOW DISCHARGE STATUS","44090002","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SWALLOW DISCHARGE STATUS","44090002","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SWALLOW DISCHARGE STATUS","44090002","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SWALLOW DISCHARGE STATUS","44090002","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC MOTOR SPEECH CURRENT STATUS","44090003","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC MOTOR SPEECH CURRENT STATUS","44090003","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOTOR SPEECH CURRENT STATUS","44090003","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC MOTOR SPEECH CURRENT STATUS","44090003","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC MOTOR SPEECH GOAL STATUS","44090004","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOTOR SPEECH GOAL STATUS","44090004","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC MOTOR SPEECH GOAL STATUS","44090004","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC MOTOR SPEECH GOAL STATUS","44090004","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC MOTOR SPEECH DISCHARGE STATUS","44090005","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC MOTOR SPEECH DISCHARGE STATUS","44090005","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC MOTOR SPEECH DISCHARGE STATUS","44090005","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MOTOR SPEECH DISCHARGE STATUS","44090005","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC LANGUAGE COMPREHENSION CURRENT STATUS","44090006","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC LANGUAGE COMPREHENSION CURRENT STATUS","44090006","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LANGUAGE COMPREHENSION CURRENT STATUS","44090006","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC LANGUAGE COMPREHENSION CURRENT STATUS","44090006","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC LANGUAGE COMPREHENSION GOAL STATUS","44090007","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC LANGUAGE COMPREHENSION GOAL STATUS","44090007","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LANGUAGE COMPREHENSION GOAL STATUS","44090007","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC LANGUAGE COMPREHENSION GOAL STATUS","44090007","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC LANGUAGE COMPREHENSION DISCHARGE STATUS","44090008","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC LANGUAGE COMPREHENSION DISCHARGE STATUS","44090008","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC LANGUAGE COMPREHENSION DISCHARGE STATUS","44090008","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC LANGUAGE COMPREHENSION DISCHARGE STATUS","44090008","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LANGUAGE EXPRESSIVE CURRENT STATUS","44090009","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC LANGUAGE EXPRESSIVE CURRENT STATUS","44090009","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LANGUAGE EXPRESSIVE CURRENT STATUS","44090009","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC LANGUAGE EXPRESSIVE CURRENT STATUS","44090009","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC LANGUAGE EXPRESSIVE GOAL STATUS","44090010","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LANGUAGE EXPRESSIVE GOAL STATUS","44090010","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC LANGUAGE EXPRESSIVE GOAL STATUS","44090010","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC LANGUAGE EXPRESSIVE GOAL STATUS","44090010","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC LANGUAGE EXPRESSIVE DISCHARGE STATUS","44090011","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC LANGUAGE EXPRESSIVE DISCHARGE STATUS","44090011","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC LANGUAGE EXPRESSIVE DISCHARGE STATUS","44090011","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC LANGUAGE EXPRESSIVE DISCHARGE STATUS","44090011","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ATTENTION CURRENT STATUS","44090012","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ATTENTION CURRENT STATUS","44090012","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ATTENTION CURRENT STATUS","44090012","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ATTENTION CURRENT STATUS","44090012","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ATTENTION CURRENT STATUS","44090012","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC ATTENTION GOAL STATUS","44090013","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ATTENTION GOAL STATUS","44090013","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ATTENTION GOAL STATUS","44090013","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC ATTENTION GOAL STATUS","44090013","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ATTENTION GOAL STATUS","44090013","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ATTENTION DISCHARGE STATUS","44090014","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ATTENTION DISCHARGE STATUS","44090014","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC ATTENTION DISCHARGE STATUS","44090014","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ATTENTION DISCHARGE STATUS","44090014","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ATTENTION DISCHARGE STATUS","44090014","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC MEMORY CURRENT STATUS","44090015","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MEMORY CURRENT STATUS","44090015","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC MEMORY CURRENT STATUS","44090015","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC MEMORY CURRENT STATUS","44090015","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC MEMORY CURRENT STATUS","44090015","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC MEMORY GOAL STATUS","44090016","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC MEMORY GOAL STATUS","44090016","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC MEMORY GOAL STATUS","44090016","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC MEMORY GOAL STATUS","44090016","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC MEMORY GOAL STATUS","44090016","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MEMORY DISCHARGE STATUS","44090017","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MEMORY DISCHARGE STATUS","44090017","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC MEMORY DISCHARGE STATUS","44090017","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC MEMORY DISCHARGE STATUS","44090017","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC MEMORY DISCHARGE STATUS","44090017","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC VOICE CURRENT STATUS","44090018","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC VOICE CURRENT STATUS","44090018","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC VOICE CURRENT STATUS","44090018","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VOICE CURRENT STATUS","44090018","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC VOICE GOAL STATUS","44090019","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC VOICE GOAL STATUS","44090019","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC VOICE GOAL STATUS","44090019","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC VOICE GOAL STATUS","44090019","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VOICE DISCHARGE STATUS","44090020","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC VOICE DISCHARGE STATUS","44090020","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC VOICE DISCHARGE STATUS","44090020","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC VOICE DISCHARGE STATUS","44090020","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPEECH LANGUAGE CURRENT STATUS","44090021","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SPEECH LANGUAGE CURRENT STATUS","44090021","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC SPEECH LANGUAGE CURRENT STATUS","44090021","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SPEECH LANGUAGE CURRENT STATUS","44090021","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SPEECH LANGUAGE CURRENT STATUS","44090021","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPEECH LANGUAGE GOAL STATUS","44090022","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SPEECH LANGUAGE GOAL STATUS","44090022","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPEECH LANGUAGE GOAL STATUS","44090022","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC SPEECH LANGUAGE GOAL STATUS","44090022","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SPEECH LANGUAGE GOAL STATUS","44090022","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SPEECH LANGUAGE DISCHARGE STATUS","44090023","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC SPEECH LANGUAGE DISCHARGE STATUS","44090023","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SPEECH LANGUAGE DISCHARGE STATUS","44090023","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC SPEECH LANGUAGE DISCHARGE STATUS","44090023","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC SPEECH LANGUAGE DISCHARGE STATUS","44090023","CDM","440","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SLV EVALUATION","44400001","CDM","444","RC","92506","HCPCS","facility","both","","","","411","411","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVALUATION OF SPEECH FLUENCY","44400002","CDM","444","RC","92521","HCPCS","facility","both","","","","309.14","309.14","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC EVALUATION OF SPEECH FLUENCY","44400002","CDM","444","RC","92521","HCPCS","facility","both","","","","609","609","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVALUATION OF SPEECH FLUENCY","44400002","CDM","444","RC","92521","HCPCS","facility","both","","","","360","360","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC EVALUATION OF SPEECH SOUND  PRODUCTION","44400003","CDM","444","RC","92522","HCPCS","facility","both","","","","309.14","309.14","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC EVALUATION OF SPEECH SOUND  PRODUCTION","44400003","CDM","444","RC","92522","HCPCS","facility","both","","","","609","609","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVALUATION OF SPEECH SOUND  PRODUCTION","44400003","CDM","444","RC","92522","HCPCS","facility","both","","","","300","300","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC EVALUATION OF SPEECH SOUND  PRODUCTION W/LANGUAGE COMPREHENSION","44400004","CDM","444","RC","92523","HCPCS","facility","both","","","","609","609","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVALUATION OF SPEECH SOUND  PRODUCTION W/LANGUAGE COMPREHENSION","44400004","CDM","444","RC","92523","HCPCS","facility","both","","","","689.63","689.63","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC EVALUATION OF SPEECH SOUND  PRODUCTION W/LANGUAGE COMPREHENSION","44400004","CDM","444","RC","92523","HCPCS","facility","both","","","","625","625","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC BEHAVIORAL & QUALIT ANALYSIS VOICE/RESONANCE","44400005","CDM","444","RC","92524","HCPCS","facility","both","","","","309.14","309.14","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC BEHAVIORAL & QUALIT ANALYSIS VOICE/RESONANCE","44400005","CDM","444","RC","92524","HCPCS","facility","both","","","","260","260","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC BEHAVIORAL & QUALIT ANALYSIS VOICE/RESONANCE","44400005","CDM","444","RC","92524","HCPCS","facility","both","","","","609","609","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAINAGE OF ABSCESS; SINGLE","45000100","CDM","450","RC","10060","HCPCS","facility","both","","","","2255","2255","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAINAGE OF ABSCESS; MULTIPLE","45000101","CDM","450","RC","10061","HCPCS","facility","both","","","","2328","2328","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL OF FOREIGN BODY, SUBQ, SIMPLE","45000104","CDM","450","RC","10120","HCPCS","facility","both","","","","269","269","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAINAGE OF HEMATOMA/FLUID","45000106","CDM","450","RC","10140","HCPCS","facility","both","","","","2050","2050","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST","45000107","CDM","450","RC","10160","HCPCS","facility","both","","","","505","505","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEBRIDE INFECTED SKIN; UP TO 10% OF BODY SURFACE","45000108","CDM","450","RC","11000","HCPCS","facility","both","","","","1011","1011","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEBRIDE, SUBQ TISSUE; FIRST 20 SQ CM OR LESS","45000111","CDM","450","RC","11042","HCPCS","facility","both","","","","9292","9292","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEBRIDE, MUSCLE AND/OR FASCIA; 1ST 20 SQ CM OR LESS","45000112","CDM","450","RC","11043","HCPCS","facility","both","","","","9292","9292","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOSED TX DISTAL RADIAL FX WITH MANIPULATION","45000187","CDM","450","RC","25605","HCPCS","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOSED TX POST HIP ARTHROPLASTY DISLOCATION; WO ANES","45000213","CDM","450","RC","27265","HCPCS","facility","both","","","","1981","1981","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STRAPPING, SHOULDER (EG, VELPEAU)","45000246","CDM","450","RC","29240","HCPCS","facility","both","","","","598","598","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STRAPPING, ELBOW OR WRIST","45000247","CDM","450","RC","29260","HCPCS","facility","both","","","","598","598","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STRAPPING, HAND OR FINGER","45000248","CDM","450","RC","29280","HCPCS","facility","both","","","","598","598","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STRAPPING, KNEE","45000251","CDM","450","RC","29530","HCPCS","facility","both","","","","485","485","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STRAPPING, ANKEL AND/OR FOOT","45000252","CDM","450","RC","29540","HCPCS","facility","both","","","","485","485","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STRAPPING, TOES","45000253","CDM","450","RC","29550","HCPCS","facility","both","","","","368","368","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT CHEST TUBE (THORACOSTOMY)","45000259","CDM","450","RC","32551","HCPCS","facility","both","","","","4124","4124","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INCISION AND DRAINAGE ABSCESS; PERITONSILLAR","45000265","CDM","450","RC","42700","HCPCS","facility","both","","","","1090","1090","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Change gastro tube, percut, wo image/guide","45000267","CDM","450","RC","43760","HCPCS","facility","both","","","","668","668","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INCISION AND DRAINAGE, RECTAL ABCESS","45000268","CDM","450","RC","46040","HCPCS","facility","both","","","","611","611","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION, EPIDURAL, OF BLOOD OR CLOT PATCH","45000277","CDM","450","RC","62273","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; OTHER PERIPHER NERVE OR BRCH","45000278","CDM","450","RC","64450","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; OTHER PERIPHER NERVE OR BRCH","45000278","CDM","450","RC","64450","HCPCS","facility","both","","","","2284","2284","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDIOVERSION ELECTRIC EXT","45000288","CDM","450","RC","92960","HCPCS","facility","both","","","","3010","3010","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Moderate sedation by same phys 5 yrs +, 1st 30 mins","45000289","CDM","450","RC","99144","HCPCS","facility","both","","","","964","964","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC Moderate sedation by same phys 5 yrs +, 1st 30 mins","45000289","CDM","450","RC","99144","HCPCS","facility","both","","","","36.38","36.38","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC Moderate sedation by same phys, ea addl 15 mins","45000290","CDM","450","RC","99145","HCPCS","facility","both","","","","36.38","36.38","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC VENIPUNCTURE AGE 3 YRS/>","45000297","CDM","450","RC","36410","HCPCS","facility","both","","","","193","193","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASPIRATE PLEURA WO IMAGING","45000299","CDM","761","RC","32554","HCPCS","facility","both","","","","2299","2299","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOSED FX SC/TC HUMERAL W MANIPULATION","45000308","CDM","450","RC","24535","HCPCS","facility","both","","","","3007","3007","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAINAGE OF ABSCESS OF PALATE, UVULA","45000309","CDM","450","RC","42000","HCPCS","facility","both","","","","1919","1919","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NASAL/SINUS ENDOSCOPY W HEMORRHAGE CONTROL","45000310","CDM","450","RC","31238","HCPCS","facility","both","","","","4026","4026","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL OR BIVALVING; GAUNTLET,  BOOT OR BODY CAST","45000311","CDM","450","RC","29700","HCPCS","facility","both","","","","859","859","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIP REPAIR, FULL THICKNESS;  > ONE-HALF VERTICAL HEIGHT, OR COMPLEX","45000312","CDM","450","RC","40654","HCPCS","facility","both","","","","6062","6062","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOSED TX FX WEIGHT BEAR  DISTAL TIBIA; W OR W/O ANES; MANIPUL","45000313","CDM","450","RC","27825","HCPCS","facility","both","","","","8599","8599","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASTRIC INTUBATION & ASPIRATION(S), TX, INCL LAVAGE","45000314","CDM","450","RC","43753","HCPCS","facility","both","","","","905","905","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPEN TX NASAL SEPTAL FRACTURE WITH OR WITHOUT STABILIZATION","45000315","CDM","450","RC","21336","HCPCS","facility","both","","","","6685","6685","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RHINOPLASTY, PRIMARY; LATERAL & ALAR CARTILAGES &/OR ELEVATE TIP","45000316","CDM","450","RC","30400","HCPCS","facility","both","","","","11326","11326","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN ABSCESS/HEMATOMA, NASAL, INTERNAL APPROACH","45000317","CDM","450","RC","30000","HCPCS","facility","both","","","","693","693","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMICAL CAUTERIZATION OF GRANULATION TISSUE","45000318","CDM","450","RC","17250","HCPCS","facility","both","","","","597","597","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL IMPACTED CERUMEN IRRIGATION/LAVAGE - UNILAT","45000319","CDM","450","RC","69209","HCPCS","facility","both","","","","214","214","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ARTHROPLASTY, METACARPOPHALANGEAL JOINT; EACH","45000320","CDM","450","RC","26530","HCPCS","facility","both","","","","10285","10285","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA","45000321","CDM","450","RC","24605","HCPCS","facility","both","","","","4717","4717","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPAIR BLOOD VESSEL DIRECT; HAND, FINGER","45000322","CDM","450","RC","35207","HCPCS","facility","both","","","","9161","9161","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRING ANESTHESIA","45000323","CDM","450","RC","27252","HCPCS","facility","both","","","","6705","6705","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLOSED TX NASAL BONE FX W/MANIPULATION W/ STABILIZATION","45000324","CDM","450","RC","21320","HCPCS","facility","both","","","","18344","18344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION; LIP FULL THICKNESS, RECONSTRUCT W/LOCAL FLAP","45000328","CDM","450","RC","40525","HCPCS","facility","both","","","","18344","18344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED PROC, DENTOALVEOLAR STRUCTURES","45000329","CDM","450","RC","41899","HCPCS","facility","both","","","","890","890","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED PROC, TONGUE OR FLOOR OF MOUTH","45000330","CDM","450","RC","41599","HCPCS","facility","both","","","","7695","7695","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FORESKIN MANIPULATION INCL LYSIS OF ADHESIONS","45000331","CDM","450","RC","54450","HCPCS","facility","both","","","","811","811","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CANTHOTOMY","45000332","CDM","450","RC","67715","HCPCS","facility","both","","","","7775","7775","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EMERGENCY DEPT VISIT LVL 1","45100001","CDM","451","RC","99281","HCPCS","facility","both","","","","250.99","250.99","","","","","","","","","","","","","Gross Charge Type: JHH 28 EMERGENCY ADULT ROOM"
"HC EMERGENCY DEPT VISIT LVL 1","45100001","CDM","451","RC","99281","HCPCS","facility","both","","","","250.99","250.99","","","","","","","","","","","","","Gross Charge Type: JHH 28 EMERGENCY PEDS ROOM"
"HC EMERGENCY DEPT VISIT LVL 2","45200002","CDM","452","RC","99282","HCPCS","facility","both","","","","661","661","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EMERGENCY DEPT VISIT LVL 2","45200002","CDM","452","RC","99282","HCPCS","facility","both","","","","250.99","250.99","","","","","","","","","","","","","Gross Charge Type: JHH 28 EMERGENCY ADULT ROOM"
"HC EMERGENCY DEPT VISIT LVL 2","45200002","CDM","452","RC","99282","HCPCS","facility","both","","","","250.99","250.99","","","","","","","","","","","","","Gross Charge Type: JHH 28 EMERGENCY PEDS ROOM"
"HC EMERGENCY DEPT VISIT LVL 3","45200003","CDM","452","RC","99283","HCPCS","facility","both","","","","502","502","","","","","","","","","","","","","Gross Charge Type: JHH 28 EMERGENCY PEDS ROOM"
"HC EMERGENCY DEPT VISIT LVL 3","45200003","CDM","452","RC","99283","HCPCS","facility","both","","","","502","502","","","","","","","","","","","","","Gross Charge Type: JHH 28 EMERGENCY ADULT ROOM"
"HC EMERGENCY DEPT VISIT LVL 4","45200004","CDM","452","RC","99284","HCPCS","facility","both","","","","1585","1585","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EMERGENCY DEPT VISIT LVL 4","45200004","CDM","452","RC","99284","HCPCS","facility","both","","","","1003.93","1003.93","","","","","","","","","","","","","Gross Charge Type: JHH 28 EMERGENCY ADULT ROOM"
"HC EMERGENCY DEPT VISIT LVL 4","45200004","CDM","452","RC","99284","HCPCS","facility","both","","","","1003.93","1003.93","","","","","","","","","","","","","Gross Charge Type: JHH 28 EMERGENCY PEDS ROOM"
"HC EMERGENCY DEPT VISIT LVL 5","45200005","CDM","452","RC","99285","HCPCS","facility","both","","","","1756.89","1756.89","","","","","","","","","","","","","Gross Charge Type: JHH 28 EMERGENCY PEDS ROOM"
"HC EMERGENCY DEPT VISIT LVL 5","45200005","CDM","452","RC","99285","HCPCS","facility","both","","","","1756.89","1756.89","","","","","","","","","","","","","Gross Charge Type: JHH 28 EMERGENCY ADULT ROOM"
"HC ER EXTENDED CARE SERVICE","45200025","CDM","452","RC","","","facility","both","","","","250.99","250.99","","","","","","","","","","","","","Gross Charge Type: JHH 28 EMERGENCY PEDS ROOM"
"HC ER EXTENDED CARE SERVICE","45200025","CDM","452","RC","","","facility","both","","","","250.99","250.99","","","","","","","","","","","","","Gross Charge Type: JHH 28 EMERGENCY ADULT ROOM"
"DEAC 7/1/2018 HC INCENTIVE SPIROMETRY, INITIAL TX","46000001","CDM","460","RC","94010","HCPCS","facility","both","","","","386","386","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC INCENTIVE SPIROMETRY, INITIAL TX","46000001","CDM","460","RC","94010","HCPCS","facility","both","","","","56.55","56.55","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC INCENTIVE SPIROMETRY, SUBSEQ TX","46000002","CDM","460","RC","94010","HCPCS","facility","both","","","","35.34","35.34","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC SPIROMETRY","46000003","CDM","460","RC","94010","HCPCS","facility","both","","","","393.6","393.6","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC SPIROMETRY","46000003","CDM","460","RC","94010","HCPCS","facility","both","","","","640","640","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPIROMETRY","46000003","CDM","460","RC","94010","HCPCS","facility","both","","","","89.48","89.48","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC SPIROMETRY W/BRONCHODILATOR","46000004","CDM","460","RC","94060","HCPCS","facility","both","","","","582.63","582.63","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC SPIROMETRY W/BRONCHODILATOR","46000004","CDM","460","RC","94060","HCPCS","facility","both","","","","1033","1033","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRONCHOSPASM PROVOCATION EVAL","46000005","CDM","460","RC","94070","HCPCS","facility","both","","","","1322.65","1322.65","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC TOTAL VITAL CAPACITY","46000006","CDM","460","RC","94150","HCPCS","facility","both","","","","64.39","64.39","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC TOTAL VITAL CAPACITY","46000006","CDM","460","RC","94150","HCPCS","facility","both","","","","257","257","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAXIMUM VOLUNTARY VENTILATION","46000007","CDM","460","RC","94200","HCPCS","facility","both","","","","189","189","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HB RESPIRATORY FLOW VOLUME LOOP - NON-MARYLAND","46000008","CDM","460","RC","94375","HCPCS","facility","both","","","","955","955","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HB RESPIRATORY FLOW VOLUME LOOP - NON-MARYLAND","46000008","CDM","460","RC","94375","HCPCS","facility","both","","","","159.03","159.03","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CARDIOPULM EXERCISE TEST, INCL MEASURE MIN VENT, CO2, O2  & ECG","46000009","CDM","460","RC","94621","HCPCS","facility","both","","","","1417.11","1417.11","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC CARDIOPULM EXERCISE TEST, INCL MEASURE MIN VENT, CO2, O2  & ECG","46000009","CDM","460","RC","94621","HCPCS","facility","both","","","","1992","1992","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OXYGEN UPTAKE REST INDIRECT","46000012","CDM","460","RC","94690","HCPCS","facility","both","","","","214.72","214.72","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC OXYGEN UPTAKE REST INDIRECT","46000012","CDM","460","RC","94690","HCPCS","facility","both","","","","944.74","944.74","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC PULMONARY FUNCTION TST PLETHYSMOGRAPHY","46000013","CDM","460","RC","94726","HCPCS","facility","both","","","","299.16","299.16","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC CO/MEMBRANE DIFFUSE CAPACITY","46000014","CDM","460","RC","94729","HCPCS","facility","both","","","","550","550","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CO/MEMBRANE DIFFUSE CAPACITY","46000014","CDM","460","RC","94729","HCPCS","facility","both","","","","71.59","71.59","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CO/MEMBRANE DIFFUSE CAPACITY","46000014","CDM","460","RC","94729","HCPCS","facility","both","","","","314.9","314.9","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC PULSE OXIMETRY","46000015","CDM","460","RC","94760","HCPCS","facility","both","","","","28.64","28.64","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC PULSE OXIMETRY","46000015","CDM","460","RC","94760","HCPCS","facility","both","","","","74.8","74.8","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC PULSE OXIMETRY","46000015","CDM","460","RC","94760","HCPCS","facility","both","","","","125.93","125.93","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC PULSE OXIMETRY","46000015","CDM","460","RC","94760","HCPCS","facility","both","","","","509","509","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PULSE OX MULTIPLE, EG EXERCISE","46000016","CDM","460","RC","94761","HCPCS","facility","both","","","","611","611","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PULSE OX MULTIPLE, EG EXERCISE","46000016","CDM","460","RC","94761","HCPCS","facility","both","","","","107.36","107.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC PULSE OX MULTIPLE, EG EXERCISE","46000016","CDM","460","RC","94761","HCPCS","facility","both","","","","472.39","472.39","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"DEAC 7/1/2018 HC CO EXPIRED GAS BY IR, INITIAL DAY","46000017","CDM","460","RC","94770","HCPCS","facility","both","","","","384.45","384.45","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"DEAC 7/1/2018 HC CO EXPIRED GAS BY IR, INITIAL DAY","46000017","CDM","460","RC","94770","HCPCS","facility","both","","","","169.64","169.64","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC CO EXPIRED GAS BY IR, INITIAL DAY","46000017","CDM","460","RC","94770","HCPCS","facility","both","","","","554","554","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC CO EXPIRED GAS BY IR, SUBSEQ DAY","46000018","CDM","460","RC","94770","HCPCS","facility","both","","","","134.29","134.29","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC CO EXPIRED GAS BY IR, SUBSEQ DAY","46000018","CDM","460","RC","94770","HCPCS","facility","both","","","","443","443","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC TENT HUMIDITY THERAPY, INITIAL  DAY","46000020","CDM","460","RC","94799","HCPCS","facility","both","","","","141.37","141.37","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC TENT HUMIDITY THERAPY, SUBSEQ DAY","46000021","CDM","460","RC","94799","HCPCS","facility","both","","","","106.02","106.02","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC ALTERNATIVE GAS ADMINISTRATION, INITIAL DAY","46000022","CDM","460","RC","94799","HCPCS","facility","both","","","","484.16","484.16","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC ALTERNATIVE GAS ADMINISTRATION, SUBSEQ DAY","46000023","CDM","460","RC","94799","HCPCS","facility","both","","","","360.46","360.46","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC CONTINUOUS AEROSOL THERAPY, INITIAL DAY","46000024","CDM","460","RC","94799","HCPCS","facility","both","","","","123.69","123.69","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC CONTINUOUS AEROSOL THERAPY, INITIAL DAY","46000024","CDM","460","RC","94799","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC CONTINUOUS AEROSOL THERAPY, SUBSEQ DAY","46000025","CDM","460","RC","94799","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC CONTINUOUS AEROSOL THERAPY, SUBSEQ DAY","46000025","CDM","460","RC","94799","HCPCS","facility","both","","","","106.02","106.02","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC ENDOTRACHEAL TUBE CARE","46000026","CDM","460","RC","94799","HCPCS","facility","both","","","","53.01","53.01","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC MANUAL VENTILATION PER 15 MIN","46000027","CDM","460","RC","94799","HCPCS","facility","both","","","","53.68","53.68","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC NITRIC OXIDE, INITIAL DAY","46000028","CDM","460","RC","94799","HCPCS","facility","both","","","","706.78","706.78","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC NITRIC OXIDE, SUBSEQ DAY","46000029","CDM","460","RC","94799","HCPCS","facility","both","","","","600.77","600.77","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC OXYGEN THERAPY, INITIAL DAY","46000030","CDM","460","RC","94799","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC OXYGEN THERAPY, INITIAL DAY","46000030","CDM","460","RC","94799","HCPCS","facility","both","","","","42.41","42.41","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC OXYGEN THERAPY, SUBSEQ DAY","46000031","CDM","460","RC","94799","HCPCS","facility","both","","","","24.72","24.72","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC OXYGEN THERAPY, SUBSEQ DAY","46000031","CDM","460","RC","94799","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BEDSIDE PULMONARY MECHANICS","46000032","CDM","460","RC","94799","HCPCS","facility","both","","","","257","257","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BEDSIDE PULMONARY MECHANICS","46000032","CDM","460","RC","94799","HCPCS","facility","both","","","","53.68","53.68","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC TRACHEOSTOMY TUBE CARE, NON-VENT","46000033","CDM","460","RC","94799","HCPCS","facility","both","","","","257","257","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRACHEOSTOMY TUBE CARE, NON-VENT","46000033","CDM","460","RC","94799","HCPCS","facility","both","","","","71.59","71.59","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC Pulmonary stress test, simple","46000051","CDM","460","RC","94620","HCPCS","facility","both","","","","469.05","469.05","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC Pulmonary stress test, simple","46000051","CDM","460","RC","94620","HCPCS","facility","both","","","","1345","1345","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PULMONARY FUNCTION TEST BY GAS","46000052","CDM","460","RC","94727","HCPCS","facility","both","","","","524","524","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PULMONARY FUNCTION TEST BY GAS","46000052","CDM","460","RC","94727","HCPCS","facility","both","","","","299.16","299.16","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC CONTINUOUS PULSE OX","46000053","CDM","460","RC","94762","HCPCS","facility","both","","","","920","920","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONTINUOUS PULSE OX","46000053","CDM","460","RC","94762","HCPCS","facility","both","","","","107.36","107.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC SURFACTANT ADMIN THRU TUBE","46000054","CDM","460","RC","94610","HCPCS","facility","both","","","","967","967","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SURFACTANT ADMIN THRU TUBE","46000054","CDM","460","RC","94610","HCPCS","facility","both","","","","107.36","107.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC EXHALED NITRIC OXIDE MEASUREMENT","46000055","CDM","460","RC","95012","HCPCS","facility","both","","","","236.2","236.2","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, INITIAL DAY < 12 HRS","46000056","CDM","460","RC","94799","HCPCS","facility","both","","","","388.74","388.74","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, INITIAL DAY < 12 HRS","46000056","CDM","460","RC","94799","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, INITIAL DAY > 12 HRS","46000057","CDM","460","RC","94799","HCPCS","facility","both","","","","83","83","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, INITIAL DAY > 12 HRS","46000057","CDM","460","RC","94799","HCPCS","facility","both","","","","600.77","600.77","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, SUBSEQ DAY < 12 HRS","46000058","CDM","460","RC","94799","HCPCS","facility","both","","","","300.39","300.39","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, SUBSEQ DAY < 12 HRS","46000058","CDM","460","RC","94799","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, SUBSEQ DAY > 12 HRS","46000059","CDM","460","RC","94799","HCPCS","facility","both","","","","28","28","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HC HEAT HF NASAL CANNULA, SUBSEQ DAY > 12 HRS","46000059","CDM","460","RC","94799","HCPCS","facility","both","","","","512.42","512.42","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC HIGH ALTITUDE SIMULATION TEST","46000060","CDM","460","RC","94452","HCPCS","facility","both","","","","708.54","708.54","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC HIGH ALTITUDE SIMULATION TEST WITH OXYGEN TITRATION","46000061","CDM","460","RC","94453","HCPCS","facility","both","","","","708.54","708.54","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"DEAC 7/1/2018 HC CHEST TUBE MONITORING","46000062","CDM","460","RC","94799","HCPCS","facility","both","","","","53.01","53.01","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC PULM STRESS TEST(6 MINUTE WALK) INC HR,OXIMET,OXY TITR, WHEN PERF","46000063","CDM","460","RC","94618","HCPCS","facility","both","","","","2585","2585","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PULM STRESS TEST(6 MINUTE WALK) INC HR,OXIMET,OXY TITR, WHEN PERF","46000063","CDM","460","RC","94618","HCPCS","facility","both","","","","472.39","472.39","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC EXERCISE TEST BRONCHOSPASM, INCL PRE & POST SPIRO,W/ECG & PULSE OX","46000064","CDM","460","RC","94617","HCPCS","facility","both","","","","1117.93","1117.93","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC EXERCISE TEST BRONCHOSPASM, INCL PRE & POST SPIRO,W/ECG & PULSE OX","46000064","CDM","460","RC","94617","HCPCS","facility","both","","","","2585","2585","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CO2 EXPIRED GAS BY IR / PER DAY","46000065","CDM","460","RC","94799","HCPCS","facility","both","","","","429.94","429.94","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC CO2 EXPIRED GAS BY IR / PER DAY","46000065","CDM","460","RC","94799","HCPCS","facility","both","","","","143.17","143.17","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CO2 EXPIRED GAS BY IR / PER DAY","46000065","CDM","460","RC","94799","HCPCS","facility","both","","","","1015","1015","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ALTERNATIVE GAS THERAPY, PER DAY","46000066","CDM","460","RC","94799","HCPCS","facility","both","","","","429.42","429.42","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CONTINOUS AEROSOL MIST W/WO OXYGEN, PER DAY","46000067","CDM","460","RC","94799","HCPCS","facility","both","","","","107.36","107.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC HEAT HF NASAL CANNULA, PER DAY","46000068","CDM","460","RC","94799","HCPCS","facility","both","","","","429.42","429.42","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC INHALED NITRIC OXIDE THERAPY, PER DAY","46000069","CDM","460","RC","94799","HCPCS","facility","both","","","","894.59","894.59","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC OXYGEN THERAPY, PER DAY","46000070","CDM","460","RC","94799","HCPCS","facility","both","","","","71.59","71.59","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC GENERAL PROCEDURAL ASSIST","46000071","CDM","460","RC","94799","HCPCS","facility","both","","","","107.36","107.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC BREATHING RESPONSE TO CO2","46000072","CDM","460","RC","94799","HCPCS","facility","both","","","","107.36","107.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CONT AEROSOL TX W/O BRONCHODILATION, PER DAY","46000073","CDM","460","RC","94799","HCPCS","facility","both","","","","894.59","894.59","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC MINI BRONCHOALVEOLAR LAVAGE TEST","46000074","CDM","460","RC","94799","HCPCS","facility","both","","","","107.36","107.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC RAPID RESPONSE TEAM","46000075","CDM","460","RC","94799","HCPCS","facility","both","","","","107.36","107.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC TRANSCUTANEOUS BEDSIDE MONITORING, PER DAY","46000076","CDM","460","RC","94799","HCPCS","facility","both","","","","143.17","143.17","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC BEDSIDE SLEEP APNEA SCREENING","46000077","CDM","460","RC","94799","HCPCS","facility","both","","","","107.36","107.36","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC DRUG ADMINISTRATION (NITRIC OXIDE) & HEMODYNMIC MEASURES","46000078","CDM","460","RC","93463","HCPCS","facility","both","","","","164.67","164.67","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC NON-EMERGENT NIV PT COMPLIANCE STUDY","46000079","CDM","460","RC","94799","HCPCS","facility","both","","","","53.68","53.68","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC SMH CONTINUOUS AEROSOL THERAPY, INITIAL DAY","46000080","CDM","460","RC","94799","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SMH CONTINUOUS AEROSOL THERAPY, SUBSEQ DAY","46000081","CDM","460","RC","94799","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SMH OXYGEN THERAPY, INITIAL DAY","46000082","CDM","460","RC","94799","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SMH OXYGEN THERAPY, SUBSEQ DAY","46000083","CDM","460","RC","94799","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SMH HEAT HF NASAL CANNULA, INITIAL DAY","46000084","CDM","460","RC","94799","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SMH HEAT HF NASAL CANNULA, SUBSEQ DAY","46000085","CDM","460","RC","94799","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AIRWAY RESISTANCE BY OSCILLOMETRY","46000087","CDM","460","RC","94728","HCPCS","facility","both","","","","236.25","236.25","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"HC COCHLEAR IMPLT EXAM < 7 W PROG","47000001","CDM","470","RC","92601","HCPCS","facility","both","","","","217.44","217.44","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC COCHLEAR IMPLT EXAM < 7 W PROG","47000001","CDM","470","RC","92601","HCPCS","facility","both","","","","1044.25","1044.25","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC REPROGRAM COCHLEAR IMPLT UNDER AGE 7","47000002","CDM","470","RC","92602","HCPCS","facility","both","","","","835.39","835.39","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC REPROGRAM COCHLEAR IMPLT UNDER AGE 7","47000002","CDM","470","RC","92602","HCPCS","facility","both","","","","154.02","154.02","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC COCHLEAR IMPLT EXAM 7 > W PROG","47000003","CDM","470","RC","92603","HCPCS","facility","both","","","","199.32","199.32","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC COCHLEAR IMPLT EXAM 7 > W PROG","47000003","CDM","470","RC","92603","HCPCS","facility","both","","","","696.14","696.14","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC REPROGRAM COCHLEAR IMPLT 7 YRS & OLDER","47000004","CDM","471","RC","92604","HCPCS","facility","both","","","","556.93","556.93","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC REPROGRAM COCHLEAR IMPLT 7 YRS & OLDER","47000004","CDM","471","RC","92604","HCPCS","facility","both","","","","126.83","126.83","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC BASIC VESTIBULAR EVALUATION","47000005","CDM","470","RC","92540","HCPCS","facility","both","","","","154.02","154.02","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC SPONTANEOUS NYSTAGMUS GAZE & FIX","47000006","CDM","470","RC","92541","HCPCS","facility","both","","","","27.17","27.17","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC POSITIONAL NYSTAGMUS MIN 4 POS","47000007","CDM","470","RC","92542","HCPCS","facility","both","","","","36.24","36.24","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC CALORIC VESTIBULAR TEST W REC, EA IRR","47000008","CDM","470","RC","92543","HCPCS","facility","both","","","","46.44","46.44","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC OPTOKINETIC NYSTAGMUS W RECORD","47000009","CDM","470","RC","92544","HCPCS","facility","both","","","","18.12","18.12","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC OSCILLATING TRACKING W RECORD","47000010","CDM","470","RC","92545","HCPCS","facility","both","","","","18.12","18.12","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC SINUSOIDAL VERTICAL AXIS ROTATION","47000011","CDM","470","RC","92546","HCPCS","facility","both","","","","317.08","317.08","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC USE VERTICAL ELECTRODES","47000012","CDM","471","RC","92547","HCPCS","facility","both","","","","27.17","27.17","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC TYMPANOMETRY & REFLEX THRESH","47000013","CDM","470","RC","92550","HCPCS","facility","both","","","","45.29","45.29","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC TYMPANOMETRY & REFLEX THRESH","47000013","CDM","470","RC","92550","HCPCS","facility","both","","","","271","271","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALORIC VSTBLR TEST W/REC, BILATERAL  BITHERMAL","47000014","CDM","470","RC","92537","HCPCS","facility","both","","","","154.02","154.02","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC CALORIC VSTBLR TEST W/REC, BILATERAL  BITHERMAL","47000014","CDM","470","RC","92537","HCPCS","facility","both","","","","768","768","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CALORIC VSTBLR TEST W/REC, BILATERAL; MONOTHERMAL","47000015","CDM","470","RC","92538","HCPCS","facility","both","","","","72.49","72.49","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC CALORIC VSTBLR TEST W/REC, BILATERAL; MONOTHERMAL","47000015","CDM","470","RC","92538","HCPCS","facility","both","","","","768","768","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AUDITORY EVOKED POTENTIALS; SCRN AUDIT POTENT W/STIMULI, AUTO ANALYS","47000017","CDM","471","RC","92650","HCPCS","facility","both","","","","54.35","54.35","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC AUDITORY EVOKED POTENTIALS; SCRN AUDIT POTENT W/STIMULI, AUTO ANALYS","47000017","CDM","471","RC","92650","HCPCS","facility","both","","","","282","282","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AUDITORY EVOKED POTENTIALS; HEARING STATUS DETER, BBAND STIMULI, I&R","47000018","CDM","471","RC","92651","HCPCS","facility","both","","","","135.9","135.9","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC AUDITORY EVOKED POTENTIALS; HEARING STATUS DETER, BBAND STIMULI, I&R","47000018","CDM","471","RC","92651","HCPCS","facility","both","","","","287","287","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AUDITORY EVOKED POTENTIALS; THRESHOLD ESTIM AT MULTI FREQ, I & R","47000019","CDM","471","RC","92652","HCPCS","facility","both","","","","337","337","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AUDITORY EVOKED POTENTIALS; THRESHOLD ESTIM AT MULTI FREQ, I & R","47000019","CDM","471","RC","92652","HCPCS","facility","both","","","","163.07","163.07","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC AUDITORY EVOKED POTENTIALS; NEURODIAGNOSTIC, W/INTRP & RPT","47000020","CDM","471","RC","92653","HCPCS","facility","both","","","","337","337","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AUDITORY EVOKED POTENTIALS; NEURODIAGNOSTIC, W/INTRP & RPT","47000020","CDM","471","RC","92653","HCPCS","facility","both","","","","126.88","126.88","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC CERVICAL VEMP TESTING W/I&R","47000021","CDM","470","RC","92517","HCPCS","facility","both","","","","135.9","135.9","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC OCULAR VEMP TESTING W/I&R","47000022","CDM","470","RC","92518","HCPCS","facility","both","","","","135.9","135.9","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC CERVICAL & OCULAR VEMP TESTING W/I&R","47000023","CDM","470","RC","92519","HCPCS","facility","both","","","","135.9","135.9","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC SMH ONLY HEARING AID CONSULT","47080001","CDM","470","RC","","","facility","both","","","","157","157","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FITTING/ORIENTATION/CHECKING OF HA (LOSS/DAMAGE)","47080002","CDM","470","RC","","","facility","both","","","","251","251","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA REPAIR/MODIFICATION COMPLETE","47080003","CDM","470","RC","","","facility","both","","","","463","463","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA REPAIR/MODIFICATION MONAURAL","47080004","CDM","470","RC","","","facility","both","","","","38","38","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA REPAIR/MODIFICATION BINAURAL","47080005","CDM","470","RC","","","facility","both","","","","51","51","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA REPAIR/MODIFICATION MONAURAL","47080006","CDM","470","RC","","","facility","both","","","","34","34","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA REPAIR/MODIFICATION BINAURAL","47080007","CDM","470","RC","","","facility","both","","","","45","45","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA REPAIR MONAURAL OUT WA","47080008","CDM","470","RC","","","facility","both","","","","69","69","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA REPAIR BINAURAL OUT WA","47080009","CDM","470","RC","","","facility","both","","","","113","113","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DISPENSING FEE UNSPECIFIED","47080010","CDM","470","RC","","","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HA DISPENSING FEE UNSPEC, REPLACEMENT","47080011","CDM","470","RC","","","facility","both","","","","201","201","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SCREENING TEST, PURE TONE AIR ONLY","47100001","CDM","471","RC","92551","HCPCS","facility","both","","","","46.4","46.4","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SCREENING TEST, PURE TONE AIR ONLY","47100001","CDM","471","RC","92551","HCPCS","facility","both","","","","314","314","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PURE TONE AUDIOMETRY, AIR ONLY","47100002","CDM","471","RC","92552","HCPCS","facility","both","","","","99.66","99.66","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC PURE TONE AUDIOMETRY, AIR ONLY","47100002","CDM","471","RC","92552","HCPCS","facility","both","","","","58.02","58.02","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC PURE TONE AUDIOMETRY, AIR ONLY","47100002","CDM","471","RC","92552","HCPCS","facility","both","","","","264","264","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PURE TONE AUDIOMETRY, AIR & BONE","47100003","CDM","471","RC","92553","HCPCS","facility","both","","","","81.21","81.21","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC PURE TONE AUDIOMETRY, AIR & BONE","47100003","CDM","471","RC","92553","HCPCS","facility","both","","","","390","390","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PURE TONE AUDIOMETRY, AIR & BONE","47100003","CDM","471","RC","92553","HCPCS","facility","both","","","","117.77","117.77","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC SPEECH AUDIOMETRY THESHOLD W/SR","47100004","CDM","471","RC","92556","HCPCS","facility","both","","","","343","343","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPEECH AUDIOMETRY THESHOLD W/SR","47100004","CDM","471","RC","92556","HCPCS","facility","both","","","","117.77","117.77","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC SPEECH AUDIOMETRY THESHOLD W/SR","47100004","CDM","471","RC","92556","HCPCS","facility","both","","","","52.27","52.27","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SPEECH AUDIOMETRY W/SR, COMPREHENSIVE","47100005","CDM","471","RC","92557","HCPCS","facility","both","","","","104.54","104.54","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SPEECH AUDIOMETRY W/SR, COMPREHENSIVE","47100005","CDM","471","RC","92557","HCPCS","facility","both","","","","831","831","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPEECH AUDIOMETRY W/SR, COMPREHENSIVE","47100005","CDM","471","RC","92557","HCPCS","facility","both","","","","235.54","235.54","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC TYMPANOMETRY (IMP TESTING)","47100006","CDM","471","RC","92567","HCPCS","facility","both","","","","58.02","58.02","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC TYMPANOMETRY (IMP TESTING)","47100006","CDM","471","RC","92567","HCPCS","facility","both","","","","27.17","27.17","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC TYMPANOMETRY (IMP TESTING)","47100006","CDM","471","RC","92567","HCPCS","facility","both","","","","243","243","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACOUSTIC REFLEX TESTING","47100007","CDM","471","RC","92568","HCPCS","facility","both","","","","243","243","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACOUSTIC REFLEX TESTING","47100007","CDM","471","RC","92568","HCPCS","facility","both","","","","46.4","46.4","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC ACOUSTIC REFLEX TESTING","47100007","CDM","471","RC","92568","HCPCS","facility","both","","","","18.12","18.12","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC VISUAL REINFORCE AUDIOMETRY","47100008","CDM","471","RC","92579","HCPCS","facility","both","","","","443","443","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VISUAL REINFORCE AUDIOMETRY","47100008","CDM","471","RC","92579","HCPCS","facility","both","","","","99.66","99.66","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC VISUAL REINFORCE AUDIOMETRY","47100008","CDM","471","RC","92579","HCPCS","facility","both","","","","139.23","139.23","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC CONDITIONING PLAY AUDIOMETRY","47100009","CDM","471","RC","92582","HCPCS","facility","both","","","","217.44","217.44","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC CONDITIONING PLAY AUDIOMETRY","47100009","CDM","471","RC","92582","HCPCS","facility","both","","","","139.23","139.23","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC CONDITIONING PLAY AUDIOMETRY","47100009","CDM","471","RC","92582","HCPCS","facility","both","","","","343","343","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEAC 01/01/2021  AUDITORY EP - COMPREHENSIVE","47100010","CDM","471","RC","92585","HCPCS","facility","both","","","","1078","1078","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEAC 01/01/2021  AUDITORY EP - COMPREHENSIVE","47100010","CDM","471","RC","92585","HCPCS","facility","both","","","","303.29","303.29","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC DEAC 01/01/2021  AUDITORY EP - COMPREHENSIVE","47100010","CDM","471","RC","92585","HCPCS","facility","both","","","","118.82","118.82","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC DEAC 01/01/2021  AUDITORY EP - LIMITED","47100011","CDM","471","RC","92586","HCPCS","facility","both","","","","900","900","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEAC 01/01/2021  AUDITORY EP - LIMITED","47100011","CDM","471","RC","92586","HCPCS","facility","both","","","","101.85","101.85","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC DEAC 01/01/2021  AUDITORY EP - LIMITED","47100011","CDM","471","RC","92586","HCPCS","facility","both","","","","156.8","156.8","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC EVOKED AUDITORY TEST LIMITED","47100012","CDM","471","RC","92587","HCPCS","facility","both","","","","27.17","27.17","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC EVOKED AUDITORY TEST LIMITED","47100012","CDM","471","RC","92587","HCPCS","facility","both","","","","765","765","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTRO HEARING AID TEST, MONAURAL","47100013","CDM","471","RC","92594","HCPCS","facility","both","","","","34.5","34.5","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC ELECTRO HEARING AID TEST, MONAURAL","47100013","CDM","471","RC","92594","HCPCS","facility","both","","","","144","144","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTRO HEARING AID TEST, MONAURAL","47100013","CDM","471","RC","92594","HCPCS","facility","both","","","","34.85","34.85","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC ELECTRO HEARING AID TEST, BINAURAL","47100014","CDM","471","RC","92595","HCPCS","facility","both","","","","193","193","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTRO HEARING AID TEST, BINAURAL","47100014","CDM","471","RC","92595","HCPCS","facility","both","","","","69.69","69.69","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC ELECTRO HEARING AID TEST, BINAURAL","47100014","CDM","471","RC","92595","HCPCS","facility","both","","","","69.02","69.02","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC SPEECH AUDIOMETRY THRESHOLD","47100015","CDM","471","RC","92555","HCPCS","facility","both","","","","72.49","72.49","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC SPEECH AUDIOMETRY THRESHOLD","47100015","CDM","471","RC","92555","HCPCS","facility","both","","","","243","243","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACOUSTIC IMMITTANCE TESTING","47100016","CDM","471","RC","92570","HCPCS","facility","both","","","","63.42","63.42","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC ACOUSTIC IMMITTANCE TESTING","47100016","CDM","471","RC","92570","HCPCS","facility","both","","","","343","343","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELECT PICTURE AUDIOMETRY","47100017","CDM","471","RC","92583","HCPCS","facility","both","","","","144.94","144.94","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC SELECT PICTURE AUDIOMETRY","47100017","CDM","471","RC","92583","HCPCS","facility","both","","","","104.43","104.43","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC SELECT PICTURE AUDIOMETRY","47100017","CDM","471","RC","92583","HCPCS","facility","both","","","","544","544","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTROCOCHLEOGRAPHY","47100018","CDM","471","RC","92584","HCPCS","facility","both","","","","1420","1420","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTROCOCHLEOGRAPHY","47100018","CDM","471","RC","92584","HCPCS","facility","both","","","","208.35","208.35","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC ELECTROCOCHLEOGRAPHY","47100018","CDM","471","RC","92584","HCPCS","facility","both","","","","171.9","171.9","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EVOKED AUDITORY TEST COMPLETE","47100019","CDM","471","RC","92588","HCPCS","facility","both","","","","54.35","54.35","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC EVOKED AUDITORY TEST COMPLETE","47100019","CDM","471","RC","92588","HCPCS","facility","both","","","","859","859","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVOKED AUDITORY TEST NEWBORN","47100020","CDM","471","RC","92587","HCPCS","facility","both","","","","238","238","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NASOPHARYNGOSCOPY","47100150","CDM","471","RC","92511","HCPCS","facility","both","","","","604","604","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID EXAM ONE EAR","47100151","CDM","471","RC","92590","HCPCS","facility","both","","","","509","509","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEARING AID EXAM BOTH EARS","47100152","CDM","471","RC","92591","HCPCS","facility","both","","","","765","765","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STENGER TEST, PURE TONE","47100153","CDM","471","RC","92565","HCPCS","facility","both","","","","54.35","54.35","","","","","","","","","","","","","Gross Charge Type: JHH 59 AUDIOLOGY"
"HC STENGER TEST, PURE TONE","47100153","CDM","471","RC","92565","HCPCS","facility","both","","","","188","188","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TINNITUS ASSESSMENT","47100154","CDM","471","RC","92625","HCPCS","facility","both","","","","573","573","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EVOKED AUDITORY TEST QUAL, SCREENING","47100163","CDM","471","RC","92558","HCPCS","facility","both","","","","314","314","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IRC CARDIOLOGY PRICE PER MINUTE","48000001","CDM","480","RC","","","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC MYOCRD STRAIN IMG USING SPECKLE TRCK ASSMT OF MYOCRD MECHAN","48000003","CDM","483","RC","93356","HCPCS","facility","both","","","","109.46","109.46","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC MYOCRD STRAIN IMG USING SPECKLE TRCK ASSMT OF MYOCRD MECHAN","48000003","CDM","483","RC","93356","HCPCS","facility","both","","","","915","915","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NS CATHETER - RETROGRADE BRACHIAL ARTERY","48100010","CDM","481","RC","36120","HCPCS","facility","both","","","","1584","1584","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT CATHETER RENAL ARTERY 2ND, BILAT","48100011","CDM","481","RC","36254","HCPCS","facility","both","","","","3204","3204","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT CATHETER RENAL ARTERY 2ND, UNILAT","48100012","CDM","481","RC","36253","HCPCS","facility","both","","","","4357","4357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PTA RENAL OR VISCERAL ARTERY","48100013","CDM","481","RC","35471","HCPCS","facility","both","","","","5728","5728","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT SWAN GANZ CATH BEDSIDE","48100014","CDM","481","RC","93503","HCPCS","facility","both","","","","2716","2716","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRO NEEDLE OR INTRACATHETER, UPPER OR LOWER EXTREMITY ARTERY","48100015","CDM","481","RC","36140","HCPCS","facility","both","","","","2084","2084","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE HEPATIC SHUNT (TIPS)","48100016","CDM","481","RC","37183","HCPCS","facility","both","","","","8138","8138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT CATHETER RENAL ARTERY 1ST UNILATERAL","48100017","CDM","481","RC","36251","HCPCS","facility","both","","","","2923","2923","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT CATHETER RENAL ARTERY 1ST BILATERAL","48100018","CDM","481","RC","36252","HCPCS","facility","both","","","","3204","3204","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TILT TABLE EVALUATION - STANDARD","48100050","CDM","481","RC","93660","HCPCS","facility","both","","","","3622","3622","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TILT TABLE EVALUATION - STANDARD","48100050","CDM","481","RC","93660","HCPCS","facility","both","","","","656.75","656.75","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC INSERT HEPATIC SHUNT (TIPS)","48100051","CDM","481","RC","37182","HCPCS","facility","both","","","","5405","5405","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SEL CATH ARTERIAL; ABD-LWR EXTREMITY; EA ADDL","48100052","CDM","481","RC","36248","HCPCS","facility","both","","","","1497","1497","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SEL CATH ARTERIAL, BRACH-CEPH; EA ADDL","48100053","CDM","481","RC","36218","HCPCS","facility","both","","","","1497","1497","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SEL CATH ARTERIAL, BRACH-CEPH; 3RD ORDER","48100054","CDM","481","RC","36217","HCPCS","facility","both","","","","5446","5446","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SEL CATH ARTERIAL, BRACH-CEPH; 2ND ORDER","48100055","CDM","481","RC","36216","HCPCS","facility","both","","","","4661","4661","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NONSELECTIVE CATHETER - AORTA","48100056","CDM","481","RC","36200","HCPCS","facility","both","","","","2326","2326","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT","48100057","CDM","481","RC","35875","HCPCS","facility","both","","","","12053","12053","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDIOVERSION ELECTRICAL CONVERSION, EXTERNAL","48100058","CDM","481","RC","92960","HCPCS","facility","both","","","","3010","3010","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDIOVERSION ELECTRICAL CONVERSION, EXTERNAL","48100058","CDM","481","RC","92960","HCPCS","facility","both","","","","492.55","492.55","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC CARDIOVERSION WITH TEE","48100059","CDM","481","RC","92960","HCPCS","facility","both","","","","3010","3010","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDIOVERSION WITH TEE","48100059","CDM","481","RC","92960","HCPCS","facility","both","","","","54.73","54.73","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC TILT TABLE EVALUATION - COMPLEX","48100060","CDM","481","RC","93660","HCPCS","facility","both","","","","985.13","985.13","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC PERICARDIOCENTESIS; INITIAL","48100077","CDM","481","RC","33010","HCPCS","facility","both","","","","1546","1546","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NS CATH, THORACIC AORTA W/ANGIO","48100078","CDM","481","RC","36221","HCPCS","facility","both","","","","4732","4732","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE CATH XTRNL CAROTID","48100110","CDM","481","RC","36227","HCPCS","facility","both","","","","4732","4732","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE CATH XTRNL CAROTID","48100110","CDM","481","RC","36227","HCPCS","facility","both","","","","7090","7090","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE CATH CAROTID/INOM ART W/ ANGIO EXTRACRANIAL","48100112","CDM","481","RC","36222","HCPCS","facility","both","","","","4732","4732","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE CATH CAROTID/INOM ART W/ ANGIO EXTRACRANIAL","48100112","CDM","481","RC","36222","HCPCS","facility","both","","","","7090","7090","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE CATH CAROTID/INOM ART W/ ANGIO INTRACRANIAL","48100113","CDM","481","RC","36223","HCPCS","facility","both","","","","7094","7094","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE CATH CAROTID/INOM ART W/ ANGIO INTRACRANIAL","48100113","CDM","481","RC","36223","HCPCS","facility","both","","","","5833","5833","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE CATH CAROTD ART","48100114","CDM","481","RC","36224","HCPCS","facility","both","","","","7740","7740","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE CATH CAROTD ART","48100114","CDM","481","RC","36224","HCPCS","facility","both","","","","11598","11598","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE CATH SUBCLAVIAN ART","48100115","CDM","481","RC","36225","HCPCS","facility","both","","","","4732","4732","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE CATH SUBCLAVIAN ART","48100115","CDM","481","RC","36225","HCPCS","facility","both","","","","7090","7090","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE CATH VERTEBRAL ART","48100116","CDM","481","RC","36226","HCPCS","facility","both","","","","11598","11598","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE CATH VERTEBRAL ART","48100116","CDM","481","RC","36226","HCPCS","facility","both","","","","7740","7740","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERICARDIOCENTESIS; SUBSEQUENT","48100117","CDM","481","RC","33011","HCPCS","facility","both","","","","1335","1335","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC 12 CVSLR STRESS TEST; TRACING","48200001","CDM","482","RC","93017","HCPCS","facility","both","","","","328.38","328.38","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC 12 CVSLR STRESS TEST; TRACING","48200001","CDM","482","RC","93017","HCPCS","facility","both","","","","1526","1526","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PM DEVICE PROGR EVAL, SNGL","48300001","CDM","483","RC","93279","HCPCS","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PM DEVICE PROGR EVAL, SNGL","48300001","CDM","483","RC","93279","HCPCS","facility","both","","","","164.19","164.19","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC PM DEVICE PROGR EVAL, DUAL","48300002","CDM","483","RC","93280","HCPCS","facility","both","","","","164.19","164.19","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC PM DEVICE PROGR EVAL, DUAL","48300002","CDM","483","RC","93280","HCPCS","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PM DEVICE PROGR EVAL, MULTI","48300003","CDM","483","RC","93281","HCPCS","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PM DEVICE PROGR EVAL, MULTI","48300003","CDM","483","RC","93281","HCPCS","facility","both","","","","164.19","164.19","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC ICD DEVICE PROG EVAL, 1 SINGLE","48300004","CDM","483","RC","93282","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC ICD DEVICE PROG EVAL, 1 SINGLE","48300004","CDM","483","RC","93282","HCPCS","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ICD DEVICE PROGR EVAL, DUAL","48300005","CDM","483","RC","93283","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC ICD DEVICE PROGR EVAL, DUAL","48300005","CDM","483","RC","93283","HCPCS","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ICD DEVICE PROGR EVAL, MULT","48300006","CDM","483","RC","93284","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC ICD DEVICE PROGR EVAL, MULT","48300006","CDM","483","RC","93284","HCPCS","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ILR DEVICE EVAL PROGR","48300007","CDM","483","RC","93285","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC PERI-PX DEVICE EVAL PACEMAKER/LEADLESS PM PHYS/QHP IN PERSON","48300008","CDM","483","RC","93286","HCPCS","facility","both","","","","164.19","164.19","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC PERI-PX DEVICE EVAL & PROG SING/DUAL/MULTI LEAD DEFIBRILLATOR","48300009","CDM","483","RC","93287","HCPCS","facility","both","","","","164.19","164.19","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC PM DEVICE EVAL IN PERSON","48300010","CDM","483","RC","93288","HCPCS","facility","both","","","","487","487","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ICD DEVICE INTERROGATE","48300011","CDM","483","RC","93289","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC ICD DEVICE INTERROGATE","48300011","CDM","483","RC","93289","HCPCS","facility","both","","","","487","487","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ILR DEVICE INTERROGATE","48300012","CDM","483","RC","93291","HCPCS","facility","both","","","","487","487","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ILR DEVICE INTERROGATE","48300012","CDM","483","RC","93291","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC TTE CONG ABN; COMPLETE","48300014","CDM","483","RC","93303","HCPCS","facility","both","","","","492.55","492.55","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC TTE CONG ABN; COMPLETE","48300014","CDM","483","RC","93303","HCPCS","facility","both","","","","4121","4121","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TTE CONG ABN; LIMITED/F-UP","48300015","CDM","483","RC","93304","HCPCS","facility","both","","","","4121","4121","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TTE CONG ABN; LIMITED/F-UP","48300015","CDM","483","RC","93304","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC TTE W/DOPPLER COMPLETE","48300016","CDM","483","RC","93306","HCPCS","facility","both","","","","656.75","656.75","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC TTE W/DOPPLER COMPLETE","48300016","CDM","483","RC","93306","HCPCS","facility","both","","","","4121","4121","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TTE W/O DOPPLER COMPLETE","48300017","CDM","483","RC","93307","HCPCS","facility","both","","","","1970","1970","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TTE W/O DOPPLER COMPLETE","48300017","CDM","483","RC","93307","HCPCS","facility","both","","","","492.55","492.55","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC TTE F-UP OR LMTD","48300018","CDM","483","RC","93308","HCPCS","facility","both","","","","1481","1481","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TTE F-UP OR LMTD","48300018","CDM","483","RC","93308","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC ECHO TRANSESOPHAGEAL COMPLETE","48300019","CDM","483","RC","93312","HCPCS","facility","both","","","","2988","2988","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ECHO TRANSESOPHAGEAL COMPLETE","48300019","CDM","483","RC","93312","HCPCS","facility","both","","","","656.75","656.75","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC TEE CONGENITAL; GLOBAL","48300020","CDM","483","RC","93315","HCPCS","facility","both","","","","985.13","985.13","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC DOPPLER ECHO; COMPLETE","48300022","CDM","483","RC","93320","HCPCS","facility","both","","","","1738","1738","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DOPPLER ECHO; COMPLETE","48300022","CDM","483","RC","93320","HCPCS","facility","both","","","","109.46","109.46","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC DOPPLER ECHO; LIMITED/ F-UP","48300023","CDM","483","RC","93321","HCPCS","facility","both","","","","1536","1536","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DOPPLER ECHO; LIMITED/ F-UP","48300023","CDM","483","RC","93321","HCPCS","facility","both","","","","87.55","87.55","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC DOPPLER COLOR FLOW","48300024","CDM","483","RC","93325","HCPCS","facility","both","","","","54.73","54.73","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC DOPPLER COLOR FLOW","48300024","CDM","483","RC","93325","HCPCS","facility","both","","","","241.61","241.61","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DOPPLER COLOR FLOW","48300024","CDM","483","RC","93325","HCPCS","facility","both","","","","416","416","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STRESS TTE ONLY","48300025","CDM","483","RC","93350","HCPCS","facility","both","","","","656.75","656.75","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC STRESS TTE ONLY","48300025","CDM","483","RC","93350","HCPCS","facility","both","","","","4121","4121","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TTE W OR W/O FOL W/CONTRAST","48300026","CDM","483","RC","","","facility","both","","","","503.5","503.5","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC 2D TTE W OR W/O FOL W/CONTRAST","48300027","CDM","483","RC","","","facility","both","","","","503.5","503.5","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC 2D TTE W OR W/O FOL W/CON FU","48300028","CDM","483","RC","","","facility","both","","","","229.84","229.84","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC 2D TEE W OR W/O FOL W/CON IN","48300029","CDM","483","RC","","","facility","both","","","","667.69","667.69","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC 2D TEE W OR W/O FOL W/CON IN","48300029","CDM","483","RC","","","facility","both","","","","2042","2042","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TTE W OR W/O FOL W/CON STRES","48300030","CDM","483","RC","","","facility","both","","","","667.69","667.69","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC TEE W OR W/O FOLLOWED BY W/CONTRAST, MONITORING","48300034","CDM","483","RC","","","facility","both","","","","2042","2042","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TTE W OR WO FOLLOWED BY W/CONTRAST, DOPPLER","48300035","CDM","483","RC","","","facility","both","","","","667.69","667.69","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC TTE W OR WO FOLLOWED BY W/CONTRAST, DOPPLER","48300035","CDM","483","RC","","","facility","both","","","","2042","2042","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ECHO TRANSESOPHAGEAL (TEE)","48300037","CDM","483","RC","93355","HCPCS","facility","both","","","","656.75","656.75","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC ECHO TRANSESOPHAGEAL PROBE PLACE ONLY","48300038","CDM","483","RC","93313","HCPCS","facility","both","","","","656.75","656.75","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC 3D ECHOCARDIOGRAPHIC IMAGING  & POSTPROCESSING DURING TEE/TTE (ADD-ON CODE)","48300039","CDM","483","RC","93319","HCPCS","facility","both","","","","142.3","142.3","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC NEEDLE EMG ANAL/URETHRAL SPHINCTER","49000003","CDM","920","RC","51785","HCPCS","facility","both","","","","520.92","520.92","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC STATISTICAL NO CHARGE VISIT","51000000","CDM","990","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HOSPITAL OUTPATIENT CLINIC VISIT","51000001","CDM","510","RC","99211","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HOSPITAL OUTPATIENT CLINIC VISIT","51000001","CDM","510","RC","99211","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HOSPITAL OUTPATIENT CLINIC VISIT","51000001","CDM","510","RC","99211","HCPCS","facility","both","","","","64.95","64.95","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC HOSPITAL OUTPATIENT CLINIC VISIT","51000001","CDM","510","RC","99211","HCPCS","facility","both","","","","238","238","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HOSPITAL OUTPATIENT CLINIC VISIT","51000001","CDM","510","RC","99211","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 2","51000002","CDM","510","RC","99202","HCPCS","facility","both","","","","331","331","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 2","51000002","CDM","510","RC","99202","HCPCS","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 2","51000002","CDM","510","RC","99202","HCPCS","facility","both","","","","129.9","129.9","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 2","51000002","CDM","510","RC","99202","HCPCS","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 2","51000002","CDM","510","RC","99202","HCPCS","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 3","51000003","CDM","510","RC","99203","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 3","51000003","CDM","510","RC","99203","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 3","51000003","CDM","510","RC","99203","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 3","51000003","CDM","510","RC","99203","HCPCS","facility","both","","","","421","421","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 3","51000003","CDM","510","RC","99203","HCPCS","facility","both","","","","227.33","227.33","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 4","51000004","CDM","510","RC","99204","HCPCS","facility","both","","","","322.04","322.04","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 4","51000004","CDM","510","RC","99204","HCPCS","facility","both","","","","512","512","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 4","51000004","CDM","510","RC","99204","HCPCS","facility","both","","","","120.47","120.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 4","51000004","CDM","510","RC","99204","HCPCS","facility","both","","","","185.83","185.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 4","51000004","CDM","510","RC","99204","HCPCS","facility","both","","","","487.13","487.13","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 5","51000005","CDM","510","RC","99205","HCPCS","facility","both","","","","144.56","144.56","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 5","51000005","CDM","510","RC","99205","HCPCS","facility","both","","","","222.98","222.98","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 5","51000005","CDM","510","RC","99205","HCPCS","facility","both","","","","386.48","386.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 5","51000005","CDM","510","RC","99205","HCPCS","facility","both","","","","584.55","584.55","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC OFFICE/OUTPATIENT VISIT NEW LVL 5","51000005","CDM","510","RC","99205","HCPCS","facility","both","","","","605","605","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT EST LVL 1","51000006","CDM","510","RC","99211","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT EST LVL 1","51000006","CDM","510","RC","99211","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 1","51000006","CDM","510","RC","99211","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 1","51000006","CDM","510","RC","99211","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 1","51000006","CDM","510","RC","99211","HCPCS","facility","both","","","","64.95","64.95","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC OFFICE/OUTPATIENT VISIT EST LVL 2","51000007","CDM","510","RC","99212","HCPCS","facility","both","","","","266","266","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT EST LVL 2","51000007","CDM","510","RC","99212","HCPCS","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 2","51000007","CDM","510","RC","99212","HCPCS","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 2","51000007","CDM","510","RC","99212","HCPCS","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 2","51000007","CDM","510","RC","99212","HCPCS","facility","both","","","","129.9","129.9","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC OFFICE/OUTPATIENT VISIT EST LVL 3","51000008","CDM","510","RC","99213","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 3","51000008","CDM","510","RC","99213","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 3","51000008","CDM","510","RC","99213","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 3","51000008","CDM","510","RC","99213","HCPCS","facility","both","","","","227.33","227.33","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC OFFICE/OUTPATIENT VISIT EST LVL 3","51000008","CDM","510","RC","99213","HCPCS","facility","both","","","","347","347","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT EST LVL 4","51000009","CDM","510","RC","99214","HCPCS","facility","both","","","","322.04","322.04","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 4","51000009","CDM","510","RC","99214","HCPCS","facility","both","","","","487.13","487.13","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC OFFICE/OUTPATIENT VISIT EST LVL 4","51000009","CDM","510","RC","99214","HCPCS","facility","both","","","","430","430","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT EST LVL 4","51000009","CDM","510","RC","99214","HCPCS","facility","both","","","","120.47","120.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 4","51000009","CDM","510","RC","99214","HCPCS","facility","both","","","","185.83","185.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 5","51000010","CDM","510","RC","99215","HCPCS","facility","both","","","","386.48","386.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 5","51000010","CDM","510","RC","99215","HCPCS","facility","both","","","","511","511","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT EST LVL 5","51000010","CDM","510","RC","99215","HCPCS","facility","both","","","","222.98","222.98","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 5","51000010","CDM","510","RC","99215","HCPCS","facility","both","","","","144.56","144.56","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 5","51000010","CDM","510","RC","99215","HCPCS","facility","both","","","","584.55","584.55","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC INTERMEDIATE EYE EXAM NEW PT","51000011","CDM","510","RC","92002","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC INTERMEDIATE EYE EXAM NEW PT","51000011","CDM","510","RC","92002","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC INTERMEDIATE EYE EXAM NEW PT","51000011","CDM","510","RC","92002","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC  COMPREHENSIVE EXAM NEW PT","51000012","CDM","510","RC","92004","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC  COMPREHENSIVE EXAM NEW PT","51000012","CDM","510","RC","92004","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC  COMPREHENSIVE EXAM NEW PT","51000012","CDM","510","RC","92004","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC INTERMEDIATE EYE EXAM ESTABLISHED PT","51000013","CDM","510","RC","92012","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC INTERMEDIATE EYE EXAM ESTABLISHED PT","51000013","CDM","510","RC","92012","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC INTERMEDIATE EYE EXAM ESTABLISHED PT","51000013","CDM","510","RC","92012","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC COMPREHENSIVE EYE EXAM ESTABLISHED PT","51000014","CDM","510","RC","92014","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC COMPREHENSIVE EYE EXAM ESTABLISHED PT","51000014","CDM","510","RC","92014","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC COMPREHENSIVE EYE EXAM ESTABLISHED PT","51000014","CDM","510","RC","92014","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PREVENTIVE COUNSELING INDIV 15MIN","51000020","CDM","510","RC","99401","HCPCS","facility","both","","","","140","140","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PREVENTIVE COUNSELING INDIV 30MIN","51000021","CDM","510","RC","99402","HCPCS","facility","both","","","","280","280","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PREVENTIVE COUNSELING INDIV 45MIN","51000022","CDM","510","RC","99403","HCPCS","facility","both","","","","419","419","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PREVENTIVE COUNSELING INDIV 60MIN","51000023","CDM","510","RC","99404","HCPCS","facility","both","","","","558","558","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPECIAL PROGRAMS EDUCATION AND TRAINING","51000024","CDM","510","RC","99211","HCPCS","facility","both","","","","128.81","128.81","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC SPECIAL PROGRAMS EDUCATION AND TRAINING","51000024","CDM","510","RC","99211","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OFFICE/OUTPATIENT VISIT EST LVL 1","51091101","CDM","510","RC","99211","HCPCS","facility","both","","","","57","57","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT EST LVL 1","51091102","CDM","510","RC","99211","HCPCS","facility","both","","","","116","116","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT EST LVL 1","51091103","CDM","510","RC","99211","HCPCS","facility","both","","","","116","116","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT EST LVL 2","51091104","CDM","510","RC","99212","HCPCS","facility","both","","","","77","77","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT EST LVL 2","51091105","CDM","510","RC","99212","HCPCS","facility","both","","","","156","156","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OFFICE/OUTPATIENT VISIT EST LVL 2","51091106","CDM","510","RC","99212","HCPCS","facility","both","","","","156","156","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC 1ST OFFICE VISIT,LVL","51091107","CDM","510","RC","99201","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC INIT OFFICE VISIT, LEVEL 2","51091108","CDM","510","RC","99202","HCPCS","facility","both","","","","141","141","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC INIT OFFICE VISIT, LEVEL 3","51091109","CDM","510","RC","99203","HCPCS","facility","both","","","","190","190","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC INIT OFFICE VISIT, LEVEL 4","51091110","CDM","510","RC","99204","HCPCS","facility","both","","","","239","239","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC INIT OFFICE VISIT, LEVEL 5","51091111","CDM","510","RC","99205","HCPCS","facility","both","","","","288","288","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC F/U OFFICE VISIT, LEVEL 1","51091112","CDM","510","RC","99211","HCPCS","facility","both","","","","57","57","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC F/U OFFICE VISIT, LEVEL 2","51091113","CDM","510","RC","99212","HCPCS","facility","both","","","","77","77","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC F/U OFFICE VISIT, LEVEL 3","51091114","CDM","510","RC","99213","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC F/U OFFICE VISIT, LEVEL 4","51091115","CDM","510","RC","99214","HCPCS","facility","both","","","","117","117","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC F/U OFFICE VISIT, LEVEL 5","51091116","CDM","510","RC","99215","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC OP CONSULT NEW,LEVEL 1","51091117","CDM","510","RC","99201","HCPCS","facility","both","","","","92","92","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC OP CONSULT NEW , LEVEL 2","51091118","CDM","510","RC","99202","HCPCS","facility","both","","","","141","141","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC OP CONSULT NEW, LEVEL 3","51091119","CDM","510","RC","99203","HCPCS","facility","both","","","","190","190","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC OP CONSULT NEW, LEVEL 4","51091120","CDM","510","RC","99204","HCPCS","facility","both","","","","239","239","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC OP CONSULT NEW, LEVEL 5","51091121","CDM","510","RC","99205","HCPCS","facility","both","","","","288","288","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC OP CONSULT ESTABLISHED, LEVEL 1","51091122","CDM","510","RC","99211","HCPCS","facility","both","","","","57","57","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC OP CONSULT ESTABLISHED, LEVEL 2","51091123","CDM","510","RC","99212","HCPCS","facility","both","","","","77","77","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC OP CONSULT ESTABLISHED, LEVEL 3","51091124","CDM","510","RC","99213","HCPCS","facility","both","","","","97","97","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC OP CONSULT ESTABLISHED, LEVEL 4","51091125","CDM","510","RC","99214","HCPCS","facility","both","","","","117","117","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MED ONC OP CONSULT ESTABLISHED, LEVEL 5","51091126","CDM","510","RC","99215","HCPCS","facility","both","","","","137","137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FOLLOWUP VISIT","51091127","CDM","510","RC","99211","HCPCS","facility","both","","","","53","53","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OSTEOPATHIC MANIPULATION 1-2 BODY REGIONS","53000001","CDM","530","RC","98925","HCPCS","facility","both","","","","246","246","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI OF TEMPOROMANDIBULAR JOINT(S)","61000001","CDM","610","RC","70336","HCPCS","facility","both","","","","1149.07","1149.07","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI OF TEMPOROMANDIBULAR JOINT(S)","61000001","CDM","610","RC","70336","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI OF TEMPOROMANDIBULAR JOINT(S)","61000001","CDM","610","RC","70336","HCPCS","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ORBIT/FACE/NECK W/O CONTRAST","61000002","CDM","610","RC","70540","HCPCS","facility","both","","","","1083.42","1083.42","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI ORBIT/FACE/NECK W/O CONTRAST","61000002","CDM","610","RC","70540","HCPCS","facility","both","","","","2633","2633","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ORBIT/FACE/NECK W/O CONTRAST","61000002","CDM","610","RC","70540","HCPCS","facility","both","","","","3850","3850","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ORBIT/FACE/NECK W/CONTRAST","61000003","CDM","610","RC","70542","HCPCS","facility","both","","","","3850","3850","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ORBIT/FACE/NECK W/CONTRAST","61000003","CDM","610","RC","70542","HCPCS","facility","both","","","","1181.89","1181.89","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI ORBIT/FACE/NECK W/O & W/CONTRAST","61000004","CDM","610","RC","70543","HCPCS","facility","both","","","","1428.08","1428.08","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI ORBIT/FACE/NECK W/O & W/CONTRAST","61000004","CDM","610","RC","70543","HCPCS","facility","both","","","","4946","4946","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI CHEST W/O CONTRAST","61000005","CDM","610","RC","71550","HCPCS","facility","both","","","","4453","4453","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI CHEST W/O CONTRAST","61000005","CDM","610","RC","71550","HCPCS","facility","both","","","","1575.82","1575.82","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI CHEST W/O CONTRAST","61000005","CDM","610","RC","71550","HCPCS","facility","both","","","","4604","4604","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI CHEST W CONTRAST","61000006","CDM","610","RC","71551","HCPCS","facility","both","","","","1723.59","1723.59","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI CHEST W CONTRAST","61000006","CDM","610","RC","71551","HCPCS","facility","both","","","","4604","4604","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI CHEST W & W/O CONTRAST","61000007","CDM","610","RC","71552","HCPCS","facility","both","","","","4604","4604","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI CHEST W & W/O CONTRAST","61000007","CDM","610","RC","71552","HCPCS","facility","both","","","","2150.35","2150.35","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI PELVIS W/O CONTRAST","61000008","CDM","610","RC","72195","HCPCS","facility","both","","","","4161","4161","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI PELVIS W/O CONTRAST","61000008","CDM","610","RC","72195","HCPCS","facility","both","","","","4763","4763","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI PELVIS W/O CONTRAST","61000008","CDM","610","RC","72195","HCPCS","facility","both","","","","1395.27","1395.27","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI PELVIS W CONTRAST","61000009","CDM","610","RC","72196","HCPCS","facility","both","","","","1493.76","1493.76","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI PELVIS W CONTRAST","61000009","CDM","610","RC","72196","HCPCS","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI PELVIS W CONTRAST","61000009","CDM","610","RC","72196","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI PELVIS W & W/O CONTRAST","61000010","CDM","610","RC","72197","HCPCS","facility","both","","","","4763","4763","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI PELVIS W & W/O CONTRAST","61000010","CDM","610","RC","72197","HCPCS","facility","both","","","","1805.64","1805.64","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI UPPER EXT NOT JOINT W/O CONTRAST","61000011","CDM","610","RC","73218","HCPCS","facility","both","","","","7016","7016","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT NOT JOINT W/O CONTRAST","61000011","CDM","610","RC","73218","HCPCS","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT NOT JOINT W/O CONTRAST","61000011","CDM","610","RC","73218","HCPCS","facility","both","","","","1378.85","1378.85","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI UPPER EXT NOT JOINT W/ CONTRAST","61000012","CDM","610","RC","73219","HCPCS","facility","both","","","","1477.32","1477.32","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI UPPER EXT NOT JOINT W/ CONTRAST","61000012","CDM","610","RC","73219","HCPCS","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT NOT JOINT W/ CONTRAST","61000012","CDM","610","RC","73219","HCPCS","facility","both","","","","7016","7016","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT NOT JOINT W & W/O CONTRAST","61000013","CDM","610","RC","73220","HCPCS","facility","both","","","","5443","5443","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT NOT JOINT W & W/O CONTRAST","61000013","CDM","610","RC","73220","HCPCS","facility","both","","","","1805.64","1805.64","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI UPPER EXT NOT JOINT W & W/O CONTRAST","61000013","CDM","610","RC","73220","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT NOT JOINT W & W/O CONTRAST","61000013","CDM","610","RC","73220","HCPCS","facility","both","","","","9021","9021","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT ANY JOINT W/O CONTRAST","61000014","CDM","610","RC","73221","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT ANY JOINT W/O CONTRAST","61000014","CDM","610","RC","73221","HCPCS","facility","both","","","","7016","7016","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT ANY JOINT W/O CONTRAST","61000014","CDM","610","RC","73221","HCPCS","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT ANY JOINT W/O CONTRAST","61000014","CDM","610","RC","73221","HCPCS","facility","both","","","","771.52","771.52","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI UPPER EXT ANY JOINT W CONTRAST","61000015","CDM","610","RC","73222","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT ANY JOINT W CONTRAST","61000015","CDM","610","RC","73222","HCPCS","facility","both","","","","7016","7016","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT ANY JOINT W CONTRAST","61000015","CDM","610","RC","73222","HCPCS","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT ANY JOINT W CONTRAST","61000015","CDM","610","RC","73222","HCPCS","facility","both","","","","1362.42","1362.42","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI UPPER EXT ANY JOINT W & W/O CONTRAST","61000016","CDM","610","RC","73223","HCPCS","facility","both","","","","9021","9021","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT ANY JOINT W & W/O CONTRAST","61000016","CDM","610","RC","73223","HCPCS","facility","both","","","","1674.32","1674.32","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI UPPER EXT ANY JOINT W & W/O CONTRAST","61000016","CDM","610","RC","73223","HCPCS","facility","both","","","","6140","6140","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI UPPER EXT ANY JOINT W & W/O CONTRAST","61000016","CDM","610","RC","73223","HCPCS","facility","both","","","","5443","5443","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI LOWER EXT NOT JOINT W/O CONTRAST","61000017","CDM","610","RC","73718","HCPCS","facility","both","","","","6140","6140","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI LOWER EXT NOT JOINT W/O CONTRAST","61000017","CDM","610","RC","73718","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI LOWER EXT NOT JOINT W/O CONTRAST","61000017","CDM","610","RC","73718","HCPCS","facility","both","","","","3102","3102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI LOWER EXT NOT JOINT W/O CONTRAST","61000017","CDM","610","RC","73718","HCPCS","facility","both","","","","1362.42","1362.42","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI LOWER EXT NOT JOINT W CONTRAST","61000018","CDM","610","RC","73719","HCPCS","facility","both","","","","1493.76","1493.76","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI LOWER EXT NOT JOINT W CONTRAST","61000018","CDM","610","RC","73719","HCPCS","facility","both","","","","6140","6140","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI LOWER EXT NOT JOINT W CONTRAST","61000018","CDM","610","RC","73719","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI LOWER EXT NOT JOINT W CONTRAST","61000018","CDM","610","RC","73719","HCPCS","facility","both","","","","3102","3102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ANY JOINT LOWER EXT W/O CONTRAST","61000019","CDM","610","RC","73721","HCPCS","facility","both","","","","6140","6140","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ANY JOINT LOWER EXT W/O CONTRAST","61000019","CDM","610","RC","73721","HCPCS","facility","both","","","","3102","3102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ANY JOINT LOWER EXT W/O CONTRAST","61000019","CDM","610","RC","73721","HCPCS","facility","both","","","","771.52","771.52","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI ANY JOINT LOWER EXT W/O CONTRAST","61000019","CDM","610","RC","73721","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ANY JOINT LOWER EXT W/CONTRAST","61000020","CDM","610","RC","73722","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ANY JOINT LOWER EXT W/CONTRAST","61000020","CDM","610","RC","73722","HCPCS","facility","both","","","","6140","6140","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ANY JOINT LOWER EXT W/CONTRAST","61000020","CDM","610","RC","73722","HCPCS","facility","both","","","","3102","3102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ANY JOINT LOWER EXT W/CONTRAST","61000020","CDM","610","RC","73722","HCPCS","facility","both","","","","1378.85","1378.85","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI ANY JOINT LOWER EXT W/O & W CON","61000021","CDM","610","RC","73723","HCPCS","facility","both","","","","5443","5443","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ANY JOINT LOWER EXT W/O & W CON","61000021","CDM","610","RC","73723","HCPCS","facility","both","","","","1674.32","1674.32","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI ANY JOINT LOWER EXT W/O & W CON","61000021","CDM","610","RC","73723","HCPCS","facility","both","","","","4135","4135","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ANY JOINT LOWER EXT W/O & W CON","61000021","CDM","610","RC","73723","HCPCS","facility","both","","","","9021","9021","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ABDOMEN W/O CONTRAST","61000022","CDM","610","RC","74181","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ABDOMEN W/O CONTRAST","61000022","CDM","610","RC","74181","HCPCS","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ABDOMEN W/O CONTRAST","61000022","CDM","610","RC","74181","HCPCS","facility","both","","","","1198.29","1198.29","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI ABDOMEN W CONTRAST","61000023","CDM","610","RC","74182","HCPCS","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ABDOMEN W CONTRAST","61000023","CDM","610","RC","74182","HCPCS","facility","both","","","","1690.76","1690.76","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI ABDOMEN W CONTRAST","61000023","CDM","610","RC","74182","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ABDOMEN W & W/O CONTRAST","61000024","CDM","610","RC","74183","HCPCS","facility","both","","","","1822.09","1822.09","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI ABDOMEN W & W/O CONTRAST","61000024","CDM","610","RC","74183","HCPCS","facility","both","","","","6398","6398","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI ABDOMEN W & W/O CONTRAST","61000024","CDM","610","RC","74183","HCPCS","facility","both","","","","5080","5080","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDIAC MRI FOR MORPH & FUNC W/O CONTRAST","61000025","CDM","610","RC","75557","HCPCS","facility","both","","","","935.68","935.68","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC CARDIAC MRI FOR MORPH & FUNC W/O CONTRAST","61000025","CDM","610","RC","75557","HCPCS","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDIAC MRI FOR MORPH & FUNC W/O CONTRAST","61000025","CDM","610","RC","75557","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDIAC MRI FOR MORPH & FUNC W/W/O CON","61000026","CDM","610","RC","75561","HCPCS","facility","both","","","","1362.42","1362.42","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC CARDIAC MRI W & W/O CONTRAST W/STRESS","61000027","CDM","610","RC","75563","HCPCS","facility","both","","","","1657.96","1657.96","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC UNLISTED MAGNETIC RESONANCE PROCEDURE","61000028","CDM","610","RC","76498","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC UNLISTED MAGNETIC RESONANCE PROCEDURE","61000028","CDM","610","RC","76498","HCPCS","facility","both","","","","2792","2792","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED MAGNETIC RESONANCE PROCEDURE","61000028","CDM","610","RC","76498","HCPCS","facility","both","","","","722.25","722.25","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI NEEDLE GUIDANCE","61000029","CDM","610","RC","77021","HCPCS","facility","both","","","","1045","1045","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI NEEDLE GUIDANCE","61000029","CDM","610","RC","77021","HCPCS","facility","both","","","","765.99","765.99","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI NEEDLE GUIDANCE","61000029","CDM","610","RC","77021","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC MRI BREAST UNILATERAL W & OR W/O CONTRAST","61000030","CDM","610","RC","77058","HCPCS","facility","both","","","","1454.25","1454.25","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI BREAST BILATERAL W & OR W/O CONTRAST","61000031","CDM","610","RC","77059","HCPCS","facility","both","","","","1442.97","1442.97","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI LEXTREM W&WO CONTR","61000040","CDM","610","RC","73720","HCPCS","facility","both","","","","5443","5443","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI LEXTREM W&WO CONTR","61000040","CDM","610","RC","73720","HCPCS","facility","both","","","","9021","9021","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI LEXTREM W&WO CONTR","61000040","CDM","610","RC","73720","HCPCS","facility","both","","","","1822.09","1822.09","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI LEXTREM W&WO CONTR","61000040","CDM","610","RC","73720","HCPCS","facility","both","","","","4135","4135","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CAD BREAST MRI","61000041","CDM","610","RC","","","facility","both","","","","11.28","11.28","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC CAD BREAST MRI","61000041","CDM","610","RC","","","facility","both","","","","67","67","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAGNETIC RESONANCE SPECTROSCOPY","61000045","CDM","610","RC","76390","HCPCS","facility","both","","","","1740","1740","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC CARDIAC MRI FOR VELOCITY FLOW MAPPING (ADD-ON)","61000046","CDM","610","RC","75565","HCPCS","facility","both","","","","197","197","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI, BONE MARROW BLOOD SUPPLY","61000047","CDM","610","RC","77084","HCPCS","facility","both","","","","1682","1682","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI BREAST UNIL W/O CONTRAST","61000048","CDM","610","RC","77046","HCPCS","facility","both","","","","2117.55","2117.55","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI BREAST UNIL W/O CONTRAST","61000048","CDM","610","RC","77046","HCPCS","facility","both","","","","3054","3054","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI BREAST BILAT W/O CONTRAST","61000050","CDM","610","RC","77047","HCPCS","facility","both","","","","5317","5317","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI BREAST BILAT W/O CONTRAST","61000050","CDM","610","RC","77047","HCPCS","facility","both","","","","2101.12","2101.12","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC CAD BREAST MRI","61000052","CDM","610","RC","","","facility","both","","","","78","78","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CAD BREAST MRI","61000052","CDM","610","RC","","","facility","both","","","","16.43","16.43","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI, FETAL, INCL PLACENTL MATERNL PELVIC IMG, SINGLE/1ST GESTATION","61000054","CDM","610","RC","74712","HCPCS","facility","both","","","","1526.6","1526.6","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI, FETAL, INCL PLACENTL MATERNL PELVIC IMG, EA ADDL GESTATION","61000055","CDM","610","RC","74713","HCPCS","facility","both","","","","640.2","640.2","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MAGNETIC RESONANCE ELASTOGRAPHY","61000056","CDM","610","RC","76391","HCPCS","facility","both","","","","2117.55","2117.55","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI GUIDANCE & MONITORING FOR PARENCHYMAL TISSUE ABLATION","61000057","CDM","610","RC","77022","HCPCS","facility","both","","","","56.01","56.01","","","","","","","","","","","","","Gross Charge Type: JHH 78 IVC"
"HC MRI BRAIN W/O CONTRAST","61100001","CDM","611","RC","70551","HCPCS","facility","both","","","","3087","3087","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI BRAIN W/O CONTRAST","61100001","CDM","611","RC","70551","HCPCS","facility","both","","","","722.25","722.25","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI BRAIN W/O CONTRAST","61100001","CDM","611","RC","70551","HCPCS","facility","both","","","","3850","3850","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI BRAIN W CONTRAST","61100002","CDM","611","RC","70552","HCPCS","facility","both","","","","1066.99","1066.99","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI BRAIN W CONTRAST","61100002","CDM","611","RC","70552","HCPCS","facility","both","","","","4616","4616","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI BRAIN W & W/O CONTRAST","61100003","CDM","611","RC","70553","HCPCS","facility","both","","","","5814","5814","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI BRAIN W & W/O CONTRAST","61100003","CDM","611","RC","70553","HCPCS","facility","both","","","","1214.73","1214.73","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI BRAIN,  FUNCTIONAL, BY TECH","61100004","CDM","611","RC","70554","HCPCS","facility","both","","","","2462.27","2462.27","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI BRAIN,  FUNCTIONAL, BY PHYSICIAN/PSYCH","61100005","CDM","611","RC","70555","HCPCS","facility","both","","","","2462.27","2462.27","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC OPEN MRI BRAIN W & W/O CONTRAST","61100006","CDM","611","RC","70559","HCPCS","facility","both","","","","1214.73","1214.73","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI SPINE CERVICAL, W/O CONTRAST","61200001","CDM","612","RC","72141","HCPCS","facility","both","","","","3850","3850","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI SPINE CERVICAL, W/O CONTRAST","61200001","CDM","612","RC","72141","HCPCS","facility","both","","","","689.45","689.45","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI SPINE CERVICAL, W/O CONTRAST","61200001","CDM","612","RC","72141","HCPCS","facility","both","","","","3364","3364","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI SPINE CERVICAL, W CONTRAST","61200002","CDM","612","RC","72142","HCPCS","facility","both","","","","1083.42","1083.42","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI SPINE CERVICAL, W CONTRAST","61200002","CDM","612","RC","72142","HCPCS","facility","both","","","","4616","4616","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI SPINE THORACIC, W/O CONTRAST","61200003","CDM","612","RC","72146","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI SPINE THORACIC, W/O CONTRAST","61200003","CDM","612","RC","72146","HCPCS","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI SPINE THORACIC, W/O CONTRAST","61200003","CDM","612","RC","72146","HCPCS","facility","both","","","","689.45","689.45","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI SPINE THORACIC, W CONTRAST","61200004","CDM","612","RC","72147","HCPCS","facility","both","","","","1083.42","1083.42","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI SPINE THORACIC, W CONTRAST","61200004","CDM","612","RC","72147","HCPCS","facility","both","","","","5080","5080","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI SPINE LUMBAR, W/O CONTRAST","61200005","CDM","612","RC","72148","HCPCS","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI SPINE LUMBAR, W/O CONTRAST","61200005","CDM","612","RC","72148","HCPCS","facility","both","","","","689.45","689.45","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI SPINE LUMBAR, W/O CONTRAST","61200005","CDM","612","RC","72148","HCPCS","facility","both","","","","3702","3702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI SPINE LUMBAR, W CONTRAST","61200006","CDM","612","RC","72149","HCPCS","facility","both","","","","1066.99","1066.99","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI SPINE LUMBAR, W CONTRAST","61200006","CDM","612","RC","72149","HCPCS","facility","both","","","","5080","5080","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI SPINE CERVICAL, W & W/O CONTRAST","61200007","CDM","612","RC","72156","HCPCS","facility","both","","","","5814","5814","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI SPINE CERVICAL, W & W/O CONTRAST","61200007","CDM","612","RC","72156","HCPCS","facility","both","","","","1214.73","1214.73","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI SPINE THORACIC, W & W/O CONTRAST","61200008","CDM","612","RC","72157","HCPCS","facility","both","","","","6398","6398","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI SPINE THORACIC, W & W/O CONTRAST","61200008","CDM","612","RC","72157","HCPCS","facility","both","","","","1231.16","1231.16","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI SPINE LUMBAR, W & W/O CONTRAST","61200009","CDM","612","RC","72158","HCPCS","facility","both","","","","6398","6398","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI SPINE LUMBAR, W & W/O CONTRAST","61200009","CDM","612","RC","72158","HCPCS","facility","both","","","","1214.73","1214.73","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI BREAST UNILATERAL WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61400001","CDM","614","RC","","","facility","both","","","","2117.55","2117.55","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI BREAST UNILATERAL WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61400001","CDM","614","RC","","","facility","both","","","","3859","3859","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI BREAST BILAT W CONTR","61400002","CDM","614","RC","","","facility","both","","","","5317","5317","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI BREAST BILAT W CONTR","61400002","CDM","614","RC","","","facility","both","","","","2101.12","2101.12","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI BREAST BILAT WO CONTR","61400003","CDM","614","RC","","","facility","both","","","","1442.97","1442.97","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI BREAST BILAT WO CONTR","61400003","CDM","614","RC","","","facility","both","","","","4416","4416","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI BREAST BILATERAL WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61400004","CDM","614","RC","","","facility","both","","","","5975","5975","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI BREAST BILATERAL WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61400004","CDM","614","RC","","","facility","both","","","","2101.12","2101.12","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRI WO CONTRAST, BREAST; UNILATERAL","61400005","CDM","614","RC","","","facility","both","","","","2663","2663","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI W CONTRAST, BREAST; UNILATERAL","61400006","CDM","614","RC","","","facility","both","","","","3206","3206","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA HEAD W/O CONTRAST","61500001","CDM","615","RC","70544","HCPCS","facility","both","","","","1526.6","1526.6","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA HEAD W/O CONTRAST","61500001","CDM","615","RC","70544","HCPCS","facility","both","","","","4328","4328","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA HEAD W CONTRAST","61500002","CDM","615","RC","70545","HCPCS","facility","both","","","","1510.17","1510.17","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA HEAD W CONTRAST","61500002","CDM","615","RC","70545","HCPCS","facility","both","","","","4328","4328","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA HEAD W & W/O CONTRAST","61500003","CDM","615","RC","70546","HCPCS","facility","both","","","","2347.33","2347.33","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA HEAD W & W/O CONTRAST","61500003","CDM","615","RC","70546","HCPCS","facility","both","","","","4946","4946","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA NECK W/O CONTRAST","61500004","CDM","615","RC","70547","HCPCS","facility","both","","","","1543.02","1543.02","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA NECK W/O CONTRAST","61500004","CDM","615","RC","70547","HCPCS","facility","both","","","","4328","4328","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA NECK W CONTRAST","61500005","CDM","615","RC","70548","HCPCS","facility","both","","","","4328","4328","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA NECK W CONTRAST","61500005","CDM","615","RC","70548","HCPCS","facility","both","","","","1625.1","1625.1","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA NECK W & W/O CONTRAST","61500006","CDM","615","RC","70549","HCPCS","facility","both","","","","2363.8","2363.8","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA NECK W & W/O CONTRAST","61500006","CDM","615","RC","70549","HCPCS","facility","both","","","","4946","4946","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRI GUIDED HIFU, STEREOTACTIC ABLATION OF TARGET, INTRACRANIAL","61500007","CDM","615","RC","61715","HCPCS","facility","both","","","","1642.63","1642.63","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA LOWER EXT W/W/O CONTRAST","61600001","CDM","616","RC","73725","HCPCS","facility","both","","","","1428.08","1428.08","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA LEXTREM W CONT","61600005","CDM","616","RC","","","facility","both","","","","1428.08","1428.08","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA LEXTREM W CONT","61600005","CDM","616","RC","","","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA LEXTREM W CONT","61600005","CDM","616","RC","","","facility","both","","","","7016","7016","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA LOWER EXTREMITY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61600006","CDM","616","RC","","","facility","both","","","","7665","7665","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA LOWER EXTREMITY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61600006","CDM","616","RC","","","facility","both","","","","1428.08","1428.08","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA LOWER EXTREMITY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61600006","CDM","616","RC","","","facility","both","","","","4890","4890","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA WO CONTRAST, LOWER EXT","61600007","CDM","616","RC","","","facility","both","","","","7016","7016","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA WO CONTRAST, LOWER EXT","61600007","CDM","616","RC","","","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA WO CONTRAST, LOWER EXT","61600007","CDM","616","RC","","","facility","both","","","","1428.08","1428.08","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA CHEST W OR W/O CONTRAST","61800001","CDM","618","RC","71555","HCPCS","facility","both","","","","1428.08","1428.08","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA SPINE W OR W/O CONTRAST","61800002","CDM","618","RC","72159","HCPCS","facility","both","","","","4699","4699","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA SPINE W OR W/O CONTRAST","61800002","CDM","618","RC","72159","HCPCS","facility","both","","","","1510.17","1510.17","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA UPPER EXT W OR W/O CONTRAST","61800003","CDM","618","RC","73225","HCPCS","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA UPPER EXT W OR W/O CONTRAST","61800003","CDM","618","RC","73225","HCPCS","facility","both","","","","7016","7016","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA UPPER EXT W OR W/O CONTRAST","61800003","CDM","618","RC","73225","HCPCS","facility","both","","","","2263","2263","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA UPPER EXT W OR W/O CONTRAST","61800003","CDM","618","RC","73225","HCPCS","facility","both","","","","1493.76","1493.76","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA ABDOMEN W OR W/O CONTRAST","61800004","CDM","618","RC","74185","HCPCS","facility","both","","","","1444.51","1444.51","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA PELVIS","61800010","CDM","618","RC","72198","HCPCS","facility","both","","","","1444.51","1444.51","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA ABD W CONTRAST","61800011","CDM","618","RC","","","facility","both","","","","4763","4763","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA ABD W CONTRAST","61800011","CDM","618","RC","","","facility","both","","","","1444.51","1444.51","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA ABDOMEN WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61800012","CDM","618","RC","","","facility","both","","","","1444.51","1444.51","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA ABDOMEN WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61800012","CDM","618","RC","","","facility","both","","","","6398","6398","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA CHEST W CONTRAST","61800013","CDM","618","RC","","","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA PELVIS WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61800014","CDM","618","RC","","","facility","both","","","","1444.51","1444.51","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA PELVIS WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61800014","CDM","618","RC","","","facility","both","","","","4763","4763","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA W CONTRAST, PELVIS","61800015","CDM","618","RC","","","facility","both","","","","131.32","131.32","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA W CONTRAST, PELVIS","61800015","CDM","618","RC","","","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA ABD WO CONTRAST","61800016","CDM","618","RC","","","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA ABD WO CONTRAST","61800016","CDM","618","RC","","","facility","both","","","","1444.51","1444.51","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA CHEST WO CONRAST","61800025","CDM","618","RC","","","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA CHEST WO CONRAST","61800025","CDM","618","RC","","","facility","both","","","","1428.08","1428.08","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA CHEST WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61800026","CDM","618","RC","","","facility","both","","","","1428.08","1428.08","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA CHEST WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61800026","CDM","618","RC","","","facility","both","","","","4611","4611","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA W/CONTRAST UPPER EXTREMITY","61800027","CDM","618","RC","","","facility","both","","","","1493.62","1493.62","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA W/CONTRAST UPPER EXTREMITY","61800027","CDM","618","RC","","","facility","both","","","","10462","10462","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA W/CONTRAST UPPER EXTREMITY","61800027","CDM","618","RC","","","facility","both","","","","6315","6315","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA W/O CONTRAST UPPER EXTREMITY","61800028","CDM","618","RC","","","facility","both","","","","1493.76","1493.76","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA W/O CONTRAST UPPER EXTREMITY","61800028","CDM","618","RC","","","facility","both","","","","7016","7016","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA W/O CONTRAST UPPER EXTREMITY","61800028","CDM","618","RC","","","facility","both","","","","4237","4237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA UPPER EXTREMITY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61800029","CDM","618","RC","","","facility","both","","","","1493.76","1493.76","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA UPPER EXTREMITY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61800029","CDM","618","RC","","","facility","both","","","","7146","7146","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA UPPER EXTREMITY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61800029","CDM","618","RC","","","facility","both","","","","11833","11833","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA W/CONTRAST SPINAL CANAL","61800030","CDM","618","RC","","","facility","both","","","","7007","7007","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA W/CONTRAST SPINAL CANAL","61800030","CDM","618","RC","","","facility","both","","","","1509.78","1509.78","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA W/O CONTRAST SPINAL CANAL","61800031","CDM","618","RC","","","facility","both","","","","1509.78","1509.78","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA W/O CONTRAST SPINAL CANAL","61800031","CDM","618","RC","","","facility","both","","","","4699","4699","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MRA SPINAL CANAL WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61800032","CDM","618","RC","","","facility","both","","","","1510.17","1510.17","","","","","","","","","","","","","Gross Charge Type: JHH 61 MRI"
"HC MRA SPINAL CANAL WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST","61800032","CDM","618","RC","","","facility","both","","","","7927","7927","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SEED CARRIER","62191101","CDM","621","RC","","","facility","both","","","","210","210","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EYE-PLAQUE TEMPLATE","62191102","CDM","621","RC","","","facility","both","","","","249","249","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC MOST FAVORED NATION (MFN) MODEL STATUS","63690045","CDM","636","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC I-125 RADIOELEMENT SEED","63691101","CDM","636","RC","","","facility","both","","","","620","620","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC I-125 VARI-STRAND SOURCES","63691102","CDM","636","RC","","","facility","both","","","","257","257","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PD-103 REDI-STRAND SOURCE","63691103","CDM","636","RC","","","facility","both","","","","299","299","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CS-131 REDI-STRAND SOURCE","63691104","CDM","636","RC","","","facility","both","","","","226","226","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU LEVEL 1 - 1ST 30 MIN","71000010","CDM","710","RC","","","facility","both","","","","1352","1352","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU LEVEL 1 - EA ADDL 30 MINS","71000011","CDM","710","RC","","","facility","both","","","","674","674","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU LEVEL 2 -1ST 30 MIN","71000012","CDM","710","RC","","","facility","both","","","","1509","1509","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU LEVEL 2 - EACH ADDL 30 MINS","71000013","CDM","710","RC","","","facility","both","","","","754","754","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU LEVEL 3 - 1ST 30 MIN","71000014","CDM","710","RC","","","facility","both","","","","1667","1667","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU LEVEL 3 - EACH ADDL 30 MINS","71000015","CDM","710","RC","","","facility","both","","","","829","829","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU LEVEL 4 - 1ST 30 MIN","71000016","CDM","710","RC","","","facility","both","","","","1822","1822","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU LEVEL 4 - EACH ADDL 30 MINS","71000017","CDM","710","RC","","","facility","both","","","","912","912","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ECT RECOVERY","71000020","CDM","710","RC","","","facility","both","","","","813.35","813.35","","","","","","","","","","","","","Gross Charge Type: JHH 33 SAME DAY SURGERY"
"HC ECT RECOVERY","71000020","CDM","710","RC","","","facility","both","","","","345","345","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRE-OP STANDARD OR","71000021","CDM","710","RC","","","facility","both","","","","948","948","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRE-OP MINOR/IR","71000022","CDM","710","RC","","","facility","both","","","","531","531","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRE-OP IV START","71000023","CDM","710","RC","","","facility","both","","","","418","418","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 31-60 MINUTES","71000202","CDM","710","RC","","","facility","both","","","","918","918","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 61-90 MINUTES","71000203","CDM","710","RC","","","facility","both","","","","358","358","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 91-120 MINUTES","71000204","CDM","710","RC","","","facility","both","","","","358","358","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 121-150 MINUTES","71000205","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 151-180 MINUTES","71000206","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 181-210 MINUTES","71000207","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 211-240 MINUTES","71000208","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 241-270 MINUTES","71000209","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 271-300 MINUTES","71000210","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 301-330 MINUTES","71000211","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 331-360 MINUTES","71000212","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 361-390 MINUTES","71000213","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 391-420 MINUTES","71000214","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 421-450 MINUTES","71000215","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 451-480 MINUTES","71000216","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 481-510 MINUTES","71000217","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 511-540 MINUTES","71000218","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 541-570 MINUTES","71000219","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/ RR 571-600 MINUTES","71000220","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR INITIAL 30 MINUTES","71000221","CDM","710","RC","","","facility","both","","","","1109","1109","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 31-60 MINUTES","71000222","CDM","710","RC","","","facility","both","","","","427","427","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 61-90 MINUTES","71000223","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 91-120 MINUTES","71000224","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 121-150 MINUTES","71000225","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 151-180 MINUTES","71000226","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 181-210 MINUTES","71000227","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 211-240 MINUTES","71000228","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 241-270 MINUTES","71000229","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 271-300 MINUTES","71000230","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 301-330 MINUTES","71000231","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 331-360 MINUTES","71000232","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 361-390 MINUTES","71000233","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 391-420 MINUTES","71000234","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 421-450 MINUTES","71000235","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 451-480 MINUTES","71000236","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 481-510 MINUTES","71000237","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 511-540 MINUTES","71000238","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 541-570 MINUTES","71000239","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II IV SED W/O RR 571-600 MINUTES","71000240","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL INITIAL 30 MINUTES","71000241","CDM","710","RC","","","facility","both","","","","561","561","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 31-60 MINUTES","71000242","CDM","710","RC","","","facility","both","","","","358","358","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 61-90 MINUTES","71000243","CDM","710","RC","","","facility","both","","","","358","358","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 91-120 MINUTES","71000244","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 121-150 MINUTES","71000245","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 151-180 MINUTES","71000246","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 181-210 MINUTES","71000247","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 211-240 MINUTES","71000248","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 241-270 MINUTES","71000249","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 271-300 MINUTES","71000250","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 301-330 MINUTES","71000251","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 331-360 MINUTES","71000252","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 361-390 MINUTES","71000253","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 391-420 MINUTES","71000254","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 421-450 MINUTES","71000255","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 451-480 MINUTES","71000256","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 481-510 MINUTES","71000257","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 511-540 MINUTES","71000258","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 541-570 MINUTES","71000259","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II REG EPIDRL 571-600 MINUTES","71000260","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES INITIAL 30 MINUTES","71000261","CDM","710","RC","","","facility","both","","","","784","784","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 31-60 MINUTES","71000262","CDM","710","RC","","","facility","both","","","","388","388","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 61-90 MINUTES","71000263","CDM","710","RC","","","facility","both","","","","388","388","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 91-120 MINUTES","71000264","CDM","710","RC","","","facility","both","","","","358","358","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 121-150 MINUTES","71000265","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 151-180 MINUTES","71000266","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 181-210 MINUTES","71000267","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 211-240 MINUTES","71000268","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 241-270 MINUTES","71000269","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 271-300 MINUTES","71000270","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 301-330 MINUTES","71000271","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 331-360 MINUTES","71000272","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 361-390 MINUTES","71000273","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 391-420 MINUTES","71000274","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 421-450 MINUTES","71000275","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 451-480 MINUTES","71000276","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 481-510 MINUTES","71000277","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 511-540 MINUTES","71000278","CDM","710","RC","","","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 541-570 MINUTES","71000279","CDM","710","RC","","","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II GENERAL ANES 571-600 MINUTES","71000280","CDM","710","RC","","","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO INITIAL 30 MINUTES","71000281","CDM","710","RC","","","facility","both","","","","687","687","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 31-60 MINUTES","71000282","CDM","710","RC","","","facility","both","","","","427","427","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 61-90 MINUTES","71000283","CDM","710","RC","","","facility","both","","","","427","427","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 91-120 MINUTES","71000284","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 121-150 MINUTES","71000285","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 151-180 MINUTES","71000286","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 181-210 MINUTES","71000287","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 211-240 MINUTES","71000288","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 241-270 MINUTES","71000289","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 271-300 MINUTES","71000290","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 301-330 MINUTES","71000291","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 331-360 MINUTES","71000292","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 361-390 MINUTES","71000293","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 391-420 MINUTES","71000294","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 421-450 MINUTES","71000295","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 451-480 MINUTES","71000296","CDM","710","RC","","","facility","both","","","","98","98","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 481-510 MINUTES","71000297","CDM","710","RC","","","facility","both","","","","98","98","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 511-540 MINUTES","71000298","CDM","710","RC","","","facility","both","","","","98","98","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 541-570 MINUTES","71000299","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II ANGIO 571-600 MINUTES","71000300","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY INITIAL 30 MINUTES","71000301","CDM","710","RC","","","facility","both","","","","687","687","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 31-60 MINUTES","71000302","CDM","710","RC","","","facility","both","","","","427","427","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 61-90 MINUTES","71000303","CDM","710","RC","","","facility","both","","","","427","427","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 91-120 MINUTES","71000304","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 121-150 MINUTES","71000305","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 151-180 MINUTES","71000306","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 181-210 MINUTES","71000307","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 211-240 MINUTES","71000308","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 241-270 MINUTES","71000309","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 271-300 MINUTES","71000310","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 301-330 MINUTES","71000311","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 331-360 MINUTES","71000312","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 361-390 MINUTES","71000313","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 391-420 MINUTES","71000314","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 421-450 MINUTES","71000315","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 451-480 MINUTES","71000316","CDM","710","RC","","","facility","both","","","","98","98","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 481-510 MINUTES","71000317","CDM","710","RC","","","facility","both","","","","98","98","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 511-540 MINUTES","71000318","CDM","710","RC","","","facility","both","","","","98","98","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 541-570 MINUTES","71000319","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II BIOPSY 571-600 MINUTES","71000320","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM INITIAL 30 MINUTES","71000321","CDM","710","RC","","","facility","both","","","","618","618","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 31-60 MINUTES","71000322","CDM","710","RC","","","facility","both","","","","358","358","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 61-90 MINUTES","71000323","CDM","710","RC","","","facility","both","","","","388","388","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 91-120 MINUTES","71000324","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 121-150 MINUTES","71000325","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 151-180 MINUTES","71000326","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 181-210 MINUTES","71000327","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 211-240 MINUTES","71000328","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 241-270 MINUTES","71000329","CDM","710","RC","","","facility","both","","","","182","182","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 271-300 MINUTES","71000330","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 301-330 MINUTES","71000331","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 331-360 MINUTES","71000332","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 361-390 MINUTES","71000333","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 391-420 MINUTES","71000334","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 421-450 MINUTES","71000335","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 451-480 MINUTES","71000336","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 481-510 MINUTES","71000337","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 511-540 MINUTES","71000338","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 541-570 MINUTES","71000339","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II MYELOGRAM 571-600 MINUTES","71000340","CDM","710","RC","","","facility","both","","","","89","89","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES INITIAL 30 MINUTES","71000341","CDM","710","RC","","","facility","both","","","","584","584","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 31-60 MINUTES","71000342","CDM","710","RC","","","facility","both","","","","208","208","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 61-90 MINUTES","71000343","CDM","710","RC","","","facility","both","","","","208","208","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 91-120 MINUTES","71000344","CDM","710","RC","","","facility","both","","","","208","208","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 121-150 MINUTES","71000345","CDM","710","RC","","","facility","both","","","","208","208","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 151-180 MINUTES","71000346","CDM","710","RC","","","facility","both","","","","208","208","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 181-210 MINUTES","71000347","CDM","710","RC","","","facility","both","","","","208","208","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 211-240 MINUTES","71000348","CDM","710","RC","","","facility","both","","","","208","208","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 241-270 MINUTES","71000349","CDM","710","RC","","","facility","both","","","","208","208","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 271-300 MINUTES","71000350","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 301-330 MINUTES","71000351","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 331-360 MINUTES","71000352","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 361-390 MINUTES","71000353","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 391-420 MINUTES","71000354","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 421-450 MINUTES","71000355","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACU PHASE II LOCAL ANES 451-480 MINUTES","71000356","CDM","710","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDO RECOVERY 1ST HALF HOUR","71025001","CDM","710","RC","","","facility","both","","","","563","563","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDO/PAIN RECOVERY EXTENDED","71025002","CDM","710","RC","","","facility","both","","","","1105","1105","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PAIN RECOVERY 1ST HALF HOUR","71025003","CDM","710","RC","","","facility","both","","","","628","628","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PAIN/ENDO RECOVERY EXTENDED","71025004","CDM","710","RC","","","facility","both","","","","1105","1105","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PAIN STIM/MILD RECOVERY","71025005","CDM","710","RC","","","facility","both","","","","1638","1638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDIAC LOOP RECORDER RECOVERY","71025006","CDM","710","RC","","","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACEMAKER RECOVERY 1ST HALF HOUR","71025007","CDM","710","RC","","","facility","both","","","","1328","1328","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACE MAKER RECOVERY EXTENDED","71025008","CDM","710","RC","","","facility","both","","","","2249","2249","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRONCHOSCOPY RECOVERY","71025009","CDM","710","RC","","","facility","both","","","","2249","2249","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STRESS/TILT RECOVERY","71025010","CDM","710","RC","","","facility","both","","","","490","490","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TEE/ EXT TILT RECOVERY","71025011","CDM","710","RC","","","facility","both","","","","1640","1640","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CARDIOVERSION RECOVERY","71025012","CDM","710","RC","","","facility","both","","","","2627","2627","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDO RECOVERY PACU LEVEL INTUBATED PATIENT","71025013","CDM","710","RC","","","facility","both","","","","3115","3115","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDO RECOVERY PACU LEVEL INTUBATED PATIENT EXTENDED","71025014","CDM","710","RC","","","facility","both","","","","3479","3479","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OUTPATIENT MATERNAL OBSERVATION PER HR","72000001","CDM","720","RC","","","facility","both","","","","181.05","181.05","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC OUTPATIENT MATERNAL INTENSIVE CARE PER HR","72000002","CDM","720","RC","","","facility","both","","","","361.97","361.97","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC ASSESSMENT/TRIAGE SERVICE FEE","72000003","CDM","720","RC","","","facility","both","","","","181.05","181.05","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC FETAL DEMISE/GENETIC TERMINATION 2/3 TRIM","72000004","CDM","720","RC","","","facility","both","","","","5429.74","5429.74","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC FETAL DEMISE/GENETIC TERMINATION W/EPIDURAL","72000005","CDM","720","RC","","","facility","both","","","","6515.75","6515.75","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC DELIVERY OUTSIDE HOSPITAL","72000006","CDM","720","RC","","","facility","both","","","","2171.92","2171.92","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC VAGINAL DELVERY (NO ANES, UNCOMPLICATED)","72000007","CDM","722","RC","","","facility","both","","","","4343.78","4343.78","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC VAGINAL DELVERY W/VACUUM FORCEPS ASST","72000008","CDM","722","RC","","","facility","both","","","","4705.82","4705.82","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC VAGINAL DELIVERY W/EPI ANESTHESIA","72000009","CDM","722","RC","","","facility","both","","","","5429.74","5429.74","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC VAGINAL DELIVERY W/EPI & FORCEPS VACUUM","72000010","CDM","722","RC","","","facility","both","","","","5791.73","5791.73","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC VAGINAL DELIVERY PRIOR C-SECTION (VBAC)","72000011","CDM","722","RC","","","facility","both","","","","5791.73","5791.73","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC CESAREAN SECTION, NON-EMERGENT","72000012","CDM","722","RC","","","facility","both","","","","3257.85","3257.85","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC CESAREAN SECTION, NON-EMERGENT W/MINOR SURG","72000013","CDM","722","RC","","","facility","both","","","","3619.86","3619.86","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC CESAREAN SECTION, NON-EMERGENT W/MAJOR SURG","72000014","CDM","722","RC","","","facility","both","","","","5610.76","5610.76","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC CESAREAN SECTION, EMERGENCY","72000015","CDM","720","RC","","","facility","both","","","","6696.69","6696.69","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC CESAREAN SECTION, EMERGENT W/MINOR SURG","72000016","CDM","722","RC","","","facility","both","","","","7058.72","7058.72","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC CESAREAN SECTION, EMERGENT W/MAJOR SURG","72000017","CDM","722","RC","","","facility","both","","","","11040.52","11040.52","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC ABD AMNIOINFUSION W/US","72000018","CDM","720","RC","","","facility","both","","","","1085.93","1085.93","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC DELIVERY DOUBLE SET-UP/FAILED FORCEPS/VACUUM","72000019","CDM","720","RC","","","facility","both","","","","361.97","361.97","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC INDUCTION/AUGMENTATION W/DELIVERY","72000020","CDM","722","RC","","","facility","both","","","","723.95","723.95","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC INTRAUTERINE PRESSURE CATH MONITOR (IUPC)","72000021","CDM","720","RC","59050","HCPCS","facility","both","","","","361.97","361.97","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC INTRAUTERINE PRESSURE CATH MONITOR (IUPC)","72000021","CDM","720","RC","59050","HCPCS","facility","both","","","","621","621","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MULTIPLE BIRTH: TWINS","72000022","CDM","722","RC","","","facility","both","","","","1085.93","1085.93","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC MULTIPLE BIRTH: TRIPLETS","72000023","CDM","722","RC","","","facility","both","","","","1628.92","1628.92","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC MULTIPLE BIRTH: QUADS","72000024","CDM","722","RC","","","facility","both","","","","2171.92","2171.92","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC NEONATAL RESUSCITATION","72000025","CDM","720","RC","","","facility","both","","","","723.95","723.95","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC NEONATAL RESUSCITATION","72000025","CDM","720","RC","","","facility","both","","","","179","179","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SURGERY, ADDL MINOR, NON-EMERGENT","72000026","CDM","720","RC","","","facility","both","","","","1447.94","1447.94","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC SURGERY, ADDL MAJOR, NON-EMERGENT","72000027","CDM","720","RC","","","facility","both","","","","3438.82","3438.82","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC SURGERY, ADDL MINOR, EMERGENT","72000028","CDM","720","RC","","","facility","both","","","","2895.88","2895.88","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC SURGERY, ADDL MAJOR, EMERGENT","72000029","CDM","720","RC","","","facility","both","","","","6877.71","6877.71","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC AMNIOCENTESIS, DIAGNOSTIC","72000032","CDM","720","RC","59000","HCPCS","facility","both","","","","543.02","543.02","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC AMNIOCENTESIS, DIAGNOSTIC","72000032","CDM","720","RC","59000","HCPCS","facility","both","","","","2704","2704","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CERVICAL CERCLAGE","72000033","CDM","720","RC","","","facility","both","","","","1809.9","1809.9","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC DILATION & CURETTAGE (D & C)","72000034","CDM","720","RC","","","facility","both","","","","1628.92","1628.92","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC DILATION & EVACUATION (D & E)","72000035","CDM","720","RC","","","facility","both","","","","1628.92","1628.92","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC EXTERNAL CEPHALIC VERSIONS","72000036","CDM","720","RC","59412","HCPCS","facility","both","","","","2969","2969","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXTERNAL CEPHALIC VERSIONS","72000036","CDM","720","RC","59412","HCPCS","facility","both","","","","1809.9","1809.9","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC NON-STRESS TEST","72000037","CDM","720","RC","59025","HCPCS","facility","both","","","","904.96","904.96","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC NON-STRESS TEST","72000037","CDM","720","RC","59025","HCPCS","facility","both","","","","543.02","543.02","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC NON-STRESS TEST","72000037","CDM","720","RC","59025","HCPCS","facility","both","","","","1188","1188","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OXYTOCIN STRESS TEST","72000038","CDM","720","RC","59020","HCPCS","facility","both","","","","904.96","904.96","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC PERIUMBILICAL SAMPLING (PUBS)","72000039","CDM","720","RC","","","facility","both","","","","3257.85","3257.85","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC PERIUMBILICAL SAMPLING (PUBS) W/MULTIPLES","72000040","CDM","720","RC","","","facility","both","","","","723.95","723.95","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC PERIUMBILICAL SAMPLING (PUBS) DOUBLE W/OR","72000041","CDM","720","RC","","","facility","both","","","","361.97","361.97","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC VAGINAL DELIVERY","72000050","CDM","720","RC","","","facility","both","","","","7266","7266","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CESAREAN SECTION","72000051","CDM","720","RC","","","facility","both","","","","10745","10745","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEAC 03/01/2021 FETAL MONITORING DURING LABOR","72000052","CDM","720","RC","59050","HCPCS","facility","both","","","","744","744","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TUBAL LIGATION W/VAGINAL DEL","72000056","CDM","720","RC","","","facility","both","","","","6118","6118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TUBAL LIGATION W/C-SECTION","72000057","CDM","720","RC","","","facility","both","","","","4510","4510","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC L&D RECOVERY ROOM","72000058","CDM","720","RC","","","facility","both","","","","3043","3043","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MINOR OR PROC, EMERG OR NON-EMERG WO DEL","72000060","CDM","720","RC","","","facility","both","","","","1447.94","1447.94","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC MAJOR OR PROC, EMERG OR NON-EMERG WO DEL","72000061","CDM","720","RC","","","facility","both","","","","6877.71","6877.71","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC CHORIONIC VILLUS SAMPLING","72000062","CDM","720","RC","59015","HCPCS","facility","both","","","","3445","3445","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FETAL SHUNT PLACEMENT W/ US GUIDANCE","72000063","CDM","720","RC","59076","HCPCS","facility","both","","","","1447.94","1447.94","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC FETAL UMBILICAL CORD OCCLUSION W/US","72000064","CDM","720","RC","59072","HCPCS","facility","both","","","","2171.92","2171.92","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC ATTENDANCE AT DELIVERY  INIT STABILIZATION OF NB","72000065","CDM","722","RC","99464","HCPCS","facility","both","","","","214.72","214.72","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC LABOR CHECK (0 TO 2 HOURS)","72000067","CDM","720","RC","","","facility","both","","","","903","903","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LABOR CHECK (2 TO 4 HOURS)","72000068","CDM","720","RC","","","facility","both","","","","1147","1147","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LABOR CHECK (4 TO 8 HOURS)","72000069","CDM","720","RC","","","facility","both","","","","1638","1638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LABOR CHECK (8 TO 12 HOURS)","72000070","CDM","720","RC","","","facility","both","","","","2140","2140","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LABOR CHECK (OVER 12 HOURS)","72000071","CDM","720","RC","","","facility","both","","","","3185","3185","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CIRCUMCISION (INCL NURSERY)","72300001","CDM","723","RC","","","facility","both","","","","543.02","543.02","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC CIRCUMCISION (INCL NURSERY)","72300001","CDM","723","RC","","","facility","both","","","","385","385","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRE-OP CARE, L & D SURGERY","72900003","CDM","729","RC","","","facility","both","","","","534","534","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC 12 LEAD EKG; TRACING ONLY","73000001","CDM","730","RC","93005","HCPCS","facility","both","","","","131.37","131.37","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC 12 LEAD EKG; TRACING ONLY","73000001","CDM","730","RC","93005","HCPCS","facility","both","","","","391","391","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SIGNAL-AVERAGED ECG","73000002","CDM","730","RC","93278","HCPCS","facility","both","","","","328.38","328.38","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC RHYTHM ECG 1-3 LEADS TRACING","73000003","CDM","730","RC","93041","HCPCS","facility","both","","","","54.73","54.73","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC ECG UP TO 48 HRS SCANNING ANALYSIS REPORT","73100001","CDM","731","RC","93226","HCPCS","facility","both","","","","547.3","547.3","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC ECG UP TO 48 HRS SCANNING ANALYSIS REPORT","73100001","CDM","731","RC","93226","HCPCS","facility","both","","","","1115","1115","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOTE PT 30 DAY ECG REV/REPORT","73100002","CDM","731","RC","93270","HCPCS","facility","both","","","","109.46","109.46","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC EXTERNAL ECG REC > 48 HR UP TO 7 DAYS RECORD; INCL CONNECT & INITIAL REC","73100010","CDM","731","RC","93242","HCPCS","facility","both","","","","109.46","109.46","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC EXTERNAL ECG REC > 7 DAYS  UP TO 15 DAYS  RECORDING; INCL CONNECT & INITIAL REC","73100011","CDM","731","RC","93246","HCPCS","facility","both","","","","109.46","109.46","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC ECG UP TO 48 HRS RECORDING","73100100","CDM","731","RC","93225","HCPCS","facility","both","","","","109.46","109.46","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC ECG UP TO 48 HRS RECORDING","73100100","CDM","731","RC","93225","HCPCS","facility","both","","","","533","533","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MSLT- SLEEP LATENCY","74000001","CDM","740","RC","95805","HCPCS","facility","both","","","","1073.07","1073.07","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC MSLT- SLEEP LATENCY","74000001","CDM","740","RC","95805","HCPCS","facility","both","","","","3612","3612","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POLYSOMNOGRAPHY W/4> PARAM","74000002","CDM","740","RC","95810","HCPCS","facility","both","","","","1458.56","1458.56","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC POLYSOMNOGRAPHY W/4> PARAM","74000002","CDM","740","RC","95810","HCPCS","facility","both","","","","6833","6833","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CPAP- SLEEP STAGING, >4 PAR","74000003","CDM","740","RC","95811","HCPCS","facility","both","","","","7670","7670","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CPAP- SLEEP STAGING, >4 PAR","74000003","CDM","740","RC","95811","HCPCS","facility","both","","","","1541.93","1541.93","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EXTENDED EEG 41-60 MIN","74000004","CDM","740","RC","95812","HCPCS","facility","both","","","","781.38","781.38","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EXTENDED EEG 41-60 MIN","74000004","CDM","740","RC","95812","HCPCS","facility","both","","","","1372","1372","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG EXTENDED MONITORING; 61-119 MIN","74000005","CDM","740","RC","95813","HCPCS","facility","both","","","","937.63","937.63","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG AWAKE & DROWSY","74000006","CDM","740","RC","95816","HCPCS","facility","both","","","","885.54","885.54","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG AWAKE & DROWSY","74000006","CDM","740","RC","95816","HCPCS","facility","both","","","","920","920","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG AWAKE & ASLEEP","74000007","CDM","740","RC","95819","HCPCS","facility","both","","","","920","920","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG AWAKE & ASLEEP","74000007","CDM","740","RC","95819","HCPCS","facility","both","","","","1052.25","1052.25","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG-SLEEP ONLY","74000008","CDM","740","RC","95822","HCPCS","facility","both","","","","927.23","927.23","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG-SLEEP ONLY","74000008","CDM","740","RC","95822","HCPCS","facility","both","","","","920","920","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG; CEREBRAL SILENCE","74000009","CDM","740","RC","95824","HCPCS","facility","both","","","","1055","1055","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG; CEREBRAL SILENCE","74000009","CDM","740","RC","95824","HCPCS","facility","both","","","","1020.98","1020.98","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG 16/> CH; EA 24 HRS","74000010","CDM","740","RC","95951","HCPCS","facility","both","","","","1159.3","1159.3","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG 16/> CH; EA 24 HRS","74000010","CDM","740","RC","95951","HCPCS","facility","both","","","","4832","4832","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIGITAL ANALYSIS OF EEG","74000011","CDM","740","RC","95957","HCPCS","facility","both","","","","583.41","583.41","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC WADA ACTIVATION TEST","74000012","CDM","740","RC","95958","HCPCS","facility","both","","","","1031.41","1031.41","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC FUNCTION CORTICAL MAP; 1ST HR","74000013","CDM","740","RC","95961","HCPCS","facility","both","","","","416.73","416.73","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC POLYSOM <6 YRS 4> PARAMETERS","74000060","CDM","740","RC","95782","HCPCS","facility","both","","","","2614.97","2614.97","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC POLYSOM <6 YRS 4> PARAMETERS","74000060","CDM","740","RC","95782","HCPCS","facility","both","","","","3837","3837","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POLYSOM <6 YRS CPAP/BILVL","74000061","CDM","740","RC","95783","HCPCS","facility","both","","","","3837","3837","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC POLYSOM <6 YRS CPAP/BILVL","74000061","CDM","740","RC","95783","HCPCS","facility","both","","","","2969.2","2969.2","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC SLEEP STUDY - UNATTD, SIMULT REC & SLEEP TIME","74000062","CDM","740","RC","95800","HCPCS","facility","both","","","","924","924","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SLEEP STUDY - UNATTD, SIMULT REC & SLEEP TIME","74000062","CDM","740","RC","95800","HCPCS","facility","both","","","","312.54","312.54","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC SLEEP STUDY - UNATTENDED, SIMULTANEOUS  RECORDING","74000063","CDM","740","RC","95801","HCPCS","facility","both","","","","924","924","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SLEEP STUDY - UNATTENDED, SIMULTANEOUS  RECORDING","74000063","CDM","740","RC","95801","HCPCS","facility","both","","","","125.02","125.02","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC SLEEP STUDY UNATTENDED & RESP EFFORT","74000064","CDM","740","RC","95806","HCPCS","facility","both","","","","312.54","312.54","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC SLEEP STUDY UNATTENDED & RESP EFFORT","74000064","CDM","740","RC","95806","HCPCS","facility","both","","","","1290","1290","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG ALL NIGHT RECORDING","74000065","CDM","740","RC","95827","HCPCS","facility","both","","","","1301.19","1301.19","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC ELECTRODE STIM BRAIN ADD-ON","74000066","CDM","740","RC","95962","HCPCS","facility","both","","","","260.48","260.48","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC ELECTROCORTICOGRAM AT SURGERY","74000067","CDM","740","RC","95829","HCPCS","facility","both","","","","4636.13","4636.13","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS","74000068","CDM","740","RC","95700","HCPCS","facility","both","","","","1569","1569","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS","74000068","CDM","740","RC","95700","HCPCS","facility","both","","","","93.77","93.77","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG W/O VIDEO BY TECH 2-12 HR UNMONITORED","74000069","CDM","740","RC","95705","HCPCS","facility","both","","","","1569","1569","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG W/O VIDEO BY TECH 2-12 HR UNMONITORED","74000069","CDM","740","RC","95705","HCPCS","facility","both","","","","1552.32","1552.32","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG W/O VIDEO BY TECH 2-12 HR INTERMITTENT MNTR","74000070","CDM","740","RC","95706","HCPCS","facility","both","","","","1552.32","1552.32","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG W/O VIDEO BY TECH 2-12 HR INTERMITTENT MNTR","74000070","CDM","740","RC","95706","HCPCS","facility","both","","","","1759","1759","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG W/O VIDEO BY TECH 2-12HR CONTINUOUS REAL-TIME MNTR","74000071","CDM","740","RC","95707","HCPCS","facility","both","","","","1954","1954","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG W/O VIDEO BY TECH 2-12HR CONTINUOUS REAL-TIME MNTR","74000071","CDM","740","RC","95707","HCPCS","facility","both","","","","1552.32","1552.32","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG W/O VID BY TECH EA INCR 12-26HR UNMONITORED","74000072","CDM","740","RC","95708","HCPCS","facility","both","","","","2247","2247","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG W/O VID BY TECH EA INCR 12-26HR UNMONITORED","74000072","CDM","740","RC","95708","HCPCS","facility","both","","","","1552.32","1552.32","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG W/O VID BY TECH EA INCR 12-26 HR INTMT MNTR","74000073","CDM","740","RC","95709","HCPCS","facility","both","","","","1552.32","1552.32","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EEG W/O VID BY TECH EA INCR 12-26 HR INTMT MNTR","74000073","CDM","740","RC","95709","HCPCS","facility","both","","","","2538","2538","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG W/O VID TECH EA INCR 12-26 HR CONT REAL-TIME MNTR","74000074","CDM","740","RC","95710","HCPCS","facility","both","","","","4213","4213","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EEG W/O VID TECH EA INCR 12-26 HR CONT REAL-TIME MNTR","74000074","CDM","740","RC","95710","HCPCS","facility","both","","","","1552.32","1552.32","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC VEEG BY TECH 2-12 HOURS UNMONITORED","74000075","CDM","740","RC","95711","HCPCS","facility","both","","","","1552.32","1552.32","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC VEEG BY TECH 2-12 HOURS UNMONITORED","74000075","CDM","740","RC","95711","HCPCS","facility","both","","","","1569","1569","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VEEG BY TECH 2-12 HR INTERMITTENT MONITORING","74000076","CDM","740","RC","95712","HCPCS","facility","both","","","","1552.32","1552.32","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC VEEG BY TECH 2-12 HR INTERMITTENT MONITORING","74000076","CDM","740","RC","95712","HCPCS","facility","both","","","","1759","1759","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VEEG BY TECH 2-12 HR CONTINUOUS REAL-TIME MONITORING","74000077","CDM","740","RC","95713","HCPCS","facility","both","","","","1552.32","1552.32","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC VEEG BY TECH 2-12 HR CONTINUOUS REAL-TIME MONITORING","74000077","CDM","740","RC","95713","HCPCS","facility","both","","","","2999","2999","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VEEG BY TECH EA INCR 12-26 HR UNMONITORED","74000078","CDM","740","RC","95714","HCPCS","facility","both","","","","2999","2999","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VEEG BY TECH EA INCR 12-26 HR UNMONITORED","74000078","CDM","740","RC","95714","HCPCS","facility","both","","","","1552.32","1552.32","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR","74000079","CDM","740","RC","95715","HCPCS","facility","both","","","","1552.32","1552.32","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR","74000079","CDM","740","RC","95715","HCPCS","facility","both","","","","3383","3383","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VEEG BY TECH EA INCR 12-26 HR CONT REAL-TIME MNTR","74000080","CDM","740","RC","95716","HCPCS","facility","both","","","","5613","5613","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VEEG BY TECH EA INCR 12-26 HR CONT REAL-TIME MNTR","74000080","CDM","740","RC","95716","HCPCS","facility","both","","","","1552.32","1552.32","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC GI STUDIES PRICE PER MINUTE ORC","75000001","CDM","750","RC","","","facility","both","","","","14.16","14.16","","","","","","","","","","","","","Gross Charge Type: JHH 79 CLINIC ORC"
"HC PROCEDURE ENDO LEVEL 1 INIT 15 MIN","75000025","CDM","750","RC","","","facility","both","","","","2703","2703","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE ENDO LEVEL 2 INIT 15 MIN","75000026","CDM","750","RC","","","facility","both","","","","3016","3016","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UPPER GI PLACEMENT GASTROSTOMY TUBE","75000100","CDM","750","RC","","","facility","both","","","","1768","1768","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EMG ANAL OR URETHRAL SPHINCTER, OTHER THAN NEEDLE","75000101","CDM","750","RC","","","facility","both","","","","618","618","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESOPHAGUS MOTILITY STUDY","75000102","CDM","750","RC","","","facility","both","","","","1877","1877","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GASTROESOPHAGEAL REFLUX TEST","75000103","CDM","750","RC","","","facility","both","","","","1877","1877","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESOPHAGEAL IMPED FUNCTION TEST","75000104","CDM","750","RC","","","facility","both","","","","1877","1877","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RECTAL SENSATION, TONE, AND COMPLIANCE TEST","75000105","CDM","750","RC","","","facility","both","","","","1377","1377","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ANORECTAL MANOMETRY","75000106","CDM","750","RC","","","facility","both","","","","1377","1377","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE ENDO LEVEL 1 EA ADDL 15 MINUTE","75000125","CDM","750","RC","","","facility","both","","","","733","733","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE ENDO LEVEL 2 EA ADDL 15 MINUTE","75000126","CDM","750","RC","","","facility","both","","","","852","852","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE ENDO LEVEL 3 INIT 15 MIN","75000127","CDM","750","RC","","","facility","both","","","","3330","3330","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROCEDURE ENDO LEVEL 3 EA ADDL 15 MINUTE","75000128","CDM","750","RC","","","facility","both","","","","978","978","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESOPHAGOSC DILATE BALLOON 30","75000129","CDM","750","RC","","","facility","both","","","","2778","2778","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EGD BALLOON DIL ESOPH 30 MM/>","75000130","CDM","750","RC","","","facility","both","","","","5078","5078","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIVER ELASTOGRAPHY","75000131","CDM","920","RC","91200","HCPCS","facility","both","","","","212.31","212.31","","","","","","","","","","","","","Gross Charge Type: JHH 79 CLINIC ORC"
"HC COLLECTION OF BLOOD VIA VAD","76100001","CDM","761","RC","36591","HCPCS","facility","both","","","","161","161","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC COLLECTION OF BLOOD VIA VAD","76100001","CDM","761","RC","36591","HCPCS","facility","both","","","","192.75","192.75","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC COLLECTION OF BLOOD VIA VAD","76100001","CDM","761","RC","36591","HCPCS","facility","both","","","","297.32","297.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC COLLECTION OF BLOOD VIA VAD","76100001","CDM","761","RC","36591","HCPCS","facility","both","","","","515.27","515.27","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC COLLECTION OF BLOOD VIA VAD","76100001","CDM","761","RC","36591","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC COLLECTION OF BLOOD VIA PICC","76100002","CDM","761","RC","36592","HCPCS","facility","both","","","","194.87","194.87","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC COLLECTION OF BLOOD VIA PICC","76100002","CDM","761","RC","36592","HCPCS","facility","both","","","","334.48","334.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC COLLECTION OF BLOOD VIA PICC","76100002","CDM","761","RC","36592","HCPCS","facility","both","","","","216.88","216.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC COLLECTION OF BLOOD VIA PICC","76100002","CDM","761","RC","36592","HCPCS","facility","both","","","","579.69","579.69","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC COLLECTION OF BLOOD VIA PICC","76100002","CDM","761","RC","36592","HCPCS","facility","both","","","","161","161","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DECLOTTING VAD OR CATHETER","76100003","CDM","761","RC","36593","HCPCS","facility","both","","","","371.65","371.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC DECLOTTING VAD OR CATHETER","76100003","CDM","761","RC","36593","HCPCS","facility","both","","","","292.28","292.28","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC DECLOTTING VAD OR CATHETER","76100003","CDM","761","RC","36593","HCPCS","facility","both","","","","644.11","644.11","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC DECLOTTING VAD OR CATHETER","76100003","CDM","761","RC","36593","HCPCS","facility","both","","","","462","462","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DECLOTTING VAD OR CATHETER","76100003","CDM","761","RC","36593","HCPCS","facility","both","","","","240.95","240.95","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC FINE NEEDLE ASPIRATION W/IMAGE","76100012","CDM","761","RC","10022","HCPCS","facility","both","","","","194","194","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOSPY OF SKIN, SINGLE LESION","76100013","CDM","761","RC","11100","HCPCS","facility","both","","","","772","772","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOSPY OF SKIN, EACH ADDL LESION","76100014","CDM","761","RC","11101","HCPCS","facility","both","","","","280","280","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL IMPLANT CONTRACEP CAPS","76100015","CDM","761","RC","11976","HCPCS","facility","both","","","","3296","3296","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PUNCTURE ASPIRATION BREAST CYST - INITIAL","76100018","CDM","761","RC","19000","HCPCS","facility","both","","","","1024","1024","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PUNCTURE ASPIRATION BREAST CYST - EA ADDL","76100019","CDM","761","RC","19001","HCPCS","facility","both","","","","667","667","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS CORE BREAST BX W GUIDE","76100020","CDM","761","RC","19102","HCPCS","facility","both","","","","1520","1520","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS CORE BREAST BX W GUIDE","76100020","CDM","761","RC","19102","HCPCS","facility","both","","","","767","767","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS BREAST BX - AUTO VA/DEVICE","76100021","CDM","761","RC","19103","HCPCS","facility","both","","","","1520","1520","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS BREAST BX - AUTO VA/DEVICE","76100021","CDM","761","RC","19103","HCPCS","facility","both","","","","767","767","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PREOP NEEDLE LOCALIZATION, BREAST, INITIAL","76100022","CDM","761","RC","19290","HCPCS","facility","both","","","","708","708","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PREOP NEEDLE LOCALIZATION, BREAST, EA ADDL","76100023","CDM","761","RC","19291","HCPCS","facility","both","","","","297","297","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE BREAST CLIP PERCUT","76100024","CDM","761","RC","19295","HCPCS","facility","both","","","","1021","1021","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE BREAST CLIP PERCUT","76100024","CDM","761","RC","19295","HCPCS","facility","both","","","","768","768","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MUSCLE BIOPSY PERCUTANEOUS NEEDLE","76100026","CDM","761","RC","20206","HCPCS","facility","both","","","","2073","2073","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE BIOPSY TROCAR/NEEDLE; SUPERFICIAL","76100027","CDM","761","RC","20220","HCPCS","facility","both","","","","2311","2311","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE BIOPSY TROCAR/NEEDLE; DEEP","76100028","CDM","761","RC","20225","HCPCS","facility","both","","","","2802","2802","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRIGGER PTS INJ, SGL/MULTI =/> 3 MUSCLES","76100029","CDM","761","RC","20553","HCPCS","facility","both","","","","1036","1036","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ARTHROCENTESIS MAJOR JOINT OR BURSA","76100030","CDM","761","RC","20610","HCPCS","facility","both","","","","909","909","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASPIRATION & INJ TX OF BONE CYST","76100031","CDM","761","RC","20615","HCPCS","facility","both","","","","3100","3100","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SOFT TISSUE BIOPSY - NECK/THORAX","76100032","CDM","761","RC","21550","HCPCS","facility","both","","","","2802","2802","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY FLEX; DIAGNOSTIC","76100033","CDM","761","RC","31575","HCPCS","facility","both","","","","665.85","665.85","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC LARYNGOSCOPY FLEX; DIAGNOSTIC","76100033","CDM","761","RC","31575","HCPCS","facility","both","","","","675","675","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY W/STROBOSCOPY","76100034","CDM","761","RC","31579","HCPCS","facility","both","","","","903.65","903.65","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC PLEURA BIOSPY; PERCUTANEOUS NEEDLE","76100035","CDM","761","RC","32400","HCPCS","facility","both","","","","1553","1553","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEAC 01/01/2021 PERCUTANEOUS BIOPSY LUNG/MEDIASTINUM","76100036","CDM","761","RC","32405","HCPCS","facility","both","","","","1391","1391","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THORACENTESIS FOR ASPIRATION","76100037","CDM","761","RC","32421","HCPCS","facility","both","","","","798","798","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APHERESIS WBC","76100038","CDM","761","RC","36511","HCPCS","facility","both","","","","1204.77","1204.77","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC APHERESIS WBC","76100038","CDM","761","RC","36511","HCPCS","facility","both","","","","3220.55","3220.55","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC APHERESIS WBC","76100038","CDM","761","RC","36511","HCPCS","facility","both","","","","7927","7927","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APHERESIS WBC","76100038","CDM","761","RC","36511","HCPCS","facility","both","","","","1858.19","1858.19","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC APHERESIS RBC","76100039","CDM","761","RC","36512","HCPCS","facility","both","","","","1204.77","1204.77","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC APHERESIS RBC","76100039","CDM","761","RC","36512","HCPCS","facility","both","","","","1858.19","1858.19","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC APHERESIS RBC","76100039","CDM","761","RC","36512","HCPCS","facility","both","","","","3220.55","3220.55","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC APHERESIS RBC","76100039","CDM","761","RC","36512","HCPCS","facility","both","","","","7927","7927","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT PICC AGE 5 YRS/>, W/O IMAGE GUIDE","76100041","CDM","761","RC","36569","HCPCS","facility","both","","","","4099","4099","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT PICC DEVICE W PORT 5 YRS/>","76100042","CDM","761","RC","36571","HCPCS","facility","both","","","","19678","19678","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONTRAST INJ W/FLUORO EVAL CV DEVICE","76100043","CDM","761","RC","36598","HCPCS","facility","both","","","","324","324","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HARVEST STEM CELLS AUTOLOGOUS","76100045","CDM","761","RC","38206","HCPCS","facility","both","","","","7225.55","7225.55","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC HARVEST STEM CELLS AUTOLOGOUS","76100045","CDM","761","RC","38206","HCPCS","facility","both","","","","6046","6046","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRYOPRESERVE AND STORAGE STEM CELLS","76100046","CDM","761","RC","38207","HCPCS","facility","both","","","","2064.45","2064.45","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC CRYOPRESERVE AND STORAGE STEM CELLS","76100046","CDM","761","RC","38207","HCPCS","facility","both","","","","5085","5085","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THAW PRESERVED STEM CELLS","76100047","CDM","761","RC","38208","HCPCS","facility","both","","","","2580.6","2580.6","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC THAW PRESERVED STEM CELLS","76100047","CDM","761","RC","38208","HCPCS","facility","both","","","","2468","2468","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RBC DEPLETION OF HARVEST STEM CELLS","76100048","CDM","761","RC","38212","HCPCS","facility","both","","","","3612.82","3612.82","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC VOLUME DEPLETE OF HARVEST STEM CELLS","76100049","CDM","761","RC","38214","HCPCS","facility","both","","","","5161.15","5161.15","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC HARVEST STEM CELL CONCENTRATE","76100050","CDM","761","RC","38215","HCPCS","facility","both","","","","6709.5","6709.5","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC HARVEST STEM CELL CONCENTRATE","76100050","CDM","761","RC","38215","HCPCS","facility","both","","","","4809","4809","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAGNOSTIC BONE MARROW; ASPIRATION(S)","76100051","CDM","761","RC","38220","HCPCS","facility","both","","","","2059","2059","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAGNOSTIC BONE MARROW: BIOPSY(IES)","76100052","CDM","761","RC","38221","HCPCS","facility","both","","","","2041","2041","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BONE MARROW HARVEST ALLOGENEIC","76100053","CDM","761","RC","38230","HCPCS","facility","both","","","","3612.82","3612.82","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC BONE MARROW STEM TRANSPLANT, AUTOLOGOUS","76100055","CDM","761","RC","38241","HCPCS","facility","both","","","","6220","6220","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LYMPHOCYTE INFUSION BONE MARROW","76100056","CDM","761","RC","38242","HCPCS","facility","both","","","","1032.27","1032.27","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC BIOPSY LYMPH NODES; SUPERFICIAL","76100057","CDM","761","RC","38505","HCPCS","facility","both","","","","2048","2048","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY SALIVARY GLAND; NEEDLE","76100058","CDM","761","RC","42400","HCPCS","facility","both","","","","1255","1255","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY LIVER; PERCUTANEOUS NEEDLE","76100060","CDM","761","RC","47000","HCPCS","facility","both","","","","2069","2069","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY PANCREAS PERCUTANEOUS NEEDLE","76100061","CDM","761","RC","48102","HCPCS","facility","both","","","","3741","3741","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN RETROPERITONEAL ABSCESS; PERC","76100062","CDM","761","RC","49061","HCPCS","facility","both","","","","3285","3285","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABD PARACENTESIS W/O IMAGING","76100063","CDM","761","RC","49082","HCPCS","facility","both","","","","855","855","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABD PARACENTESIS W/IMAGING","76100064","CDM","761","RC","49083","HCPCS","facility","both","","","","906.2","906.2","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ABD PARACENTESIS W/IMAGING","76100064","CDM","761","RC","49083","HCPCS","facility","both","","","","3886","3886","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERC NDL BIOPSY ABD/RETROPERITONEAL MASS","76100065","CDM","761","RC","49180","HCPCS","facility","both","","","","2072","2072","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC RENAL BIOPSY PERCUTANEOUS","76100066","CDM","761","RC","50200","HCPCS","facility","both","","","","2843","2843","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASP &/OR INJ OF RENAL CYST/PELVIS; PERC","76100067","CDM","761","RC","50390","HCPCS","facility","both","","","","2296","2296","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN BLADDER W/CATH INSERTION","76100068","CDM","761","RC","51102","HCPCS","facility","both","","","","6518","6518","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT NON-DWELL BLADDER CATH","76100070","CDM","761","RC","51701","HCPCS","facility","both","","","","991","991","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT TEMP BLADDER CATHETER","76100071","CDM","761","RC","51702","HCPCS","facility","both","","","","323","323","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TREATMENT OF BLADDER LESION","76100073","CDM","761","RC","51720","HCPCS","facility","both","","","","2760","2760","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC US POST VOID RESIDUAL URINE","76100076","CDM","761","RC","51798","HCPCS","facility","both","","","","271","271","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PROSTATE NDL/PUNCH BIOPSY;SGL/MULT","76100077","CDM","761","RC","55700","HCPCS","facility","both","","","","2569","2569","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FIT AND INSERT PESSARY","76100082","CDM","761","RC","57160","HCPCS","facility","both","","","","638","638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AMNIOCENTESIS THERAPEUTIC","76100100","CDM","720","RC","59001","HCPCS","facility","both","","","","543.02","543.02","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC AMNIOCENTESIS THERAPEUTIC","76100100","CDM","720","RC","59001","HCPCS","facility","both","","","","5698","5698","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSABD AMNIOINFUSION W US","76100101","CDM","761","RC","59070","HCPCS","facility","both","","","","543.02","543.02","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC TRANSABD AMNIOINFUSION W US","76100101","CDM","761","RC","59070","HCPCS","facility","both","","","","1074","1074","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FETAL FLUID DRAINAGE W US GUIDE","76100102","CDM","720","RC","59074","HCPCS","facility","both","","","","2114","2114","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FETAL FLUID DRAINAGE W US GUIDE","76100102","CDM","720","RC","59074","HCPCS","facility","both","","","","543.02","543.02","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC BIOPSY THYROID PERC CORE NEEDLE","76100106","CDM","761","RC","60100","HCPCS","facility","both","","","","1294","1294","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERC ASPIRATION SPINAL CORD CYST","76100107","CDM","761","RC","62268","HCPCS","facility","both","","","","1610","1610","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SPINAL PUNCTURE LUMBAR DIAGNOSTIC; W/O IMG","76100108","CDM","761","RC","62270","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC SPINAL PUNCTURE LUMBAR DIAGNOSTIC; W/O IMG","76100108","CDM","761","RC","62270","HCPCS","facility","both","","","","1110","1110","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN CEREBRO SPINAL FLUID; W/O IMG","76100109","CDM","761","RC","62272","HCPCS","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DRAIN CEREBRO SPINAL FLUID; W/O IMG","76100109","CDM","761","RC","62272","HCPCS","facility","both","","","","1420","1420","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODENERVATION; NECK NERVE MUSCLE(S)","76100111","CDM","761","RC","64613","HCPCS","facility","both","","","","704","704","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODEN; EXTREM/TRUNK NERVE MUSCLE(S)","76100112","CDM","761","RC","64614","HCPCS","facility","both","","","","589","589","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRAVITREAL INJECTION OF DRUG","76100113","CDM","761","RC","67028","HCPCS","facility","both","","","","177.24","177.24","","","","","","","","","","","","","Gross Charge Type: JHH 79 CLINIC ORC"
"HC GI TRACT CAPSULE ENDOSCOPY","76100116","CDM","761","RC","91110","HCPCS","facility","both","","","","5601","5601","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPEUTIC APHERESIS","76100118","CDM","761","RC","36514","HCPCS","facility","both","","","","1204.77","1204.77","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC THERAPEUTIC APHERESIS","76100118","CDM","761","RC","36514","HCPCS","facility","both","","","","7927","7927","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPEUTIC APHERESIS","76100118","CDM","761","RC","36514","HCPCS","facility","both","","","","3220.55","3220.55","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC THERAPEUTIC APHERESIS","76100118","CDM","761","RC","36514","HCPCS","facility","both","","","","1858.19","1858.19","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC APHERESIS SELECTIVE; W/EXTRACORP IMMUNOADSORP FILTRAT & PLASMA REINF","76100119","CDM","761","RC","36516","HCPCS","facility","both","","","","9661.6","9661.6","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC APHERESIS SELECTIVE; W/EXTRACORP IMMUNOADSORP FILTRAT & PLASMA REINF","76100119","CDM","761","RC","36516","HCPCS","facility","both","","","","5574.51","5574.51","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC APHERESIS SELECTIVE; W/EXTRACORP IMMUNOADSORP FILTRAT & PLASMA REINF","76100119","CDM","761","RC","36516","HCPCS","facility","both","","","","3614.16","3614.16","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC APHERESIS SELECTIVE; W/EXTRACORP IMMUNOADSORP FILTRAT & PLASMA REINF","76100119","CDM","761","RC","36516","HCPCS","facility","both","","","","22992","22992","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLY MULTI-LAYER COMPRESSION LOWER LEG","76100150","CDM","761","RC","29581","HCPCS","facility","both","","","","300.83","300.83","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC APPLY MULTI-LAYER COMPRESSION LOWER LEG","76100150","CDM","761","RC","29581","HCPCS","facility","both","","","","345","345","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLY MULTI-LAYER COMPRESSION LOWER LEG","76100150","CDM","761","RC","29581","HCPCS","facility","both","","","","200.49","200.49","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC I&D DEEP ABSCESS SOFT TISS NK/THOR","76100151","CDM","761","RC","21501","HCPCS","facility","both","","","","4770","4770","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLEURA CATHETER INSERTION W/IMAGE","76100152","CDM","761","RC","32557","HCPCS","facility","both","","","","2311","2311","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPOSITIONING CENTRAL VENOUS CATHETER W/FLOURO","76100153","CDM","761","RC","36597","HCPCS","facility","both","","","","1736","1736","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPLACE GASTRO/CECO TUBE PERCUTANEOUS","76100154","CDM","761","RC","49450","HCPCS","facility","both","","","","2136","2136","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FLUORO EXAM GASTRO/COLON TUBE","76100155","CDM","761","RC","49465","HCPCS","facility","both","","","","1137","1137","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASPIRATE PLEURA W/IMAGING","76100156","CDM","761","RC","32555","HCPCS","facility","both","","","","793.17","793.17","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC ASPIRATE PLEURA W/IMAGING","76100156","CDM","761","RC","32555","HCPCS","facility","both","","","","2299","2299","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE PREV IMPLANTED EPIDERAL CATH","76100157","CDM","761","RC","62355","HCPCS","facility","both","","","","4225","4225","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT TRANSCERVICAL FALLOPIAN TUBE CATH DX","76100158","CDM","761","RC","58345","HCPCS","facility","both","","","","4524","4524","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACE DEVICE/MARKER NON PRO","76100250","CDM","761","RC","","","facility","both","","","","5416","5416","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SIJ ANESTH/STEROID INJ","76100251","CDM","761","RC","","","facility","both","","","","3383","3383","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT HEART PM ATRIAL","76100300","CDM","761","RC","33206","HCPCS","facility","both","","","","7433","7433","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT HEART PM VENTRICULAR","76100301","CDM","761","RC","33207","HCPCS","facility","both","","","","7433","7433","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSRT HEART PM ATRIAL & VENT","76100302","CDM","761","RC","33208","HCPCS","facility","both","","","","9124","9124","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT ELECTRD/PM CATH SNGL","76100303","CDM","761","RC","33210","HCPCS","facility","both","","","","9128","9128","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT CARD ELECTRODES DUAL","76100304","CDM","761","RC","33211","HCPCS","facility","both","","","","8054","8054","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT PULSE GEN SNGL LEAD","76100305","CDM","761","RC","33212","HCPCS","facility","both","","","","6248","6248","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT PULSE GEN DUAL LEADS","76100306","CDM","761","RC","33213","HCPCS","facility","both","","","","6850","6850","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UPGRADE IMPL PACEMKR; SC TO DC","76100307","CDM","761","RC","33214","HCPCS","facility","both","","","","9124","9124","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPOSITION PACING-DEFIB LEAD","76100308","CDM","761","RC","33215","HCPCS","facility","both","","","","3449","3449","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT 1 ELECTRODE PM-DEFIB","76100309","CDM","761","RC","33216","HCPCS","facility","both","","","","7150","7150","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT 2 ELECTRODE PM-DEFIB","76100310","CDM","761","RC","33217","HCPCS","facility","both","","","","5925","5925","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPAIR LEAD PACE-DEFIB ONE","76100311","CDM","761","RC","33218","HCPCS","facility","both","","","","3324","3324","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPAIR LEAD PACE-DEFIB DUAL","76100312","CDM","761","RC","33220","HCPCS","facility","both","","","","4647","4647","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT PULSE GEN MULT LEADS","76100313","CDM","761","RC","33221","HCPCS","facility","both","","","","10318","10318","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PACER POCKET REVISION","76100314","CDM","761","RC","33222","HCPCS","facility","both","","","","1956","1956","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REVISE POCKET FOR DEFIB","76100315","CDM","761","RC","33223","HCPCS","facility","both","","","","1974","1974","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT PACING LEAD & CONNECT","76100316","CDM","761","RC","33224","HCPCS","facility","both","","","","9124","9124","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC L VENTRIC PACING LEAD ADD-ON","76100317","CDM","761","RC","33225","HCPCS","facility","both","","","","9124","9124","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPOSITION L VENTRIC LEAD","76100318","CDM","761","RC","33226","HCPCS","facility","both","","","","2855","2855","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE&REPLACE PM GEN SINGL","76100319","CDM","761","RC","33227","HCPCS","facility","both","","","","6248","6248","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMV&REPLC PM GEN DUAL LEAD","76100320","CDM","761","RC","33228","HCPCS","facility","both","","","","6850","6850","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMV&REPLC PM GEN MULT LEADS","76100321","CDM","761","RC","33229","HCPCS","facility","both","","","","9507","9507","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSRT PULSE GEN W/DUAL LEADS","76100322","CDM","761","RC","33230","HCPCS","facility","both","","","","22636","22636","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSRT PULSE GEN W/MULT LEADS","76100323","CDM","761","RC","33231","HCPCS","facility","both","","","","22636","22636","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL OF PM GENERATOR","76100324","CDM","761","RC","33233","HCPCS","facility","both","","","","6528","6528","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVE PULSE GENERATOR","76100325","CDM","761","RC","33241","HCPCS","facility","both","","","","3898","3898","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REM SC/DC CARD-DEFIBR ELECTROD OPEN","76100326","CDM","761","RC","33243","HCPCS","facility","both","","","","1497","1497","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REM SC/DC ICD LEAD; TV EXTRACT","76100327","CDM","761","RC","33244","HCPCS","facility","both","","","","3032","3032","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT PACE-DEFIB W/LEAD","76100328","CDM","761","RC","33249","HCPCS","facility","both","","","","28240","28240","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMV&REPLC CVD GEN SING LEAD","76100329","CDM","761","RC","33262","HCPCS","facility","both","","","","22636","22636","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMV&REPLC CVD GEN DUAL LEAD","76100330","CDM","761","RC","33263","HCPCS","facility","both","","","","22636","22636","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMV&REPLC CVD GEN MULT LEAD","76100331","CDM","761","RC","33264","HCPCS","facility","both","","","","22636","22636","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMPL PT-ACTIVATED CARD EVENT RECORDER","76100332","CDM","761","RC","33282","HCPCS","facility","both","","","","2914","2914","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL OF AN IMPL CARD EVENT RECORDER","76100333","CDM","761","RC","33284","HCPCS","facility","both","","","","302","302","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMPL OR REVISE EPID CATH FOR PAIN","76100334","CDM","761","RC","62350","HCPCS","facility","both","","","","5539","5539","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSRT/REPL SPINE NSTIM GENERATOR/RCVR REQ POCKET/CONNECT E. ARRAY","76100335","CDM","761","RC","63685","HCPCS","facility","both","","","","18231","18231","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ LAMOT/LAM LUMBAR","76100336","CDM","761","RC","","","facility","both","","","","4265","4265","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ESOPHAGUS, REFLUX TEST; WITH MUCOSAL","76100338","CDM","750","RC","","","facility","both","","","","1877","1877","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESTRUCT W NEUROLYTIC AGENT; CELIAC PLEXUS","76100339","CDM","761","RC","64680","HCPCS","facility","both","","","","5981","5981","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DESTRUCT W NEUROLYTIC AGENT; CELIAC PLEXUS","76100339","CDM","761","RC","64680","HCPCS","facility","both","","","","8944","8944","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACENTA DELIVERY","76100340","CDM","720","RC","59414","HCPCS","facility","both","","","","991","991","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN PELVIC ABSCESS, TRANSVAG/TRANSRECT, PERC","76100342","CDM","761","RC","58823","HCPCS","facility","both","","","","1807","1807","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN PERIVESICAL OR PREVESICAL ABSCESS","76100343","CDM","761","RC","51080","HCPCS","facility","both","","","","5341","5341","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHANGE URETER TUBE/STENT","76100344","CDM","761","RC","50688","HCPCS","facility","both","","","","4049","4049","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN PERIRENAL OR RENAL ABSCESS; OPEN","76100345","CDM","761","RC","50020","HCPCS","facility","both","","","","17923","17923","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCHANGE PREVIOUS DRAINAGE CATHETER","76100346","CDM","761","RC","49423","HCPCS","facility","both","","","","1573","1573","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT TUNNELED INTRAPERITONEAL CATH; PERC","76100347","CDM","761","RC","49418","HCPCS","facility","both","","","","5711","5711","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN SUBDIAPHRAGMATIC ABSCESS; PERC","76100348","CDM","761","RC","49041","HCPCS","facility","both","","","","3378","3378","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REVISION/REINSERT OF TRANSHEPATIC TUBE","76100349","CDM","761","RC","47530","HCPCS","facility","both","","","","3723","3723","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS BILIARY DRAINAGE EXTERNAL","76100350","CDM","761","RC","47510","HCPCS","facility","both","","","","12079","12079","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUTANEOUS CHOLECYSTOSTOMY","76100351","CDM","761","RC","47490","HCPCS","facility","both","","","","7205","7205","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC I&D APPENDICEAL ABSCESS; PERCUTANEOUS","76100352","CDM","761","RC","44901","HCPCS","facility","both","","","","2449","2449","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NG TUBE PLACEMENT W/FLOURO","76100353","CDM","761","RC","43752","HCPCS","facility","both","","","","564","564","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DILATION OF ESOPHAGUS BY BALLOON 30 MM/>","76100354","CDM","761","RC","43458","HCPCS","facility","both","","","","1529","1529","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFUSION TRANSCATH TX, NON THROMBOLYTIC","76100356","CDM","761","RC","37202","HCPCS","facility","both","","","","3436","3436","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SA MECH REMOVAL, OBSTRUCTIVE CVAD","76100357","CDM","761","RC","36595","HCPCS","facility","both","","","","10883","10883","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSTILLATION, AGENT FOR PLEURODESIS","76100359","CDM","761","RC","32560","HCPCS","facility","both","","","","1613","1613","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION SINUS TRACT; DIAGNOSTIC (SINOGRAM)","76100368","CDM","761","RC","20501","HCPCS","facility","both","","","","721","721","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION INTO SKIN LESIONS =<7","76100369","CDM","761","RC","11900","HCPCS","facility","both","","","","353","353","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEBRIDEMENT, BONE 1ST 20 SQ CM OR LESS","76100373","CDM","761","RC","11044","HCPCS","facility","both","","","","9292","9292","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THROMBECTOMY AVF DIALYSIS GRAFT","76100376","CDM","761","RC","36831","HCPCS","facility","both","","","","14163","14163","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BX BREAST 1ST LESION STEREOTACTIC GUIDANCE","76100377","CDM","761","RC","19081","HCPCS","facility","both","","","","4708","4708","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BX BREAST ADD LESION STEREOTACTIC GUIDANCE","76100378","CDM","761","RC","19082","HCPCS","facility","both","","","","4121","4121","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BX BREAST 1ST LESION US IMAG","76100379","CDM","761","RC","19083","HCPCS","facility","both","","","","4298","4298","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BX BREAST ADD LESION US IMAG","76100380","CDM","761","RC","19084","HCPCS","facility","both","","","","3713","3713","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BX BREAST 1ST LESION MR IMAG","76100381","CDM","761","RC","19085","HCPCS","facility","both","","","","3604","3604","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BX BREAST ADD LESION MR IMAG","76100382","CDM","761","RC","19086","HCPCS","facility","both","","","","3019","3019","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ DEVICE BREAST 1ST IMAG","76100383","CDM","761","RC","19281","HCPCS","facility","both","","","","2072","2072","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ DEVICE BREAST EA IMAG","76100384","CDM","761","RC","19282","HCPCS","facility","both","","","","1487","1487","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ DEV BREAST 1ST STEREOTACTIC GUIDANCE","76100385","CDM","761","RC","19283","HCPCS","facility","both","","","","3233","3233","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ DEV BREAST ADD STEREOTACTIC GUIDANCE","76100386","CDM","761","RC","19284","HCPCS","facility","both","","","","2649","2649","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ DEV BREAST 1ST US IMAG","76100387","CDM","761","RC","19285","HCPCS","facility","both","","","","2821","2821","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ DEV BREAST ADD US IMAG","76100388","CDM","761","RC","19286","HCPCS","facility","both","","","","2237","2237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ DEV BREAST 1ST MR GUIDE","76100389","CDM","761","RC","19287","HCPCS","facility","both","","","","2128","2128","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ DEV BREAST ADD MR GUIDE","76100390","CDM","761","RC","19288","HCPCS","facility","both","","","","1544","1544","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERC VERTEBROPLASTY INJ, CERVICOTHORACIC","76100401","CDM","761","RC","22510","HCPCS","facility","both","","","","7585","7585","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERC VERTEBROPLASTY INJ, LUMBOSACRAL","76100402","CDM","761","RC","22511","HCPCS","facility","both","","","","4746","4746","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERC VERTEBROPLASTY INJ, EA ADDL","76100403","CDM","761","RC","22512","HCPCS","facility","both","","","","4746","4746","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ VERTEBRAL AUGMENTATION, THORACIC","76100404","CDM","761","RC","22513","HCPCS","facility","both","","","","7955","7955","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ VERTEBRAL AUGMENTATION, LUMBAR","76100405","CDM","761","RC","22514","HCPCS","facility","both","","","","7955","7955","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ VERTEBRAL AUGMENTATION, EA ADDL","76100406","CDM","761","RC","22515","HCPCS","facility","both","","","","7955","7955","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERC SACRAL AUGUMENTATION, UNIL INJ","76100407","CDM","761","RC","","","facility","both","","","","6133","6133","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERC SACRAL AUGUMENTATION, BILAT INJ","76100408","CDM","761","RC","","","facility","both","","","","10687","10687","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN/INJ MAJOR JOINT/BURSA W/US","76100409","CDM","761","RC","20611","HCPCS","facility","both","","","","906.2","906.2","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DRAIN/INJ MAJOR JOINT/BURSA W/US","76100409","CDM","761","RC","20611","HCPCS","facility","both","","","","3477","3477","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYELOGRAPHY LUMBAR INJECTION; CERVICAL","76100410","CDM","761","RC","62302","HCPCS","facility","both","","","","724.87","724.87","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC MYELOGRAPHY LUMBAR INJECTION; CERVICAL","76100410","CDM","761","RC","62302","HCPCS","facility","both","","","","4248","4248","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYELOGRAPHY LUMBAR INJECTION; THORACIC","76100411","CDM","761","RC","62303","HCPCS","facility","both","","","","5371","5371","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYELOGRAPHY LUMBAR INJECTION; THORACIC","76100411","CDM","761","RC","62303","HCPCS","facility","both","","","","724.87","724.87","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC MYELOGRAPHY LUMBAR INJECTION; LUMBOSACRAL","76100412","CDM","761","RC","62304","HCPCS","facility","both","","","","4050","4050","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYELOGRAPHY LUMBAR INJECTION; LUMBOSACRAL","76100412","CDM","761","RC","62304","HCPCS","facility","both","","","","724.87","724.87","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC MYELOGRAPHY LUMBAR INJECTION; 2 OR MORE REGIONS","76100413","CDM","761","RC","62305","HCPCS","facility","both","","","","5097","5097","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYELOGRAPHY LUMBAR INJECTION; 2 OR MORE REGIONS","76100413","CDM","761","RC","62305","HCPCS","facility","both","","","","1087.31","1087.31","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC TBA, OPEN; BRACHIOCEPHALIC TRUNK/BRANCH","76100414","CDM","761","RC","35458","HCPCS","facility","both","","","","5375","5375","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PTA BRACHIOCEPHALIC ARTERIES","76100415","CDM","761","RC","35475","HCPCS","facility","both","","","","5375","5375","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PERC EXTR ANEURYSM","76100416","CDM","761","RC","36002","HCPCS","facility","both","","","","1861","1861","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LUMEN  MECH REM OBSTR CVAD","76100417","CDM","761","RC","36596","HCPCS","facility","both","","","","10834","10834","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REM BILIARY STONE VIA T-TUBE","76100418","CDM","761","RC","47630","HCPCS","facility","both","","","","4204","4204","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN/INJ SMALL JOINT/BURSA W/US","76100419","CDM","761","RC","20604","HCPCS","facility","both","","","","745","745","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAIN/INJ INTERMEDIATE JOINT/BURSA W/US","76100420","CDM","761","RC","20606","HCPCS","facility","both","","","","1044","1044","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECT FOR SACROILIAC JOINT","76100421","CDM","761","RC","","","facility","both","","","","793","793","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRODUCTION OF LONG GI TUBE","76100422","CDM","761","RC","44500","HCPCS","facility","both","","","","3184","3184","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PROC, ANKLE ARTHROGRAPHY","76100423","CDM","761","RC","27648","HCPCS","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PROC, HIP ARTHROGRAPHY, W/ ANESTH","76100424","CDM","761","RC","27095","HCPCS","facility","both","","","","206","206","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MASTOTOMY WITH EXPLORATION DEEP","76100425","CDM","761","RC","19020","HCPCS","facility","both","","","","3237","3237","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRAVASC US NONCORONARY, INITIAL NONCORONARY VESSEL","76100426","CDM","761","RC","37252","HCPCS","facility","both","","","","1717","1717","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION FOR CHOLANGIOGRAM, EXISTING ACCESS","76100427","CDM","761","RC","47531","HCPCS","facility","both","","","","4396","4396","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION FOR CHOLANGIOGRAM, EXISTING ACCESS","76100427","CDM","761","RC","47531","HCPCS","facility","both","","","","362.47","362.47","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC INJECTION FOR CHOLANGIOGRAM, NEW ACCESS","76100428","CDM","761","RC","47532","HCPCS","facility","both","","","","3755","3755","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACEMENT BILIARY DRAINAGE CATH, EXTERNAL","76100429","CDM","761","RC","47533","HCPCS","facility","both","","","","29815","29815","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACEMENT BILIARY DRAINAGE CATH, INTERNAL-EXTERNAL","76100430","CDM","761","RC","47534","HCPCS","facility","both","","","","29815","29815","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONVERSION EXTERNAL BILIARY  DRAINAGE CATH","76100431","CDM","761","RC","47535","HCPCS","facility","both","","","","21063","21063","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCHANGE BILIARY DRAINAGE CATH","76100432","CDM","761","RC","47536","HCPCS","facility","both","","","","21063","21063","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL BILIARY DRAINAGE CATH","76100433","CDM","761","RC","47537","HCPCS","facility","both","","","","7430","7430","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ PLMT BILE DUCT STENT(S), EXISTING ACCESS","76100434","CDM","761","RC","47538","HCPCS","facility","both","","","","29815","29815","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ PLMT BILE DUCT STENT(S), NEW ACCESS, W/O SEPAR CATH","76100435","CDM","761","RC","47539","HCPCS","facility","both","","","","21063","21063","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ PLMT BILE DUCT STENT, NEW ACCESS, W/ SEPAR CATH","76100436","CDM","761","RC","47540","HCPCS","facility","both","","","","21063","21063","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL DUCT GALLBLADDER CALCULI","76100437","CDM","761","RC","47544","HCPCS","facility","both","","","","6835","6835","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PROC NEPHROSTOGRM &/ URETEROGRM, NEW ACCESS","76100438","CDM","761","RC","50430","HCPCS","facility","both","","","","2777","2777","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PROC NEPHROSTOGRM &/ URETEROGRM, EXIST ACCESS","76100439","CDM","761","RC","50431","HCPCS","facility","both","","","","2777","2777","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACEMENT NEPHROSTOMY CATHETER","76100440","CDM","761","RC","50432","HCPCS","facility","both","","","","4425","4425","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLACEMENT NEPHROURETERAL CATHETER, NEW ACCESS","76100441","CDM","761","RC","50433","HCPCS","facility","both","","","","4425","4425","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CONVERT NEPHROSTOMY CATHETER","76100442","CDM","761","RC","50434","HCPCS","facility","both","","","","2436","2436","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCHANGE NEPHROSTOMY CATHETER","76100443","CDM","761","RC","50435","HCPCS","facility","both","","","","3449","3449","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDOLUMINAL BX URETER AND/OR RENAL PELVIS","76100444","CDM","761","RC","50606","HCPCS","facility","both","","","","2436","2436","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLMT URETERAL STENT PRQ,  PRE-EXISTING NEPHR TRACT","76100445","CDM","761","RC","50693","HCPCS","facility","both","","","","6974","6974","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLMT URETERAL STENT PRQ, NEW ACCESS, W/O SEPAR CATH","76100446","CDM","761","RC","50694","HCPCS","facility","both","","","","6974","6974","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLMT URETERAL STENT PRQ, NEW ACCESS, W/ SEPAR CATH","76100447","CDM","761","RC","50695","HCPCS","facility","both","","","","6974","6974","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDOVASC PROLONG ADMIN RX AGENT 1ST","76100448","CDM","761","RC","61650","HCPCS","facility","both","","","","6430","6430","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDOVASC PROLONG ADMIN RX AGENT ADD","76100449","CDM","761","RC","61651","HCPCS","facility","both","","","","6430","6430","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPEN TX DISTAL PHALANGEAL FRACTURE EACH","76100450","CDM","761","RC","26765","HCPCS","facility","both","","","","4027","4027","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MULTIFETAL REDUCTION","76100451","CDM","761","RC","59866","HCPCS","facility","both","","","","1056","1056","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; PUDENDAL NERVE","76100452","CDM","761","RC","64430","HCPCS","facility","both","","","","2410","2410","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FETAL INVASIVE PROC,UNLISTED","76100453","CDM","761","RC","59897","HCPCS","facility","both","","","","2171.92","2171.92","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC BONE MARROW ASPIRATE & BIOPSY - SAME INCISION & SAME DOS","76100454","CDM","761","RC","","","facility","both","","","","1178","1178","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEBRIDEMENT INFECTED SKIN EA ADD < = 10% BS","76100455","CDM","761","RC","11001","HCPCS","facility","both","","","","1011","1011","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEBRIDEMENT, SUBCUTANEOUS TISSUE; ADD-ON < = 20 SQ CM","76100456","CDM","761","RC","11045","HCPCS","facility","both","","","","9292","9292","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEBRIDEMENT, MUSCLE/FASCIA; ADD-ON < = 20 SQ CM","76100457","CDM","761","RC","11046","HCPCS","facility","both","","","","9292","9292","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEBRIDEMENT, BONE; ADD-ON < = 20 SQ CM","76100458","CDM","761","RC","11047","HCPCS","facility","both","","","","9292","9292","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERTION/REPLACEMENT SUBCUTANEOUS DEFIBRILLATOR","76100459","CDM","761","RC","33270","HCPCS","facility","both","","","","28240","28240","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE","76100460","CDM","761","RC","33271","HCPCS","facility","both","","","","5334","5334","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL OF SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR","76100461","CDM","761","RC","33272","HCPCS","facility","both","","","","4636","4636","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPOSITIONING PREVIOUS  IMPLANTED SUBQ DEFIB ELECTRODE","76100462","CDM","761","RC","33273","HCPCS","facility","both","","","","4258","4258","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LIGATE/DIVIDE/EXCISE VARICOSE VEIN CLUSTER(S), 1 LEG","76100463","CDM","761","RC","37785","HCPCS","facility","both","","","","16498","16498","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMORRHOIDECTOMY, INT & EXT, SNGL COL/GRP; W/FISTULECTOMY","76100464","CDM","761","RC","46258","HCPCS","facility","both","","","","17079","17079","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CELL DONOR SEARCH MANAGEMENT","76100465","CDM","761","RC","38204","HCPCS","facility","both","","","","285.6","285.6","","","","","","","","","","","","","Gross Charge Type: HB JHH DONOR BILLING CLIENT FSC"
"HC HARVEST ALLOGENEIC STEM CELL","76100466","CDM","761","RC","38205","HCPCS","facility","both","","","","1976.35","1976.35","","","","","","","","","","","","","Gross Charge Type: HB JHH DONOR BILLING CLIENT FSC"
"HC ILIAC REVASC ARTERY; ANGIOPLASTY INIT VESSEL","76100467","CDM","761","RC","37220","HCPCS","facility","both","","","","18175","18175","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERCUT MECH THROMBECTOMY, VENOUS","76100468","CDM","761","RC","37187","HCPCS","facility","both","","","","11651","11651","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC AVULSION NAIL PLATE, PARTIAL/COMPLETE, SIMPLE; EA ADDTL","76100469","CDM","761","RC","11732","HCPCS","facility","both","","","","82","82","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION TUMOR, SOFT TISSUE FOOT/TOE <1.5CM","76100470","CDM","761","RC","28045","HCPCS","facility","both","","","","6062","6062","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARTIAL EXCISION BONE; DISTAL PHALANX OF FINGER","76100471","CDM","761","RC","26236","HCPCS","facility","both","","","","1980","1980","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CLSD TX PELVIC RING FX; UNI OR BIL; W/O MANIPUL","76100472","CDM","761","RC","27197","HCPCS","facility","both","","","","413","413","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PARTIAL EXCISION PHALANX TOE BONE","76100473","CDM","761","RC","28124","HCPCS","facility","both","","","","3049","3049","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTERPHALANGEAL TOE JNT EXCISION, EACH","76100474","CDM","761","RC","28160","HCPCS","facility","both","","","","4984","4984","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTR CATH DIALYS CIRCT W/TRLUML BAL ANGIOPLASTY","76100475","CDM","761","RC","36901","HCPCS","facility","both","","","","17176","17176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTR CATH DIAL CIRC W/TRCATH PLC INTRVSC STENT(S)","76100476","CDM","761","RC","36902","HCPCS","facility","both","","","","17176","17176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTR CATH DIAL CIRC W/INTRAPROC PHARM THRMB INJ","76100477","CDM","761","RC","36903","HCPCS","facility","both","","","","17176","17176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THRMB/INFUS DIAL CIRC & INTRAPRC PHARM THRMB INJ","76100478","CDM","761","RC","36904","HCPCS","facility","both","","","","17176","17176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THRMB/INFUS DIAL CIRC W/TRNSLUM BAL ANGIOPLASTY","76100479","CDM","761","RC","36905","HCPCS","facility","both","","","","17176","17176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THRMB/INFUS DIAL CIRC&INTRPRC PHAR INJ W/STENT(S)","76100480","CDM","761","RC","36906","HCPCS","facility","both","","","","17176","17176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BALLOON  ANGIOPLASTY CTR DIALYSIS SEGMENT","76100481","CDM","761","RC","36907","HCPCS","facility","both","","","","17176","17176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC STENT PLACEMENT CENTRAL DIALYSIS SEGMENT","76100482","CDM","761","RC","36908","HCPCS","facility","both","","","","3632","3632","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIALYSIS CIRCUIT PERM VASC EMBOL OR OCCLUSION","76100483","CDM","761","RC","36909","HCPCS","facility","both","","","","2784","2784","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRLUML BALLOON ANGIOPLASTY; INITIAL ARTERY","76100484","CDM","761","RC","37246","HCPCS","facility","both","","","","17176","17176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRLUML BALLOON ANGIOPLASTY; ADDL ART","76100485","CDM","761","RC","37247","HCPCS","facility","both","","","","17176","17176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRLUML BALLOON ANGIOPLASTY;  INITIAL VEIN","76100486","CDM","761","RC","37248","HCPCS","facility","both","","","","17176","17176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRLUML BALLOON ANGIOPLASTY; ADDL VEIN","76100487","CDM","761","RC","37249","HCPCS","facility","both","","","","17176","17176","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECT INTERLAMINAR CRV/THRC; W/O IMG","76100488","CDM","761","RC","62320","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECT INTERLAMINAR CRV/THRC; W/IMG","76100489","CDM","761","RC","62321","HCPCS","facility","both","","","","5447","5447","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECT INTERLAMINAR LMBR/SAC; W/O IMG","76100490","CDM","761","RC","62322","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECT INTERLAMINAR LMBR/SAC; W/IMG","76100491","CDM","761","RC","62323","HCPCS","facility","both","","","","5447","5447","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ INFUS/BOLUS, INTERLAMINAR CRV/THRC,W/O IMG","76100492","CDM","761","RC","62324","HCPCS","facility","both","","","","2143","2143","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ INFUS/BOLUS, INTERLAMINAR CRV/THRC,W/IMG","76100493","CDM","761","RC","62325","HCPCS","facility","both","","","","6064","6064","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ INFUS/BOLUS, INTERLAMINAR LMBR/SAC,W/O IMG","76100494","CDM","761","RC","62326","HCPCS","facility","both","","","","2143","2143","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ INFUS/BOLUS, INTERLAMINAR LMBR/SAC,W/IMG","76100495","CDM","761","RC","62327","HCPCS","facility","both","","","","6064","6064","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ ABLATION 1 + LIVER TUMOR(S), RADIOFREQ","76100496","CDM","761","RC","47382","HCPCS","facility","both","","","","12110","12110","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERQ INTERDISCAL/PARAVERT TISSUE ASPIRATION, DX","76100497","CDM","761","RC","62267","HCPCS","facility","both","","","","3853","3853","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SCLEROTX FLUID COLLECT, PERC, INCL CONTRAST INJ(S), SCLERO INJ(S)","76100498","CDM","761","RC","49185","HCPCS","facility","both","","","","6917","6917","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPEUTIC APHERESIS; FOR PLATELETS","76100499","CDM","761","RC","36513","HCPCS","facility","both","","","","2566","2566","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPEUTIC APHERESIS; W/ EXTRACORP IMMUNOADSORP & PLASMA REINFUSE","76100500","CDM","761","RC","36515","HCPCS","facility","both","","","","12565","12565","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL INDWELLING URETERAL STENT, PERQ  APPROACH","76100501","CDM","761","RC","50384","HCPCS","facility","both","","","","3449","3449","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ(S), ANESTH AGENT(S) &/OR STERIOD; SUPRASCAPULAR NERVE","76100502","CDM","761","RC","64418","HCPCS","facility","both","","","","1967","1967","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF","76100503","CDM","761","RC","32552","HCPCS","facility","both","","","","2656","2656","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ASPIRATION AND/OR INJECTION, THYROID CYST","76100504","CDM","761","RC","60300","HCPCS","facility","both","","","","2095","2095","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAGNOSTIC BONE MARROW; BIOPSY(IES) AND ASPIRATION(S)","76100516","CDM","761","RC","38222","HCPCS","facility","both","","","","3531","3531","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION OF NON-COMPOUNDED FOAM SCLEROSANT; 1 VEIN","76100518","CDM","761","RC","36465","HCPCS","facility","both","","","","9962","9962","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION OF NON-COMPOUNDED FOAM SCLEROSANT; MULTIPLE VEINS","76100519","CDM","761","RC","36466","HCPCS","facility","both","","","","9962","9962","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDOVENOUS THERAPY CHEMICAL ADHESIVE; 1ST VEIN TREATED","76100520","CDM","761","RC","36482","HCPCS","facility","both","","","","19138","19138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ENDOVENOUS THERAPY CHEMICAL ADHESIVE; SUBSEQUENT VEIN TREATED","76100521","CDM","761","RC","36483","HCPCS","facility","both","","","","9570","9570","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC  INJECTION SCLEROSING SOLUTION; SINGLE VEIN","76100522","CDM","761","RC","36470","HCPCS","facility","both","","","","1981","1981","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION SCLEROSING SOLUTION; MULTIPLE VEIN SAME LEG","76100523","CDM","761","RC","36471","HCPCS","facility","both","","","","1981","1981","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REVSC, ENDOVSC, OPEN/PERQ, TIB/PERON ARTERY, UNI, INITIAL; W/TLA","76100524","CDM","761","RC","37228","HCPCS","facility","both","","","","10012","10012","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABLATION 1 OR MORE LIVER TUMOR(S), PERCUTANEOUS, CRYOABLATION","76100525","CDM","761","RC","47383","HCPCS","facility","both","","","","12195","12195","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABLATION 1 OR MORE RENAL TUMORS PERCUTANEOUS, UNIL, RADIOFREQ","76100526","CDM","761","RC","50592","HCPCS","facility","both","","","","13066","13066","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABLATION RENAL TUMOR(S),  UNIL, PERCUTANEOUS, CRYOTHERAPY","76100527","CDM","761","RC","50593","HCPCS","facility","both","","","","17542","17542","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL TUNNELED INTRAPERITONEAL CATHETER","76100528","CDM","761","RC","49422","HCPCS","facility","both","","","","4702","4702","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSTILL (S), VIA CHEST TUBE/CATH,  FIBRINOLYSIS AGENT, INIT DAY","76100529","CDM","761","RC","32561","HCPCS","facility","both","","","","757","757","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABLATE BONE TUMOR, PERQ, W/IMAG PERF,  CRYO","76100530","CDM","761","RC","20983","HCPCS","facility","both","","","","13757","13757","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABLATE PULM TUMOR, PERQ, W/IMAG PERF, UNIL, CRY","76100531","CDM","761","RC","32994","HCPCS","facility","both","","","","7748","7748","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CRYOSURG ABLATE EA FIBROADENOMA, W/ US","76100532","CDM","761","RC","19105","HCPCS","facility","both","","","","4708","4708","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABLATE, PERQ, INCL IMAGE, UPPER EXTREM/PERPH NERVE","76100533","CDM","761","RC","","","facility","both","","","","11183","11183","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABLATE, PERQ, INCL IMAGE, LOWER EXTREM/PERPH NERVE","76100534","CDM","761","RC","","","facility","both","","","","11183","11183","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABLATE, PERQ, INCL IMAGE, PLEXUS/TRUNCAL NERVE","76100535","CDM","761","RC","","","facility","both","","","","11183","11183","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ABLATE, 1 OR MORE PULM TUMOR, PERQ, UNIL; RF","76100536","CDM","761","RC","32998","HCPCS","facility","both","","","","10848","10848","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FINE NEEDLE ASPIRATION BIOPSY, W/O GUIDANCE, EA ADDL LESION","76100537","CDM","761","RC","10004","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FINE NEEDLE ASPIRATION BIOPSY, W/US GUIDANCE, 1ST LESION","76100538","CDM","761","RC","10005","HCPCS","facility","both","","","","2922","2922","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FINE NEEDLE ASPIRATION BIOPSY, W/US GUIDANCE, EA ADDL LESION","76100539","CDM","761","RC","10006","HCPCS","facility","both","","","","2784","2784","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FINE NEEDLE ASPIRATION BIOPSY, W/FLUORO GUIDANCE, 1ST LESION","76100540","CDM","761","RC","10007","HCPCS","facility","both","","","","1796","1796","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FINE NEEDLE ASPIRATION BIOPSY, W/FLUORO GUIDANCE, EA ADDL LESION","76100541","CDM","761","RC","10008","HCPCS","facility","both","","","","1796","1796","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FINE NEEDLE ASPIRATION BIOPSY, W/CT GUIDANCE, 1ST LESION","76100542","CDM","761","RC","10009","HCPCS","facility","both","","","","6525","6525","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FINE NEEDLE ASPIRATION BIOPSY, W/CT GUIDANCE, EA ADDL LESION","76100543","CDM","761","RC","10010","HCPCS","facility","both","","","","6525","6525","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FINE NEEDLE ASPIRATION BIOPSY, W/MR GUIDANCE, 1ST LESION","76100544","CDM","761","RC","10011","HCPCS","facility","both","","","","1850","1850","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FINE NEEDLE ASPIRATION BIOPSY, W/MR GUIDANCE, EA ADDL LESION","76100545","CDM","761","RC","10012","HCPCS","facility","both","","","","1347","1347","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PUNCH BIOSPY OF SKIN, SINGLE LESION","76100547","CDM","761","RC","11104","HCPCS","facility","both","","","","1347","1347","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INCISIONAL BIOSPY OF SKIN, SINGLE LESION","76100548","CDM","761","RC","11106","HCPCS","facility","both","","","","1347","1347","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TANGENTIAL BIOSPY OF SKIN, EA SEPARATE/ADDL LESION","76100549","CDM","761","RC","11103","HCPCS","facility","both","","","","488","488","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PUNCH BIOSPY OF SKIN, EA SEPARATE/ADDL LESION","76100550","CDM","761","RC","11105","HCPCS","facility","both","","","","488","488","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INCISIONAL BIOSPY OF SKIN, EA SEPARATE/ADDL LESION","76100551","CDM","761","RC","11107","HCPCS","facility","both","","","","488","488","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERTION, SUBQ CARDIAC RHYTHM MONITOR, INCL PROGRAM","76100552","CDM","761","RC","33285","HCPCS","facility","both","","","","5334","5334","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL, SUBQ CARDIAC RHYTHM MONITOR","76100553","CDM","761","RC","33286","HCPCS","facility","both","","","","885","885","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DILATION EXISTING TRACT, PERC, W/IMG GUIDE, POST TUBE PLACE","76100554","CDM","761","RC","50436","HCPCS","facility","both","","","","2768","2768","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DILAT EXIST TRACT, PERC, W/IMG GUIDE, POSTTUBEPLACE, NEWRENALACCESS","76100555","CDM","761","RC","50437","HCPCS","facility","both","","","","2878","2878","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PROC CONTRAST KNEE ARTHROGRAPHY/CONTRAST CT/MRI","76100556","CDM","761","RC","27369","HCPCS","facility","both","","","","864","864","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHANGE G TUBE, PERC, W/O IMG/GUIDE, W/O REVISION OF G TRACT","76100557","CDM","761","RC","43762","HCPCS","facility","both","","","","638","638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHANGE G TUBE, PERC, W/O IMG/GUIDE, W/REVISION OF G TRACT","76100558","CDM","761","RC","43763","HCPCS","facility","both","","","","638","638","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT PICC, INCLUDING IMAGING, 5 YR+","76100559","CDM","761","RC","36573","HCPCS","facility","both","","","","3592","3592","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADJ TISS TRANS/REARR FORE/CHKS/CHIN/MOU/NCK/AXIL/GENT/HND/FT 10SQCM","76100560","CDM","761","RC","14040","HCPCS","facility","both","","","","3577","3577","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CYSTO W/URETEROSCOPY W/REMOVAL/MANIPULATION STONES","76100561","CDM","761","RC","52352","HCPCS","facility","both","","","","6084","6084","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEUROPLASTY MAJOR PRPH NRV ARM/LEG OPEN; OTHER/THAN SPECIFIED","76100562","CDM","761","RC","64708","HCPCS","facility","both","","","","5104","5104","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EGD, FLEXIBLE, TRANSORAL; W/ FOREIGN BODY REMOVAL","76100564","CDM","761","RC","43247","HCPCS","facility","both","","","","1582","1582","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH; SIMPLE","76100565","CDM","761","RC","20520","HCPCS","facility","both","","","","4303","4303","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE","76100567","CDM","761","RC","43239","HCPCS","facility","both","","","","2500","2500","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCHANGE TRANSFUSION BLOOD; NOT NEWBORN","76100570","CDM","761","RC","36455","HCPCS","facility","both","","","","1624","1624","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED","76100571","CDM","761","RC","33016","HCPCS","facility","both","","","","8567","8567","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT","76100577","CDM","761","RC","62328","HCPCS","facility","both","","","","5447","5447","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC THERAPEUTIC SPINAL PUNCTURE, DRAINAGE CSF W/FLUOR/CT","76100578","CDM","761","RC","62329","HCPCS","facility","both","","","","5447","5447","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED PROCEDURE MUSCULOSKELETAL SYSTEM GENERAL","76100579","CDM","761","RC","20999","HCPCS","facility","both","","","","796","796","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REVASC, OPEN/PERCUT, ILIAC ARTERY W/ANGIOPLASTY; EA ADD IPSI VESSEL","76100580","CDM","761","RC","37222","HCPCS","facility","both","","","","4575","4575","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REVASC, OPEN/PERCUT, TIBIAL/PERONEAL, W/ANGIOPLASTY; UNIL, EA ADD VESSEL","76100581","CDM","761","RC","37232","HCPCS","facility","both","","","","1919","1919","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REVASC, OPEN/PERCUT, ILIAC ART W/STENT & ANGIOPLASTY; EA ADD IPSI VESSEL","76100582","CDM","761","RC","37223","HCPCS","facility","both","","","","1919","1919","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PLMT INTERSTITIAL DEVICE RAD THERAPY, PROSTATE, 1/MULTI","76100621","CDM","761","RC","55876","HCPCS","facility","both","","","","5867","5867","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LAPAROSCOPY  SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY","76100622","CDM","761","RC","47563","HCPCS","facility","both","","","","22775","22775","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ PROCEDURE FOR RETROGRADE URETHROCYSTOGRAPY","76100623","CDM","761","RC","51610","HCPCS","facility","both","","","","631","631","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION EVALUATE PREVIOUS PERITONEAL-VENOUS SHUNT","76100624","CDM","761","RC","49427","HCPCS","facility","both","","","","1942","1942","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJECT PROC","76100625","CDM","761","RC","61070","HCPCS","facility","both","","","","4170","4170","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REVASC, OPEN/PRQ, FEM/POPL, UNIL, W/STENT/ANGIOPL SAME VESSEL","76100626","CDM","761","RC","37226","HCPCS","facility","both","","","","21378","21378","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE W/FLUORO, IF PERFORMED","76100627","CDM","761","RC","49460","HCPCS","facility","both","","","","1853","1853","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRIMARY PRQ MECHANICAL THROMBECTOMY N-COR N-ICRA, 1ST VESSEL","76100628","CDM","761","RC","37184","HCPCS","facility","both","","","","16344","16344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRIMARY PRQ MECHANICAL THROMBECTOMY N-COR N-ICRA, SUBSQ VESSEL","76100629","CDM","761","RC","37185","HCPCS","facility","both","","","","1008","1008","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERTION VAGINAL RADIATION DEVICE","76100630","CDM","761","RC","57156","HCPCS","facility","both","","","","4805","4805","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERTION VAGINAL RADIATION DEVICE","76100630","CDM","761","RC","57156","HCPCS","facility","both","","","","232.67","232.67","","","","","","","","","","","","","Gross Charge Type: JHH 46 RADIATION ONC"
"HC CORE NEEDLE BX, LUNG/MEDIASTINUM, PERQ, INCL IMG GUIDE","76100631","CDM","761","RC","32408","HCPCS","facility","both","","","","2311","2311","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRQ TRANSLUML MECHNL THROMBECTOMY, VEIN(S), REPEAT TX","76100634","CDM","761","RC","37188","HCPCS","facility","both","","","","11655","11655","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SECONDARY PRQ TRANSLUML THROMBECTOMY, N-CORONARY N-INTRACRANIAL","76100635","CDM","761","RC","37186","HCPCS","facility","both","","","","9562","9562","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRAVASCULAR US, NONCORONARY, INCL RS&I, EA ADDL VESSEL","76100636","CDM","761","RC","37253","HCPCS","facility","both","","","","1715","1715","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSCATH PLACE XCRANIAL VERTEBRAL ART STENT(S), OPEN/PERQ, 1ST VESSEL","76100637","CDM","761","RC","","","facility","both","","","","5477","5477","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRANSCATH PLACE XCRANIAL VERTEBRAL ART STENT(S), OPEN/PERQ, EA ADDL","76100638","CDM","761","RC","","","facility","both","","","","1369","1369","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG 0.5 CM/<","76100639","CDM","761","RC","11600","HCPCS","facility","both","","","","3456","3456","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG 0.6-1.0 CM","76100640","CDM","761","RC","11601","HCPCS","facility","both","","","","4184","4184","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG 1.1-2.0 CM","76100641","CDM","761","RC","11602","HCPCS","facility","both","","","","2041","2041","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG 2.1-3.0 CM","76100642","CDM","761","RC","11603","HCPCS","facility","both","","","","5426","5426","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG 3.1-4.0 CM","76100643","CDM","761","RC","11604","HCPCS","facility","both","","","","6009","6009","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM","76100644","CDM","761","RC","11606","HCPCS","facility","both","","","","9380","9380","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERTION TISSUE EXPANDER(S), NOT BREAST, INCL SBSQ EXPANSION","76100645","CDM","761","RC","11960","HCPCS","facility","both","","","","19763","19763","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPAIR COMPLEX, TRUNK; 1.1-2.5 CM","76100646","CDM","761","RC","13100","HCPCS","facility","both","","","","2873","2873","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADJACENT TISSUE TRANSFER/REARRANGEMENT, TRUNK; 10 SQCM/<","76100647","CDM","761","RC","14000","HCPCS","facility","both","","","","10552","10552","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADJACENT TISSUE TRANSFER/REARRANGEMENT, TRUNK; 10.1-30.0 SQCM","76100648","CDM","761","RC","14001","HCPCS","facility","both","","","","9701","9701","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC APPLY SKIN SUB GRAFT TRUNK/ARMS/LEGS TOTAL AREA/100SQ CM /<1ST 25","76100649","CDM","761","RC","15271","HCPCS","facility","both","","","","1987","1987","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY, INTRANASAL","76100650","CDM","761","RC","30100","HCPCS","facility","both","","","","2222","2222","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION, NASAL POLYP(S), (SIMPLE)","76100651","CDM","761","RC","30110","HCPCS","facility","both","","","","4020","4020","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LAVAGE BY CANNULATION; MAXILLARY SINUS","76100652","CDM","761","RC","31000","HCPCS","facility","both","","","","1278","1278","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NASAL ENDOSCOPY, DIAGNOSTIC, UNIL/BILAT","76100653","CDM","761","RC","31231","HCPCS","facility","both","","","","695","695","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NASAL/SINUS ENDOSCOPY, DIAGNOSTIC, W/MAXILLARY SINUSOSCOPY","76100654","CDM","761","RC","31233","HCPCS","facility","both","","","","1599","1599","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NASAL/SINUS ENDOSCOPY, SURGICAL; W/BX, POLYPECTOMY/DEBRIDE","76100655","CDM","761","RC","31237","HCPCS","facility","both","","","","4026","4026","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NASAL/SINUS ENDOSCOPY, MAX ANTROSTOMY; W/RMVL TISSUE MAX SINUS","76100656","CDM","761","RC","31267","HCPCS","facility","both","","","","24357","24357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NASAL/SINUS ENDOSCOPY; W/SPENOIDOTOMY","76100657","CDM","761","RC","31287","HCPCS","facility","both","","","","18458","18458","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY, INDIRECT; DIAGNOSTIC","76100658","CDM","761","RC","31505","HCPCS","facility","both","","","","695","695","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY W/WO TRACHEOSCOPY; FOR ASPIRATION","76100659","CDM","761","RC","31515","HCPCS","facility","both","","","","1316","1316","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY, DIRECT, OPERATIVE; W/BIOPSY","76100660","CDM","761","RC","31535","HCPCS","facility","both","","","","11951","11951","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY, W/EXCISION TUMOR &/OR STRIPPING  CORDS/EPIGLOTTIS","76100661","CDM","761","RC","31540","HCPCS","facility","both","","","","13010","13010","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPE W/INJ VOCAL CORD(S), THERAPEUTIC","76100662","CDM","761","RC","31570","HCPCS","facility","both","","","","13010","13010","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY W/INJ VOCAL CORD(S), THERAPEUTIC; W/MICRO/TELESCOPE","76100663","CDM","761","RC","31571","HCPCS","facility","both","","","","13010","13010","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY, FLEXIBLE, ABLATE/DESTRUCT LESION(S) W/LASER, UNIL","76100664","CDM","761","RC","31572","HCPCS","facility","both","","","","11404","11404","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY, FLEXIBLE; W/THERAPEUTIC INJECTION(S)","76100665","CDM","761","RC","31573","HCPCS","facility","both","","","","4026","4026","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY, FLEXIBLE; W/INJ(S) FOR AUGMENTATION, UNIL","76100666","CDM","761","RC","31574","HCPCS","facility","both","","","","4026","4026","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY, FLEXIBLE; W/BIOPSY(IES)","76100667","CDM","761","RC","31576","HCPCS","facility","both","","","","2988","2988","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY, FLEXIBLE, W/REMVL LESION(S), NON-LASER","76100668","CDM","761","RC","31578","HCPCS","facility","both","","","","9281","9281","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LARYNGOSCOPY FLEX/RIGID, TELESCOPIC W/STROBOSCOPY","76100669","CDM","761","RC","31579","HCPCS","facility","both","","","","1410","1410","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TRACHEOBRONCOSCOPY VIA ESTABLISHED TRACH INCISION","76100670","CDM","761","RC","31615","HCPCS","facility","both","","","","873","873","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRONCHOSCOPY, INCL FLUOR GUIDE, DX, W/CELL WASHING","76100671","CDM","761","RC","31622","HCPCS","facility","both","","","","3344","3344","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRONCHOSCOPY, INCL FLUOR GUIDE; W/ BRONCHIAL ALVEOLAR LAVAGE","76100672","CDM","761","RC","31624","HCPCS","facility","both","","","","3396","3396","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BRONCHOSCOPY, INCL FLUOR GUIDE, W/BRONCH/ENDOBRONC BX(S),1+ SITES","76100673","CDM","761","RC","31625","HCPCS","facility","both","","","","3964","3964","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SURGICAL CLOSURE OF TRACHEOSTOMY/FISTULA; W/PLASTIC REPAIR","76100674","CDM","761","RC","31825","HCPCS","facility","both","","","","18357","18357","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REVISION OF TRACHEOSTOMY SCAR","76100675","CDM","761","RC","31830","HCPCS","facility","both","","","","9718","9718","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY/EXCISION LYMPH NODE(S); OPEN, SUPERFICIAL","76100676","CDM","761","RC","38500","HCPCS","facility","both","","","","19917","19917","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY OF LIP","76100677","CDM","761","RC","40490","HCPCS","facility","both","","","","830","830","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY, VESTIBULE MOUTH","76100678","CDM","761","RC","40808","HCPCS","facility","both","","","","1002","1002","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION LESION MUCOSA & SUBMUCOSA, VESTIBULE; W/SIMPLE REPAIR","76100679","CDM","761","RC","40812","HCPCS","facility","both","","","","5786","5786","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED PROCEDURE, LIPS","76100680","CDM","761","RC","40799","HCPCS","facility","both","","","","394","394","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INCISION LABIAL FRENUM (FRENOTOMY)","76100681","CDM","761","RC","40806","HCPCS","facility","both","","","","744","744","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION OF FRENUM, LABIAL OR BUCCAL","76100682","CDM","761","RC","40819","HCPCS","facility","both","","","","6252","6252","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INCISION OF LINGUAL FRENUM (FRENOTOMY)","76100683","CDM","761","RC","41010","HCPCS","facility","both","","","","3376","3376","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY OF TONGUE; ANTERIOR 2/3","76100684","CDM","761","RC","41100","HCPCS","facility","both","","","","1233","1233","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY OF TONGUE; POSTERIOR 1/3","76100685","CDM","761","RC","41105","HCPCS","facility","both","","","","4493","4493","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY OF FLOOR OF MOUTH","76100686","CDM","761","RC","41108","HCPCS","facility","both","","","","4595","4595","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION LESION TONGUE W/O CLOSURE","76100687","CDM","761","RC","41110","HCPCS","facility","both","","","","4980","4980","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION OF LINGUAL FRENUM (FRENECTOMY)","76100688","CDM","761","RC","41115","HCPCS","facility","both","","","","4517","4517","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY OF PALATE, UVULA","76100689","CDM","761","RC","42100","HCPCS","facility","both","","","","3332","3332","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SIALOLITHOTOMY; SUBMANDIBULAR, SUBLINGUAL/PAROTID, UNCOMP, INTRAORAL","76100690","CDM","761","RC","42330","HCPCS","facility","both","","","","6276","6276","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY SALIVARY GLAND; INCISIONAL","76100691","CDM","761","RC","42405","HCPCS","facility","both","","","","6972","6972","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION SUBLINGUAL SALIVARY CYST (RANULA)","76100692","CDM","761","RC","42408","HCPCS","facility","both","","","","13378","13378","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DILATION SALIVARY DUCT","76100693","CDM","761","RC","42650","HCPCS","facility","both","","","","2222","2222","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED PROCEDURE, SALIVARY GLANDS OR DUCTS","76100694","CDM","761","RC","42699","HCPCS","facility","both","","","","557","557","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY, OROPHARYNX","76100695","CDM","761","RC","42800","HCPCS","facility","both","","","","3522","3522","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY; NASOPHARYNX, VISIBLE LESION, SIMPLE","76100696","CDM","761","RC","42804","HCPCS","facility","both","","","","4509","4509","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EGD; W/DIRECTED PLACEMENT PERCUTANEOUS GASTROSTOMY TUBE","76100697","CDM","761","RC","43246","HCPCS","facility","both","","","","6836","6836","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EGD; W/INSERT GUIDE WIRE FOLLOWED BY DILATOR PASSAGE ESOPHAGUS","76100698","CDM","761","RC","43248","HCPCS","facility","both","","","","3418","3418","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EGD; W/BALLOON DILATION ESOPHAGUS (<30MM DIAMETER)","76100699","CDM","761","RC","43249","HCPCS","facility","both","","","","5243","5243","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EGD; W/ENDOSCOPIC STENT PLACEMENT (INCL W/GUIDE WIRE &  DILATION)","76100700","CDM","761","RC","43266","HCPCS","facility","both","","","","21168","21168","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DILATION ESOPHAGUS, BY UNGUIDED SOUND/BOUGIE, 1/MULTI PASSES","76100701","CDM","761","RC","43450","HCPCS","facility","both","","","","2474","2474","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION(S), ANESTHETIC AGENT(S) &/OR STERIOD; VAGUS NERVE","76100702","CDM","761","RC","64408","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJ (S), ANESTH AGENT(S) &/OR STERIOD; BRACHIAL PLEXUS, INCL IMG GUIDANCE","76100703","CDM","761","RC","64415","HCPCS","facility","both","","","","4483","4483","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION","76100704","CDM","761","RC","64505","HCPCS","facility","both","","","","1527","1527","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODENERVATION PAROTID & SUBMANDIBULAR SALIVARY GLANDS, BILAT","76100705","CDM","761","RC","64611","HCPCS","facility","both","","","","1757","1757","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODENERVATION MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL NERVE, UNIL","76100706","CDM","761","RC","64612","HCPCS","facility","both","","","","2488","2488","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CHEMODERVATE FACIAL/TRIGEMINAL/CERVICAL MUSCLE, MIGRAINE","76100707","CDM","761","RC","64615","HCPCS","facility","both","","","","2488","2488","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAINAGE EXTERNAL EAR, ABSCESS/HEMATOMA; COMPLICATED","76100708","CDM","761","RC","69005","HCPCS","facility","both","","","","7981","7981","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS","76100709","CDM","761","RC","69020","HCPCS","facility","both","","","","4058","4058","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY EXTERNAL EAR","76100710","CDM","761","RC","69100","HCPCS","facility","both","","","","557","557","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOPSY EXTERNAL AUDITORY CANAL","76100711","CDM","761","RC","69105","HCPCS","facility","both","","","","2222","2222","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL","76100712","CDM","761","RC","69145","HCPCS","facility","both","","","","4747","4747","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEBRIDEMENT MASTOIDECTOMY CAVITY, SIMPLE","76100713","CDM","761","RC","69220","HCPCS","facility","both","","","","883","883","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DEBRIDEMENT MASTOIDECTOMY CAVITY, COMPLEX","76100714","CDM","761","RC","69222","HCPCS","facility","both","","","","1560","1560","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYRINGOTOMY INCL ASPIRATION &/OR EUSTACHIAN TUBE INFLATION","76100715","CDM","761","RC","69420","HCPCS","facility","both","","","","1428","1428","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TYMPANOSTOMY; LOCAL/TOPICAL ANESTHESIA","76100716","CDM","761","RC","69433","HCPCS","facility","both","","","","1503","1503","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MYRINGOPLASTY","76100717","CDM","761","RC","69620","HCPCS","facility","both","","","","18919","18919","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UNLISTED PROCEDURE, MIDDLE EAR","76100718","CDM","761","RC","69799","HCPCS","facility","both","","","","394","394","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LABYRINTHOTOMY, W/PERFUSION VESTIBULOACTIVE DRUG(S); TRANSCANAL","76100719","CDM","761","RC","69801","HCPCS","facility","both","","","","2682","2682","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPERATING MICROSCOPE (ADD-ON CODE)","76100720","CDM","761","RC","69990","HCPCS","facility","both","","","","900","900","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ORBITOTOMY W/O BONE FLAP; W/REMOVAL LESION","76100721","CDM","761","RC","67412","HCPCS","facility","both","","","","11462","11462","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REPLACEMENT OF G-J TUBE, PERC, FLUORO GUIDE, INCL CONTRAST INJ(S)","76100724","CDM","761","RC","49452","HCPCS","facility","both","","","","2255","2255","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRODUCTION CATHETER, RT HEART OR MAIN PULM ARTERY","76100725","CDM","761","RC","36013","HCPCS","facility","both","","","","4881","4881","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELECTIVE CATHETER PLACEMENT, LT OR RT PULM ARTERY","76100726","CDM","761","RC","36014","HCPCS","facility","both","","","","4581","4581","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SELECTIVE CATHETER PLACEMENT, SEGMENTAL OR SUBSEGMENTAL PULM ARTERY","76100727","CDM","761","RC","36015","HCPCS","facility","both","","","","4581","4581","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INSERT UTERINE TANDEM/OVOIDS","76191101","CDM","761","RC","57155","HCPCS","facility","both","","","","3981","3981","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HOSPITAL OBSERVATION SERVICE PER HR","76200001","CDM","762","RC","","","facility","both","","","","98.12","98.12","","","","","","","","","","","","","Gross Charge Type: JHH 80 ALL OBSERVATION"
"HC HOSPITAL OBSERVATION SERVICE PER HR","76200001","CDM","762","RC","","","facility","both","","","","118","118","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OBSERVATION CARE DISCHARGE","76200005","CDM","762","RC","99217","HCPCS","facility","both","","","","847","847","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INITIAL OBSERVATION CARE","76200006","CDM","762","RC","99218","HCPCS","facility","both","","","","1058","1058","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNIZATION ADMIN SQ/IM, SINGLE","77100001","CDM","771","RC","90471","HCPCS","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC IMMUNIZATION ADMIN SQ/IM, SINGLE","77100001","CDM","771","RC","90471","HCPCS","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC IMMUNIZATION ADMIN SQ/IM, SINGLE","77100001","CDM","771","RC","90471","HCPCS","facility","both","","","","169","169","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNIZATION ADMIN SQ/IM, SINGLE","77100001","CDM","771","RC","90471","HCPCS","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC IMMUNIZATION ADMIN SQ/IM, SINGLE","77100001","CDM","771","RC","90471","HCPCS","facility","both","","","","64.95","64.95","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC IMMUNIZATION ADMIN SQ/IM, EA ADDL","77100002","CDM","771","RC","90472","HCPCS","facility","both","","","","32.46","32.46","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC IMMUNIZATION ADMIN SQ/IM, EA ADDL","77100002","CDM","771","RC","90472","HCPCS","facility","both","","","","86","86","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNIZATION ADMIN SQ/IM, EA ADDL","77100002","CDM","771","RC","90472","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC IMMUNIZATION ADMIN SQ/IM, EA ADDL","77100002","CDM","771","RC","90472","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC IMMUNIZATION ADMIN SQ/IM, EA ADDL","77100002","CDM","771","RC","90472","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC IMMUNIZATION ADMIN, NASAL/ORAL SINGLE","77100003","CDM","771","RC","90473","HCPCS","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC IMMUNIZATION ADMIN, NASAL/ORAL SINGLE","77100003","CDM","771","RC","90473","HCPCS","facility","both","","","","64.95","64.95","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC IMMUNIZATION ADMIN, NASAL/ORAL SINGLE","77100003","CDM","771","RC","90473","HCPCS","facility","both","","","","94","94","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNIZATION ADMIN, NASAL/ORAL SINGLE","77100003","CDM","771","RC","90473","HCPCS","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC IMMUNIZATION ADMIN, NASAL/ORAL SINGLE","77100003","CDM","771","RC","90473","HCPCS","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC VACCINE ADMINISTRATION, FLU","77100004","CDM","771","RC","","","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC VACCINE ADMINISTRATION, FLU","77100004","CDM","771","RC","","","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC VACCINE ADMINISTRATION, FLU","77100004","CDM","771","RC","","","facility","both","","","","64.95","64.95","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC VACCINE ADMINISTRATION, FLU","77100004","CDM","771","RC","","","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC VACCINE ADMINISTRATION, FLU","77100004","CDM","771","RC","","","facility","both","","","","74","74","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VACCINE ADMINISTRATION, PNEUMONIA","77100005","CDM","771","RC","","","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC VACCINE ADMINISTRATION, PNEUMONIA","77100005","CDM","771","RC","","","facility","both","","","","71","71","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VACCINE ADMINISTRATION, PNEUMONIA","77100005","CDM","771","RC","","","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC VACCINE ADMINISTRATION, PNEUMONIA","77100005","CDM","771","RC","","","facility","both","","","","64.95","64.95","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC VACCINE ADMINISTRATION, PNEUMONIA","77100005","CDM","771","RC","","","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC VACCINE ADMINISTRATION, HEP B","77100006","CDM","771","RC","","","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC VACCINE ADMINISTRATION, HEP B","77100006","CDM","771","RC","","","facility","both","","","","64.95","64.95","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"HC VACCINE ADMINISTRATION, HEP B","77100006","CDM","771","RC","","","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC VACCINE ADMINISTRATION, HEP B","77100006","CDM","771","RC","","","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC VACCINE ADMINISTRATION, HEP B","77100006","CDM","771","RC","","","facility","both","","","","75","75","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMMUNIZATION ADMIN, NASAL/ORAL, EA ADDL","77100007","CDM","771","RC","90474","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC IMMUNIZATION ADMIN, NASAL/ORAL, EA ADDL","77100007","CDM","771","RC","90474","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC IMMUNIZATION ADMIN, NASAL/ORAL, EA ADDL","77100007","CDM","771","RC","90474","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC IMMUNIZATION ADMIN, NASAL/ORAL, EA ADDL","77100007","CDM","771","RC","90474","HCPCS","facility","both","","","","13","13","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VACCINE ADMINISTRATION, FLU - NURSE ONLY","77100008","CDM","771","RC","","","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC VACCINE ADMINISTRATION, FLU - NURSE ONLY","77100008","CDM","771","RC","","","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC VACCINE ADMINISTRATION, FLU - NURSE ONLY","77100008","CDM","771","RC","","","facility","both","","","","30","30","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 1ST DOSE","77100009","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 1ST DOSE","77100009","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 1ST DOSE","77100009","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 1ST DOSE","77100009","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 2ND DOSE","77100010","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 2ND DOSE","77100010","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 2ND DOSE","77100010","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 2ND DOSE","77100010","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 100MCG/0.5ML 1ST DOSE","77100011","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 100MCG/0.5ML 1ST DOSE","77100011","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 100MCG/0.5ML 1ST DOSE","77100011","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 100MCG/0.5ML 1ST DOSE","77100011","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC IMMUN ADM SARSCOV2 100MCG/0.5ML 2ND DOSE","77100012","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC IMMUN ADM SARSCOV2 100MCG/0.5ML 2ND DOSE","77100012","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC IMMUN ADM SARSCOV2 100MCG/0.5ML 2ND DOSE","77100012","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC IMMUN ADM SARSCOV2 100MCG/0.5ML 2ND DOSE","77100012","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 5X1010VP/.5ML, 1ST DOSE","77100013","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 5X1010VP/.5ML, 1ST DOSE","77100013","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 5X1010VP/.5ML, 1ST DOSE","77100013","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 5X1010VP/.5ML, 1ST DOSE","77100013","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 5X1010VP/.5ML, 2ND DOSE","77100014","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 5X1010VP/.5ML, 2ND DOSE","77100014","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 5X1010VP/.5ML, 2ND DOSE","77100014","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 5X1010VP/.5ML, 2ND DOSE","77100014","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 VAC AD26 /.5ML, SINGLE DOSE","77100015","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 VAC AD26 /.5ML, SINGLE DOSE","77100015","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 VAC AD26 /.5ML, SINGLE DOSE","77100015","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 VAC AD26 /.5ML, SINGLE DOSE","77100015","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 5 MCG/0.5 ML 1ST DOSE","77100016","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 5 MCG/0.5 ML 2ND DOSE","77100017","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 3RD","77100018","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 3RD","77100018","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 3RD","77100018","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML 3RD","77100018","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC IMMUN ADM SARSCOV2 100MCG/0.5ML 3RD DOSE","77100019","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC IMMUN ADM SARSCOV2 100MCG/0.5ML 3RD DOSE","77100019","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC IMMUN ADM SARSCOV2 100MCG/0.5ML 3RD DOSE","77100019","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC IMMUN ADM SARSCOV2 100MCG/0.5ML 3RD DOSE","77100019","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50MCG/0.25ML; BOOSTER DOSE","77100020","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50MCG/0.25ML; BOOSTER DOSE","77100020","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50MCG/0.25ML; BOOSTER DOSE","77100020","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50MCG/0.25ML; BOOSTER DOSE","77100020","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML; BOOSTER DOSE","77100021","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML; BOOSTER DOSE","77100021","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML; BOOSTER DOSE","77100021","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3ML; BOOSTER DOSE","77100021","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 ML; TRIS-SUCROSE FORM; 1ST DOSE","77100022","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 ML; TRIS-SUCROSE FORM; 1ST DOSE","77100022","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 ML; TRIS-SUCROSE FORM; 1ST DOSE","77100022","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 ML; TRIS-SUCROSE FORM; 1ST DOSE","77100022","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 ML; TRIS-SUCROSE FORM; 2ND DOSE","77100023","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 ML; TRIS-SUCROSE FORM; 2ND DOSE","77100023","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 ML; TRIS-SUCROSE FORM; 2ND DOSE","77100023","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 ML; TRIS-SUCROSE FORM; 2ND DOSE","77100023","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC SARSCOV2 VAC AD26 .5ML BOOSTER","77100024","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC SARSCOV2 VAC AD26 .5ML BOOSTER","77100024","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC SARSCOV2 VAC AD26 .5ML BOOSTER","77100024","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC SARSCOV2 VAC AD26 .5ML BOOSTER","77100024","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 4/1/2025 HC TIXAGEVIMAB & CILGAVIMAB, INCL INJ & POST ADMIN MONITORING","77100025","CDM","771","RC","","","facility","both","","","","148.64","148.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 4/1/2025 HC TIXAGEVIMAB & CILGAVIMAB, INCL INJ & POST ADMIN MONITORING","77100025","CDM","771","RC","","","facility","both","","","","96.37","96.37","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 4/1/2025 HC TIXAGEVIMAB & CILGAVIMAB, INCL INJ & POST ADMIN MONITORING","77100025","CDM","771","RC","","","facility","both","","","","1043","1043","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 4/1/2025 HC TIXAGEVIMAB & CILGAVIMAB, INCL INJ & POST ADMIN MONITORING","77100025","CDM","771","RC","","","facility","both","","","","143.01","143.01","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 1ST DOSE","77100026","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 1ST DOSE","77100026","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 1ST DOSE","77100026","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 1ST DOSE","77100026","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 2ND DOSE","77100027","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 2ND DOSE","77100027","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 2ND DOSE","77100027","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 2ND DOSE","77100027","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 3RD DOSE","77100028","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 3RD DOSE","77100028","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 3RD DOSE","77100028","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; 3RD DOSE","77100028","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; BOOSTER","77100029","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; BOOSTER","77100029","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; BOOSTER","77100029","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 30MCG/0.3 ML; TRIS-SUCROSE FORM; BOOSTER","77100029","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 4/1/2025 HC IV INFUSION SOTROVIMAB, INCL INFUSION & POST ADMIN MONITORING","77100030","CDM","771","RC","","","facility","both","","","","1043","1043","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 4/1/2025 HC IV INFUSION SOTROVIMAB, INCL INFUSION & POST ADMIN MONITORING","77100030","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 4/1/2025 HC IV INFUSION SOTROVIMAB, INCL INFUSION & POST ADMIN MONITORING","77100030","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 4/1/2025 HC IV INFUSION SOTROVIMAB, INCL INFUSION & POST ADMIN MONITORING","77100030","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 4/1/2025 HC BEBTELOVIMAB,INCLU INJECTION & POST ADMIN MONITORING","77100031","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 4/1/2025 HC BEBTELOVIMAB,INCLU INJECTION & POST ADMIN MONITORING","77100031","CDM","771","RC","","","facility","both","","","","1043","1043","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 4/1/2025 HC BEBTELOVIMAB,INCLU INJECTION & POST ADMIN MONITORING","77100031","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 4/1/2025 HC BEBTELOVIMAB,INCLU INJECTION & POST ADMIN MONITORING","77100031","CDM","771","RC","","","facility","both","","","","450","450","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML BOOSTER DOSE","77100032","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML BOOSTER DOSE","77100032","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML BOOSTER DOSE","77100032","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML BOOSTER DOSE","77100032","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 10 MCG/0.2 ML TRIS-SUCROSE BOOSTER","77100033","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 10 MCG/0.2 ML TRIS-SUCROSE BOOSTER","77100033","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 10 MCG/0.2 ML TRIS-SUCROSE BOOSTER","77100033","CDM","771","RC","","","facility","both","","","","47","47","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 10 MCG/0.2 ML TRIS-SUCROSE BOOSTER","77100033","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-1ST DOSE","77100034","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-1ST DOSE","77100034","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-1ST DOSE","77100034","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-1ST DOSE","77100034","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-2 DOSE","77100035","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-2 DOSE","77100035","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-2 DOSE","77100035","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-2 DOSE","77100035","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-3 DOSE","77100036","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-3 DOSE","77100036","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-3 DOSE","77100036","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 3MCG TRS-SUCR-3 DOSE","77100036","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 25MCG/0.25ML 1ST DOSE","77100037","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 25MCG/0.25ML 1ST DOSE","77100037","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 25MCG/0.25ML 1ST DOSE","77100037","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 25MCG/0.25ML 1ST DOSE","77100037","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 25MCG/0.25ML 2ND DOSE","77100038","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 25MCG/0.25ML 2ND DOSE","77100038","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 25MCG/0.25ML 2ND DOSE","77100038","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 25MCG/0.25ML 2ND DOSE","77100038","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 1ST DOSE 6-11","77100039","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 1ST DOSE 6-11","77100039","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 1ST DOSE 6-11","77100039","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 1ST DOSE 6-11","77100039","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 2ND DOSE 6-11","77100040","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 2ND DOSE 6-11","77100040","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 2ND DOSE 6-11","77100040","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 2ND DOSE 6-11","77100040","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 3RD DOSE 6-11","77100041","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 3RD DOSE 6-11","77100041","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 3RD DOSE 6-11","77100041","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 50 MCG/0.5 ML 3RD DOSE 6-11","77100041","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC IMM ADM SARSCOV2 25 MCG/0.25 ML 3RD DOSE","77100043","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 11/01/2023 HC IMM ADM SARSCOV2 25 MCG/0.25 ML 3RD DOSE","77100043","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 11/01/2023 HC IMM ADM SARSCOV2 25 MCG/0.25 ML 3RD DOSE","77100043","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCOV2 10MCG/0.2 TRIS-SUCROSE - 3RD DOSE","77100044","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC IMM ADMN SARSCOV2 BIVALENT 30 MCG/0.3 ML BOOSTER","77100045","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC IMM ADMN SARSCOV2 BIVALENT 10 MCG/0.2 ML BOOSTER","77100046","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC IMM ADMN SARSCOV2 BIVALENT 50 MCG/0.5 ML BOOSTER","77100047","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC IMM ADMN SARSCOV2 BIVALENT 25 MCG/0.25 ML BOOSTER","77100048","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADMN SARSCOV2 5 MCG/0.5 ML BOOSTER DOSE","77100049","CDM","771","RC","","","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADMN SARSCOV2 5 MCG/0.5 ML BOOSTER DOSE","77100049","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADMN SARSCOV2 5 MCG/0.5 ML BOOSTER DOSE","77100050","CDM","771","RC","","","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADMN SARSCOV2 5 MCG/0.5 ML BOOSTER DOSE","77100050","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML 3RD DOSE","77100051","CDM","771","RC","","","facility","both","","","","120","120","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML 3RD DOSE","77100051","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCV2 BVL 30MCG/0.3ML 1ST DOSE","77100052","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCV2 BVL 30MCG/0.3ML 1ST DOSE","77100052","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SRSCV2 BVL 25MCG/0.25ML 1ST DOSE","77100053","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SRSCV2 BVL 25MCG/0.25ML 1ST DOSE","77100053","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SRSCV2 BVL 25 MCG/0.25ML 2ND DOSE","77100054","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SRSCV2 BVL 25 MCG/0.25ML 2ND DOSE","77100054","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCV2 BVL 10 MCG/0.2ML 1ST DOSE","77100055","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCV2 BVL 10 MCG/0.2ML 1ST DOSE","77100055","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCV2 BVL 3 MCG/0.2ML 1ST DOSE","77100056","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADM SARSCV2 BVL 3 MCG/0.2ML 1ST DOSE","77100056","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCV2 BVL 3 MCG/0.2ML 2ND DOSE","77100057","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADM SARSCV2 BVL 3 MCG/0.2ML 2ND DOSE","77100057","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 11/01/2023 HC ADMN SARSCOV2 BIVALENT 3 MCG/0.2ML ADDL DOSE","77100058","CDM","771","RC","","","facility","both","","","","49","49","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 11/01/2023 HC ADMN SARSCOV2 BIVALENT 3 MCG/0.2ML ADDL DOSE","77100058","CDM","771","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC IMM ADMN SARSCOV2 VACCINE, SINGLE DOSE","77100059","CDM","771","RC","90480","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC IMM ADMN SARSCOV2 VACCINE, SINGLE DOSE","77100059","CDM","771","RC","90480","HCPCS","facility","both","","","","270","270","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADM RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP","77100060","CDM","771","RC","96380","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC ADM RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP","77100060","CDM","771","RC","96380","HCPCS","facility","both","","","","133","133","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADM RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX","77100061","CDM","771","RC","96381","HCPCS","facility","both","","","","133","133","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ADM RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX","77100061","CDM","771","RC","96381","HCPCS","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 5-10 MIN","78000002","CDM","420","RC","98970","HCPCS","facility","both","","","","33","33","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 5-10 MIN","78000002","CDM","420","RC","98970","HCPCS","facility","both","","","","10.27","10.27","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 5-10 MIN","78000002","CDM","420","RC","98970","HCPCS","facility","both","","","","13.01","13.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 5-10 MIN","78000002","CDM","420","RC","98970","HCPCS","facility","both","","","","12.14","12.14","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 11-20 MIN","78000003","CDM","420","RC","98971","HCPCS","facility","both","","","","12.14","12.14","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 11-20 MIN","78000003","CDM","420","RC","98971","HCPCS","facility","both","","","","13.01","13.01","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 11-20 MIN","78000003","CDM","420","RC","98971","HCPCS","facility","both","","","","10.27","10.27","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 11-20 MIN","78000003","CDM","420","RC","98971","HCPCS","facility","both","","","","57","57","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 21 OR > MIN","78000004","CDM","420","RC","98972","HCPCS","facility","both","","","","20.56","20.56","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 21 OR > MIN","78000004","CDM","420","RC","98972","HCPCS","facility","both","","","","90","90","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 21 OR > MIN","78000004","CDM","420","RC","98972","HCPCS","facility","both","","","","24.26","24.26","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC ONLINE ASSESSMENT, QUAL NON MD, EST PT, UP TO 7 DAYS, 21 OR > MIN","78000004","CDM","420","RC","98972","HCPCS","facility","both","","","","25.96","25.96","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  5-10 MIN","78000005","CDM","940","RC","98966","HCPCS","facility","both","","","","58.17","58.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  5-10 MIN","78000005","CDM","940","RC","98966","HCPCS","facility","both","","","","30.71","30.71","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  5-10 MIN","78000005","CDM","940","RC","98966","HCPCS","facility","both","","","","21.76","21.76","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  11-20 MIN","78000006","CDM","940","RC","98967","HCPCS","facility","both","","","","21.76","21.76","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  11-20 MIN","78000006","CDM","940","RC","98967","HCPCS","facility","both","","","","30.71","30.71","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  11-20 MIN","78000006","CDM","940","RC","98967","HCPCS","facility","both","","","","58.17","58.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  21-30 MIN","78000007","CDM","940","RC","98968","HCPCS","facility","both","","","","58.17","58.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  21-30 MIN","78000007","CDM","940","RC","98968","HCPCS","facility","both","","","","21.76","21.76","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 4/1/2023 HC TELEPHONE ASSESSMENT, NON PHYSICIAN,  21-30 MIN","78000007","CDM","940","RC","98968","HCPCS","facility","both","","","","30.71","30.71","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC INPATIENT HEMODIALYSIS","80100001","CDM","801","RC","","","facility","both","","","","834.39","834.39","","","","","","","","","","","","","Gross Charge Type: JHH 51 RENAL DIALYSIS"
"HC INPATIENT HEMODIALYSIS","80100001","CDM","801","RC","","","facility","both","","","","2924","2924","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC HEMODIALYSIS ONE EVALUATION","80100050","CDM","801","RC","90935","HCPCS","facility","both","","","","2550","2550","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INPATIENT PERITONEAL (NON-CAPD)","80200001","CDM","802","RC","","","facility","both","","","","834.39","834.39","","","","","","","","","","","","","Gross Charge Type: JHH 51 RENAL DIALYSIS"
"HC INPATIENT CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD)","80300001","CDM","803","RC","","","facility","both","","","","834.39","834.39","","","","","","","","","","","","","Gross Charge Type: JHH 51 RENAL DIALYSIS"
"HC INPATIENT CCPD","80400001","CDM","804","RC","90945","HCPCS","facility","both","","","","834.39","834.39","","","","","","","","","","","","","Gross Charge Type: JHH 51 RENAL DIALYSIS"
"HC OTHER INPATIENT DIALYSIS","80900001","CDM","809","RC","","","facility","both","","","","2924","2924","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OTHER INPATIENT DIALYSIS","80900001","CDM","809","RC","","","facility","both","","","","834.39","834.39","","","","","","","","","","","","","Gross Charge Type: JHH 51 RENAL DIALYSIS"
"HC LIVING DONOR KIDNEY TRANSPLANT ORGAN ACQUISITION","81100001","CDM","811","RC","","","facility","both","","","","65000","65000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC KIDNEY, INKTP TRANSPLANT","81100003","CDM","811","RC","","","facility","both","","","","80000","80000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC DECEASED DONOR KIDNEY TRANSPLANT ORGAN ACQUISITION","81200001","CDM","812","RC","","","facility","both","","","","80500","80500","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC BONE MARROW ACQUISITION FEE","81500001","CDM","815","RC","","","facility","both","","","","21000","21000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC BONE MARROW ACQUISTION FEE","81900001","CDM","819","RC","","","facility","both","","","","31000","31000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC EMERGENCY DIALYSIS ESRD PT","82900001","CDM","829","RC","","","facility","both","","","","3839","3839","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EMERGENCY DIALYSIS ESRD PT","82900001","CDM","829","RC","","","facility","both","","","","834.39","834.39","","","","","","","","","","","","","Gross Charge Type: JHH 51 RENAL DIALYSIS"
"HC CCPD OUTPATIENT OR HOME","85100001","CDM","851","RC","90945","HCPCS","facility","both","","","","102.62","102.62","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC CCPD SELF CARE TRAINING","85100002","CDM","851","RC","90999","HCPCS","facility","both","","","","242.41","242.41","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"DEAC 01/01/2025 HC CAR-T; COLLECT BLOOD-DERIVED T LYMPHOCYTES; AUTOLOGOUS; PER DAY","87100001","CDM","871","RC","","","facility","both","","","","6038.09","6038.09","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC CAR-T; COLLECT BLOOD-DERIVED T LYMPHOCYTES; AUTOLOGOUS; PER DAY","87100005","CDM","871","RC","38225","HCPCS","facility","both","","","","7225.52","7225.52","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"DEAC 01/01/2025 HC CAR-T; PREPARATION BLOOD DERIVED T LYMPHOCYTES; TRANSPORATION","87200001","CDM","872","RC","","","facility","both","","","","7331.98","7331.98","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC CAR-T; PREPARATION BLOOD DERIVED T LYMPHOCYTES; TRANSPORTATION","87200006","CDM","872","RC","38226","HCPCS","facility","both","","","","8773.86","8773.86","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"DEAC 01/01/2025 HC CAR-T; RECEIPT AND PREPARATION STORAGE; ADMINISTRATION","87300001","CDM","873","RC","","","facility","both","","","","2156.5","2156.5","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"HC CAR-T; RECEIPT AND PREPARATION STORAGE; ADMINISTRATION","87300007","CDM","873","RC","38227","HCPCS","facility","both","","","","2580.54","2580.54","","","","","","","","","","","","","Gross Charge Type: JHH 57 LEUKOPHERESIS (LEU)"
"DEAC 01/01/2025 HC CAR-T; INFUSION CELL ADMINISTRATION; AUTOLOGOUS","87400001","CDM","874","RC","","","facility","both","","","","584.55","584.55","","","","","","","","","","","","","Gross Charge Type: JHH 35 ONCOLOGY CLINIC  (OCL)"
"DEAC 01/01/2025 HC CAR-T; INFUSION CELL ADMINISTRATION; AUTOLOGOUS","87400001","CDM","874","RC","","","facility","both","","","","1129.76","1129.76","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 01/01/2025 HC CAR-T; INFUSION CELL ADMINISTRATION; AUTOLOGOUS","87400001","CDM","874","RC","","","facility","both","","","","603.56","603.56","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 01/01/2025 HC CAR-T; INFUSION CELL ADMINISTRATION; AUTOLOGOUS","87400001","CDM","874","RC","","","facility","both","","","","422.61","422.61","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CAR-T; INFUSION CELL ADMINISTRATION; AUTOLOGOUS","87400008","CDM","874","RC","38228","HCPCS","facility","both","","","","1159.31","1159.31","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CAR-T; INFUSION CELL ADMINISTRATION; AUTOLOGOUS","87400008","CDM","874","RC","38228","HCPCS","facility","both","","","","433.73","433.73","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CAR-T; INFUSION CELL ADMINISTRATION; AUTOLOGOUS","87400008","CDM","874","RC","38228","HCPCS","facility","both","","","","668.88","668.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC DECEASED DONOR LIVER TRANSPLANT ORGAN ACQUISITION","89200001","CDM","812","RC","","","facility","both","","","","85000","85000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC HEART/LUNG TRANSPLANT ORGAN ACQUISITION","89200002","CDM","812","RC","","","facility","both","","","","150000","150000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC PANCREAS TRANSPLANT ORGAN ACQUISITION","89200003","CDM","812","RC","","","facility","both","","","","50000","50000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC KIDNEY/PANCREAS TRANSPLANT ORGAN ACQUISITION","89200005","CDM","892","RC","","","facility","both","","","","115000","115000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC HEART TRANSPLANT ORGAN ACQUISITION","89200006","CDM","812","RC","","","facility","both","","","","90000","90000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC LIVING DONOR LIVER TRANSPLANT ORGAN ACQUISITION","89200007","CDM","812","RC","","","facility","both","","","","70000","70000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC SINGLE LUNG TRANSPLANT ORGAN ACQUISITION","89200008","CDM","812","RC","","","facility","both","","","","95000","95000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC DOUBLE LUNG TRANSPLANT ORGAN ACQUISITION","89200009","CDM","812","RC","","","facility","both","","","","95000","95000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC HAND TRANSPLANT ORGAN ACQUISITION","89200014","CDM","812","RC","","","facility","both","","","","85000","85000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC FACE TRANSPLANT ORGAN ACQUISITION","89200015","CDM","812","RC","","","facility","both","","","","85000","85000","","","","","","","","","","","","","Gross Charge Type: JHH 55 ORGAN ACQUISITION (OA)"
"HC PSYCH DIAGNOSTIC EVALUATION","90000010","CDM","900","RC","90791","HCPCS","facility","both","","","","445.96","445.96","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCH DIAGNOSTIC EVALUATION","90000010","CDM","900","RC","90791","HCPCS","facility","both","","","","772.94","772.94","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCH DIAGNOSTIC EVALUATION","90000010","CDM","900","RC","90791","HCPCS","facility","both","","","","289.13","289.13","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCH DIAG EVAL W/MED SRVCS","90000020","CDM","900","RC","90792","HCPCS","facility","both","","","","361.41","361.41","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCH DIAG EVAL W/MED SRVCS","90000020","CDM","900","RC","90792","HCPCS","facility","both","","","","557.47","557.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCH DIAG EVAL W/MED SRVCS","90000020","CDM","900","RC","90792","HCPCS","facility","both","","","","966.18","966.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCHOTHERAPY CRISIS EA ADDL 30 MIN","90000021","CDM","900","RC","90840","HCPCS","facility","both","","","","322.04","322.04","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCHOTHERAPY CRISIS EA ADDL 30 MIN","90000021","CDM","900","RC","90840","HCPCS","facility","both","","","","185.83","185.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCHOTHERAPY CRISIS EA ADDL 30 MIN","90000021","CDM","900","RC","90840","HCPCS","facility","both","","","","120.47","120.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC TCRANIAL MAGN STIM TX PLAN","90000050","CDM","900","RC","90867","HCPCS","facility","both","","","","341","341","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC TCRANIAL MAGN STIM TX DELI","90000051","CDM","900","RC","90868","HCPCS","facility","both","","","","894","894","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ECT TREATMENT PRICE PER MIN","90100001","CDM","901","RC","90870","HCPCS","facility","both","","","","1009","1009","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ECT TREATMENT PRICE PER MIN","90100001","CDM","901","RC","90870","HCPCS","facility","both","","","","40.63","40.63","","","","","","","","","","","","","Gross Charge Type: JHH 40 OR"
"HC INTENSIVE OUTPATIENT PSYCH PER DAY","90500001","CDM","905","RC","","","facility","both","","","","966.18","966.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC INTENSIVE OUTPATIENT PSYCH PER DAY","90500001","CDM","905","RC","","","facility","both","","","","557.47","557.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC INTENSIVE OUTPATIENT PSYCH PER DAY","90500001","CDM","905","RC","","","facility","both","","","","361.41","361.41","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PARTIAL HOSPITAL, LESS INTENSIVE","91200001","CDM","912","RC","","","facility","both","","","","1776.57","1776.57","","","","","","","","","","","","","Gross Charge Type: JHH 32 PSYCH. DAY & NIGHT CARE SERV (PDC)"
"HC HEALTH & BEHAVIORAL INTERVENTION, EA 15 MIN","91400008","CDM","949","RC","96152","HCPCS","facility","both","","","","85.62","85.62","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HEALTH & BEHAVIORAL INTERVENTION, EA 15 MIN","91400008","CDM","949","RC","96152","HCPCS","facility","both","","","","115.4","115.4","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HEALTH & BEHAVIORAL INTERVENTION, EA 15 MIN","91400008","CDM","949","RC","96152","HCPCS","facility","both","","","","228.91","228.91","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCH STATUS REPORT","91400011","CDM","914","RC","90889","HCPCS","facility","both","","","","290.84","290.84","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCH STATUS REPORT","91400011","CDM","914","RC","90889","HCPCS","facility","both","","","","108.83","108.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCH STATUS REPORT","91400011","CDM","914","RC","90889","HCPCS","facility","both","","","","153.58","153.58","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYTX COMPLEX INTERACTIVE","91400030","CDM","914","RC","90785","HCPCS","facility","both","","","","64.43","64.43","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYTX COMPLEX INTERACTIVE","91400030","CDM","914","RC","90785","HCPCS","facility","both","","","","37.16","37.16","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYTX COMPLEX INTERACTIVE","91400030","CDM","914","RC","90785","HCPCS","facility","both","","","","24.07","24.07","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCHOTHERAPY PT 30 MINUTES","91400050","CDM","914","RC","90832","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC PSYCHOTHERAPY PT 30 MINUTES","91400050","CDM","914","RC","90832","HCPCS","facility","both","","","","322.04","322.04","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCHOTHERAPY PT 30 MINUTES","91400050","CDM","914","RC","90832","HCPCS","facility","both","","","","120.47","120.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCHOTHERAPY PT 30 MINUTES","91400050","CDM","914","RC","90832","HCPCS","facility","both","","","","185.83","185.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCHOTHERAPY PT 30 MINUTES","91400050","CDM","914","RC","90832","HCPCS","facility","both","","","","363.79","363.79","","","","","","","","","","","","","Gross Charge Type: JHH 32 PSYCH. DAY & NIGHT CARE SERV (PDC)"
"HC PSYCHOTHERAPY PT W/E&M 30 MIN","91400052","CDM","914","RC","90833","HCPCS","facility","both","","","","120.47","120.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCHOTHERAPY PT W/E&M 30 MIN","91400052","CDM","914","RC","90833","HCPCS","facility","both","","","","185.83","185.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCHOTHERAPY PT W/E&M 30 MIN","91400052","CDM","914","RC","90833","HCPCS","facility","both","","","","322.04","322.04","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCHOTHERAPY PT 45 MINUTES","91400055","CDM","914","RC","90834","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC PSYCHOTHERAPY PT 45 MINUTES","91400055","CDM","914","RC","90834","HCPCS","facility","both","","","","144.56","144.56","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCHOTHERAPY PT 45 MINUTES","91400055","CDM","914","RC","90834","HCPCS","facility","both","","","","601.36","601.36","","","","","","","","","","","","","Gross Charge Type: JHH 32 PSYCH. DAY & NIGHT CARE SERV (PDC)"
"HC PSYCHOTHERAPY PT 45 MINUTES","91400055","CDM","914","RC","90834","HCPCS","facility","both","","","","386.48","386.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCHOTHERAPY PT 45 MINUTES","91400055","CDM","914","RC","90834","HCPCS","facility","both","","","","222.98","222.98","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCHOTHERAPY PT W/E&M 45 MIN","91400060","CDM","914","RC","90836","HCPCS","facility","both","","","","144.56","144.56","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCHOTHERAPY PT W/E&M 45 MIN","91400060","CDM","914","RC","90836","HCPCS","facility","both","","","","386.48","386.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCHOTHERAPY PT W/E&M 45 MIN","91400060","CDM","914","RC","90836","HCPCS","facility","both","","","","222.98","222.98","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCHOTHERAPY PT 60 MINUTES","91400061","CDM","914","RC","90837","HCPCS","facility","both","","","","579.69","579.69","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCHOTHERAPY PT 60 MINUTES","91400061","CDM","914","RC","90837","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC PSYCHOTHERAPY PT 60 MINUTES","91400061","CDM","914","RC","90837","HCPCS","facility","both","","","","334.48","334.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCHOTHERAPY PT 60 MINUTES","91400061","CDM","914","RC","90837","HCPCS","facility","both","","","","216.88","216.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCHOTHERAPY PT W/E&M 60 MIN","91400062","CDM","914","RC","90838","HCPCS","facility","both","","","","216.88","216.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCHOTHERAPY PT W/E&M 60 MIN","91400062","CDM","914","RC","90838","HCPCS","facility","both","","","","334.48","334.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCHOTHERAPY PT W/E&M 60 MIN","91400062","CDM","914","RC","90838","HCPCS","facility","both","","","","579.69","579.69","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCHOTHERAPY  CRISIS,  INITIAL 60 MIN","91400063","CDM","914","RC","90839","HCPCS","facility","both","","","","216.88","216.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT","91400064","CDM","949","RC","96156","HCPCS","facility","both","","","","386.48","386.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT","91400064","CDM","949","RC","96156","HCPCS","facility","both","","","","222.98","222.98","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT","91400064","CDM","949","RC","96156","HCPCS","facility","both","","","","144.56","144.56","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV INDIV FACE TO FACE; 1ST 30 MIN","91400065","CDM","949","RC","96158","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV INDIV FACE TO FACE; 1ST 30 MIN","91400065","CDM","949","RC","96158","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV INDIV FACE TO FACE; 1ST 30 MIN","91400065","CDM","949","RC","96158","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV INDIV FACE TO FACE; EA ADDL 15 MIN","91400066","CDM","949","RC","96159","HCPCS","facility","both","","","","24.07","24.07","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV INDIV FACE TO FACE; EA ADDL 15 MIN","91400066","CDM","949","RC","96159","HCPCS","facility","both","","","","37.16","37.16","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV INDIV FACE TO FACE; EA ADDL 15 MIN","91400066","CDM","949","RC","96159","HCPCS","facility","both","","","","64.43","64.43","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC GROUP PSYCHOTHERAPY","91500001","CDM","915","RC","90853","HCPCS","facility","both","","","","485.57","485.57","","","","","","","","","","","","","Gross Charge Type: JHH 32 PSYCH. DAY & NIGHT CARE SERV (PDC)"
"HC GROUP PSYCHOTHERAPY","91500001","CDM","915","RC","90853","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC GROUP PSYCHOTHERAPY","91500001","CDM","915","RC","90853","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC GROUP PSYCHOTHERAPY","91500001","CDM","915","RC","90853","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC GROUP PSYCHOTHERAPY","91500001","CDM","915","RC","90853","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC HEALTH/BEHAVIOR INTERVENTION, EA 15 MINS, GROUP","91500003","CDM","949","RC","96153","HCPCS","facility","both","","","","115.42","115.42","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV GROUP FACE TO FACE; 1ST 30 MIN","91500004","CDM","949","RC","96164","HCPCS","facility","both","","","","37.16","37.16","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV GROUP FACE TO FACE; 1ST 30 MIN","91500004","CDM","949","RC","96164","HCPCS","facility","both","","","","24.07","24.07","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV GROUP FACE TO FACE; 1ST 30 MIN","91500004","CDM","949","RC","96164","HCPCS","facility","both","","","","64.43","64.43","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV GROUP FACE TO FACE;  EA ADDL 15 MIN","91500005","CDM","949","RC","96165","HCPCS","facility","both","","","","64.43","64.43","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV GROUP FACE TO FACE;  EA ADDL 15 MIN","91500005","CDM","949","RC","96165","HCPCS","facility","both","","","","24.07","24.07","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV GROUP FACE TO FACE;  EA ADDL 15 MIN","91500005","CDM","949","RC","96165","HCPCS","facility","both","","","","37.16","37.16","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC FAMILY THERAPY W/O PATIENT; 50 MIN","91600001","CDM","916","RC","90846","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC FAMILY THERAPY W/O PATIENT; 50 MIN","91600001","CDM","916","RC","90846","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC FAMILY THERAPY W/O PATIENT; 50 MIN","91600001","CDM","916","RC","90846","HCPCS","facility","both","","","","1776.57","1776.57","","","","","","","","","","","","","Gross Charge Type: JHH 32 PSYCH. DAY & NIGHT CARE SERV (PDC)"
"HC FAMILY THERAPY W/O PATIENT; 50 MIN","91600001","CDM","916","RC","90846","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC FAMILY THERAPY W/O PATIENT; 50 MIN","91600001","CDM","916","RC","90846","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC FAMILY THERAPY W/PATIENT; 50 MIN","91600002","CDM","916","RC","90847","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC FAMILY THERAPY W/PATIENT; 50 MIN","91600002","CDM","916","RC","90847","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC FAMILY THERAPY W/PATIENT; 50 MIN","91600002","CDM","916","RC","90847","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC FAMILY THERAPY W/PATIENT; 50 MIN","91600002","CDM","916","RC","90847","HCPCS","facility","both","","","","485.57","485.57","","","","","","","","","","","","","Gross Charge Type: JHH 32 PSYCH. DAY & NIGHT CARE SERV (PDC)"
"HC FAMILY THERAPY W/PATIENT; 50 MIN","91600002","CDM","916","RC","90847","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC H&B INTERVENTION, FAMILY W/PT, EA 15 MIN","91600003","CDM","949","RC","96154","HCPCS","facility","both","","","","85.62","85.62","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC H&B INTERVENTION, FAMILY W/PT, EA 15 MIN","91600003","CDM","949","RC","96154","HCPCS","facility","both","","","","228.91","228.91","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC H&B INTERVENTION, FAMILY W/PT, EA 15 MIN","91600003","CDM","949","RC","96154","HCPCS","facility","both","","","","115.4","115.4","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC H&B INTERVENTION, FAMILY ONLY, EA 15 MIN","91600004","CDM","949","RC","96155","HCPCS","facility","both","","","","228.91","228.91","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC H&B INTERVENTION, FAMILY ONLY, EA 15 MIN","91600004","CDM","949","RC","96155","HCPCS","facility","both","","","","115.4","115.4","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC H&B INTERVENTION, FAMILY ONLY, EA 15 MIN","91600004","CDM","949","RC","96155","HCPCS","facility","both","","","","85.62","85.62","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC MULTI-FAMILY GROUP THERAPY","91600005","CDM","916","RC","90849","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC MULTI-FAMILY GROUP THERAPY","91600005","CDM","916","RC","90849","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC MULTI-FAMILY GROUP THERAPY","91600005","CDM","916","RC","90849","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV FAM W/PT FACE TO FACE;  1ST 30 MIN","91600006","CDM","949","RC","96167","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV FAM W/PT FACE TO FACE;  1ST 30 MIN","91600006","CDM","949","RC","96167","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV FAM W/PT FACE TO FACE;  1ST 30 MIN","91600006","CDM","949","RC","96167","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV FAM W/PT FACE TO FACE; EA ADD 15 MIN","91600007","CDM","949","RC","96168","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV FAM W/PT FACE TO FACE; EA ADD 15 MIN","91600007","CDM","949","RC","96168","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV FAM W/PT FACE TO FACE; EA ADD 15 MIN","91600007","CDM","949","RC","96168","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV FAM W/O PT FACE TO FACE; 1ST 30 MIN","91600008","CDM","949","RC","96170","HCPCS","facility","both","","","","450.86","450.86","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV FAM W/O PT FACE TO FACE; 1ST 30 MIN","91600008","CDM","949","RC","96170","HCPCS","facility","both","","","","168.65","168.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV FAM W/O PT FACE TO FACE; 1ST 30 MIN","91600008","CDM","949","RC","96170","HCPCS","facility","both","","","","260.17","260.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV FAM W/O PT FACE TO FACE; EA ADDL 15","91600009","CDM","949","RC","96171","HCPCS","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV FAM W/O PT FACE TO FACE; EA ADDL 15","91600009","CDM","949","RC","96171","HCPCS","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HEALTH BEHAVIOR INTERV FAM W/O PT FACE TO FACE; EA ADDL 15","91600009","CDM","949","RC","96171","HCPCS","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC BIOFEEDBACK TRAINING W/EMG","91700001","CDM","917","RC","90911","HCPCS","facility","both","","","","115.4","115.4","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC BIOFEEDBACK TRAINING W/EMG","91700001","CDM","917","RC","90911","HCPCS","facility","both","","","","85.51","85.51","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC BIOFEEDBACK TRAINING W/EMG","91700001","CDM","917","RC","90911","HCPCS","facility","both","","","","461","461","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOFEEDBACK TRAINING W/EMG","91700001","CDM","917","RC","90911","HCPCS","facility","both","","","","218.63","218.63","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC BIOFEEDBACK TRAINING W/EMG","91700001","CDM","917","RC","90911","HCPCS","facility","both","","","","81.78","81.78","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC BIOFEEDBACK TRAINING BY ANY MODALITY","91700050","CDM","917","RC","90901","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC BIOFEEDBACK TRAINING BY ANY MODALITY","91700050","CDM","917","RC","90901","HCPCS","facility","both","","","","184","184","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BIOFEEDBACK TRAINING BY ANY MODALITY","91700050","CDM","917","RC","90901","HCPCS","facility","both","","","","76.37","76.37","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC BIOFEEDBACK TRAINING BY ANY MODALITY","91700050","CDM","917","RC","90901","HCPCS","facility","both","","","","82.61","82.61","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC BFB TRAING W/EMG &/MANOMETRY; 1ST 15 MIN W/PT CONTACT","91700051","CDM","917","RC","90912","HCPCS","facility","both","","","","65.3","65.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC BFB TRAING W/EMG &/MANOMETRY; 1ST 15 MIN W/PT CONTACT","91700051","CDM","917","RC","90912","HCPCS","facility","both","","","","179","179","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC BFB TRAING W/EMG &/MANOMETRY; 1ST 15 MIN W/PT CONTACT","91700051","CDM","917","RC","90912","HCPCS","facility","both","","","","131","131","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BFB TRAING W/EMG &/MANOMETRY; 1ST 15 MIN W/PT CONTACT","91700051","CDM","917","RC","90912","HCPCS","facility","both","","","","174.51","174.51","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC BFB TRAING W/EMG &/MANOMETRY; 1ST 15 MIN W/PT CONTACT","91700051","CDM","917","RC","90912","HCPCS","facility","both","","","","143.21","143.21","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC BFB TRAING W/EMG &/MANOMETRY; 1ST 15 MIN W/PT CONTACT","91700051","CDM","917","RC","90912","HCPCS","facility","both","","","","92.14","92.14","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC BFB TRAING W/EMG&/MANOMETRY; EA ADDL 15 MIN W/PT CONTACT","91700052","CDM","917","RC","90913","HCPCS","facility","both","","","","174.51","174.51","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC BFB TRAING W/EMG&/MANOMETRY; EA ADDL 15 MIN W/PT CONTACT","91700052","CDM","917","RC","90913","HCPCS","facility","both","","","","92.14","92.14","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC BFB TRAING W/EMG&/MANOMETRY; EA ADDL 15 MIN W/PT CONTACT","91700052","CDM","917","RC","90913","HCPCS","facility","both","","","","65.3","65.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC BFB TRAING W/EMG&/MANOMETRY; EA ADDL 15 MIN W/PT CONTACT","91700052","CDM","917","RC","90913","HCPCS","facility","both","","","","38.2","38.2","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC BFB TRAING W/EMG&/MANOMETRY; EA ADDL 15 MIN W/PT CONTACT","91700052","CDM","917","RC","90913","HCPCS","facility","both","","","","54","54","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PSYCH TESTING, PER HR, PSYCH","91800001","CDM","918","RC","96101","HCPCS","facility","both","","","","288.88","288.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCH TESTING, PER HR, PSYCH","91800001","CDM","918","RC","96101","HCPCS","facility","both","","","","407.58","407.58","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCH TESTING, PER HR, PSYCH","91800001","CDM","918","RC","96101","HCPCS","facility","both","","","","772.06","772.06","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCH TESTING, PER HR, TECH","91800002","CDM","918","RC","96102","HCPCS","facility","both","","","","407.58","407.58","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCH TESTING, PER HR, TECH","91800002","CDM","918","RC","96102","HCPCS","facility","both","","","","288.88","288.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCH TESTING, PER HR, TECH","91800002","CDM","918","RC","96102","HCPCS","facility","both","","","","772.06","772.06","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCH TESTING, COMPUTER","91800003","CDM","918","RC","96103","HCPCS","facility","both","","","","288.88","288.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCH TESTING, COMPUTER","91800003","CDM","918","RC","96103","HCPCS","facility","both","","","","407.58","407.58","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCH TESTING, COMPUTER","91800003","CDM","918","RC","96103","HCPCS","facility","both","","","","772.06","772.06","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC NEUROBEHAVIORAL STATUS EXAM, FIRST HR","91800004","CDM","918","RC","96116","HCPCS","facility","both","","","","515.27","515.27","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC NEUROBEHAVIORAL STATUS EXAM, FIRST HR","91800004","CDM","918","RC","96116","HCPCS","facility","both","","","","192.75","192.75","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC NEUROBEHAVIORAL STATUS EXAM, FIRST HR","91800004","CDM","918","RC","96116","HCPCS","facility","both","","","","297.32","297.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC NEUROPSYCH TESTING, PER HR, PSYCH","91800005","CDM","918","RC","96118","HCPCS","facility","both","","","","772.06","772.06","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC NEUROPSYCH TESTING, PER HR, PSYCH","91800005","CDM","918","RC","96118","HCPCS","facility","both","","","","407.58","407.58","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC NEUROPSYCH TESTING, PER HR, PSYCH","91800005","CDM","918","RC","96118","HCPCS","facility","both","","","","288.88","288.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC NEUROPSYCH TESTING, PER HR, TECH","91800006","CDM","918","RC","96119","HCPCS","facility","both","","","","772.06","772.06","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC NEUROPSYCH TESTING, PER HR, TECH","91800006","CDM","918","RC","96119","HCPCS","facility","both","","","","288.88","288.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC NEUROPSYCH TESTING, PER HR, TECH","91800006","CDM","918","RC","96119","HCPCS","facility","both","","","","407.58","407.58","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC NEUROPSYCH TESTING, PER HR, COMPUTER","91800007","CDM","918","RC","96120","HCPCS","facility","both","","","","288.88","288.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC NEUROPSYCH TESTING, PER HR, COMPUTER","91800007","CDM","918","RC","96120","HCPCS","facility","both","","","","407.58","407.58","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC NEUROPSYCH TESTING, PER HR, COMPUTER","91800007","CDM","918","RC","96120","HCPCS","facility","both","","","","772.06","772.06","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HEALTH & BEHAVIORAL ASSESSMENT, EA 15 MIN","91800008","CDM","949","RC","96150","HCPCS","facility","both","","","","85.62","85.62","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HEALTH & BEHAVIORAL ASSESSMENT, EA 15 MIN","91800008","CDM","949","RC","96150","HCPCS","facility","both","","","","228.91","228.91","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC HEALTH & BEHAVIORAL ASSESSMENT, EA 15 MIN","91800008","CDM","949","RC","96150","HCPCS","facility","both","","","","115.4","115.4","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HEALTH & BEHAVIORAL RE-ASSESSMENT, EA 15 MIN","91800009","CDM","949","RC","96151","HCPCS","facility","both","","","","85.62","85.62","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC HEALTH & BEHAVIORAL RE-ASSESSMENT, EA 15 MIN","91800009","CDM","949","RC","96151","HCPCS","facility","both","","","","115.4","115.4","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC HEALTH & BEHAVIORAL RE-ASSESSMENT, EA 15 MIN","91800009","CDM","949","RC","96151","HCPCS","facility","both","","","","228.91","228.91","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC DEVELOPMENTAL TEST EXTEND","91800020","CDM","918","RC","96111","HCPCS","facility","both","","","","407.58","407.58","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC DEVELOPMENTAL TEST EXTEND","91800020","CDM","918","RC","96111","HCPCS","facility","both","","","","114.54","114.54","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC DEVELOPMENTAL TEST EXTEND","91800020","CDM","918","RC","96111","HCPCS","facility","both","","","","288.88","288.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC DEVELOPMENTAL TEST EXTEND","91800020","CDM","918","RC","96111","HCPCS","facility","both","","","","138.11","138.11","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC DEVELOPMENTAL TEST EXTEND","91800020","CDM","918","RC","96111","HCPCS","facility","both","","","","772.06","772.06","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PSYCH TESTING EVALUATION PHYSICIAN/HEALTH PROF, FIRST HR","91800021","CDM","918","RC","96130","HCPCS","facility","both","","","","297.32","297.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCH TESTING EVALUATION PHYSICIAN/HEALTH PROF, FIRST HR","91800021","CDM","918","RC","96130","HCPCS","facility","both","","","","192.75","192.75","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCH TESTING EVALUATION  PHYSICIAN/HEALTH PROF, EA ADDL HR","91800022","CDM","918","RC","96131","HCPCS","facility","both","","","","222.98","222.98","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCH TESTING EVALUATION  PHYSICIAN/HEALTH PROF, EA ADDL HR","91800022","CDM","918","RC","96131","HCPCS","facility","both","","","","144.56","144.56","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCH/NEUROPSYCH TEST, TWO/MORE, FIRST 30 MIN, TECH","91800023","CDM","918","RC","96138","HCPCS","facility","both","","","","240.95","240.95","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCH/NEUROPSYCH TEST, TWO/MORE, FIRST 30 MIN, TECH","91800023","CDM","918","RC","96138","HCPCS","facility","both","","","","371.65","371.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCH/NEUROPSYCH TEST, TWO/MORE, EA ADDL 30 MIN, TECH","91800024","CDM","918","RC","96139","HCPCS","facility","both","","","","371.65","371.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PSYCH/NEUROPSYCH TEST, TWO/MORE, EA ADDL 30 MIN, TECH","91800024","CDM","918","RC","96139","HCPCS","facility","both","","","","240.95","240.95","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCH/NEUROPSYCH TESTING, SINGLE AUTOMATED  RESULT","91800025","CDM","918","RC","96146","HCPCS","facility","both","","","","261.2","261.2","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PSYCH/NEUROPSYCH TESTING, SINGLE AUTOMATED  RESULT","91800025","CDM","918","RC","96146","HCPCS","facility","both","","","","368.57","368.57","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC DEVELOPMENTAL TEST EXTEND, FIRST HOUR","91800026","CDM","918","RC","96112","HCPCS","facility","both","","","","365","365","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC DEVELOPMENTAL TEST EXTEND, EA ADDL 30 MINUTES","91800027","CDM","918","RC","96113","HCPCS","facility","both","","","","165","165","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC NEUROPSYCH TESTING EVALUATION, PHYS/HEALTH PROF; FIRST HOUR","91800028","CDM","918","RC","96132","HCPCS","facility","both","","","","289.15","289.15","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC NEUROPSYCH TESTING EVALUATION, PHYS/HEALTH PROF; FIRST HOUR","91800028","CDM","918","RC","96132","HCPCS","facility","both","","","","445.96","445.96","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC NEUROPSYCH TESTING EVALUATION, PHYS/HEALTH PROF; EA ADDL HR","91800029","CDM","918","RC","96133","HCPCS","facility","both","","","","334.48","334.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC NEUROPSYCH TESTING EVALUATION, PHYS/HEALTH PROF; EA ADDL HR","91800029","CDM","918","RC","96133","HCPCS","facility","both","","","","216.88","216.88","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC NEUROPSYCH TEST, TWO/MORE, FIRST 30 MIN, PHYS/ HEALTH PROF","91800030","CDM","918","RC","96136","HCPCS","facility","both","","","","168.65","168.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC NEUROPSYCH TEST, TWO/MORE, FIRST 30 MIN, PHYS/ HEALTH PROF","91800030","CDM","918","RC","96136","HCPCS","facility","both","","","","260.17","260.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC NEUROPSYCH TEST, TWO/MORE, EA ADDL 30 MINS, PHYS/HEALTH PROF","91800031","CDM","918","RC","96137","HCPCS","facility","both","","","","260.17","260.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC NEUROPSYCH TEST, TWO/MORE, EA ADDL 30 MINS, PHYS/HEALTH PROF","91800031","CDM","918","RC","96137","HCPCS","facility","both","","","","168.65","168.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC NEUROBEHAVIORAL STATUS EXAM, EA ADDL HR, PHYS/ HEALTH PROF","91800032","CDM","918","RC","96121","HCPCS","facility","both","","","","120.47","120.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC NEUROBEHAVIORAL STATUS EXAM, EA ADDL HR, PHYS/ HEALTH PROF","91800032","CDM","918","RC","96121","HCPCS","facility","both","","","","185.83","185.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC MH SVC PLAN DEVELOP BY NON-PHYSICIAN","91900015","CDM","919","RC","","","facility","both","","","","289.13","289.13","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC DETERMINATION OF REFRACTIVE STATE","92000001","CDM","920","RC","92015","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC DETERMINATION OF REFRACTIVE STATE","92000001","CDM","920","RC","92015","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC DETERMINATION OF REFRACTIVE STATE","92000001","CDM","920","RC","92015","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC GONIOSCOPY","92000002","CDM","920","RC","92020","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC GONIOSCOPY","92000002","CDM","920","RC","92020","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC GONIOSCOPY","92000002","CDM","920","RC","92020","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC BINOCULAR VISION EXAM, I&R","92000003","CDM","920","RC","92060","HCPCS","facility","both","","","","297.32","297.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC BINOCULAR VISION EXAM, I&R","92000003","CDM","920","RC","92060","HCPCS","facility","both","","","","192.75","192.75","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC BINOCULAR VISION EXAM, I&R","92000003","CDM","920","RC","92060","HCPCS","facility","both","","","","515.27","515.27","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC  INTERMEDIATE VISUAL FIELD EXAM","92000005","CDM","920","RC","92082","HCPCS","facility","both","","","","192.75","192.75","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC  INTERMEDIATE VISUAL FIELD EXAM","92000005","CDM","920","RC","92082","HCPCS","facility","both","","","","515.27","515.27","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC  INTERMEDIATE VISUAL FIELD EXAM","92000005","CDM","920","RC","92082","HCPCS","facility","both","","","","297.32","297.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC EXTENDED, VISUAL FIELD EXAM(S), UNIL OR BIL","92000006","CDM","920","RC","92083","HCPCS","facility","both","","","","708.52","708.52","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC EXTENDED, VISUAL FIELD EXAM(S), UNIL OR BIL","92000006","CDM","920","RC","92083","HCPCS","facility","both","","","","265.05","265.05","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC EXTENDED, VISUAL FIELD EXAM(S), UNIL OR BIL","92000006","CDM","920","RC","92083","HCPCS","facility","both","","","","408.8","408.8","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGE, POSTERIOR, OPTIC NERVE","92000007","CDM","920","RC","92133","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGE, POSTERIOR, OPTIC NERVE","92000007","CDM","920","RC","92133","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGE, POSTERIOR, OPTIC NERVE","92000007","CDM","920","RC","92133","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OPHTHALMOSCOPY EXTENDED, INITIAL","92000008","CDM","920","RC","92225","HCPCS","facility","both","","","","76.94","76.94","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OPHTHALMOSCOPY EXTENDED, INITIAL","92000008","CDM","920","RC","92225","HCPCS","facility","both","","","","57.11","57.11","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OPHTHALMOSCOPY EXTENDED, INITIAL","92000008","CDM","920","RC","92225","HCPCS","facility","both","","","","152.62","152.62","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OPHTHALMOSCOPY EXTENDED, SUBSEQ","92000009","CDM","920","RC","92226","HCPCS","facility","both","","","","57.11","57.11","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OPHTHALMOSCOPY EXTENDED, SUBSEQ","92000009","CDM","920","RC","92226","HCPCS","facility","both","","","","152.62","152.62","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OPHTHALMOSCOPY EXTENDED, SUBSEQ","92000009","CDM","920","RC","92226","HCPCS","facility","both","","","","76.94","76.94","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PM/ICD REMOTE TECH SERV =<90 DAYS","92000015","CDM","920","RC","93296","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC INTERROGATION VAD IN PERSON","92000016","CDM","920","RC","93750","HCPCS","facility","both","","","","164.19","164.19","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC SLS-EPS; PERIPH NRV; UPPER LIMBS","92000020","CDM","920","RC","95925","HCPCS","facility","both","","","","322.98","322.98","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC SLS-EPS; PERIPH NRV; UPPER LIMBS","92000020","CDM","920","RC","95925","HCPCS","facility","both","","","","985","985","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SLS-EPS; PERIPH NRV; LOWER LIMBS","92000021","CDM","920","RC","95926","HCPCS","facility","both","","","","985","985","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SLS-EPS; PERIPH NRV; LOWER LIMBS","92000021","CDM","920","RC","95926","HCPCS","facility","both","","","","312.54","312.54","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC CENTRAL MOTOR EVOKED UPP LIMBS","92000022","CDM","920","RC","95928","HCPCS","facility","both","","","","385.47","385.47","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC CENTRAL MOTOR EVOKED LWR LIMBS","92000023","CDM","920","RC","95929","HCPCS","facility","both","","","","406.29","406.29","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC BLINK TEST","92000024","CDM","920","RC","95933","HCPCS","facility","both","","","","135.42","135.42","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC ANALYZE NEUROSTIM SIMPLE","92000060","CDM","920","RC","95971","HCPCS","facility","both","","","","193","193","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IONM IN OPERATNG ROOM 15 MIN","92000070","CDM","920","RC","95940","HCPCS","facility","both","","","","31.26","31.26","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC IONM REMOTE/>1 PT OR PER HR","92000071","CDM","920","RC","95941","HCPCS","facility","both","","","","31.26","31.26","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC LIMITED VISUAL FIELD EXAM","92000072","CDM","920","RC","92081","HCPCS","facility","both","","","","185.83","185.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC LIMITED VISUAL FIELD EXAM","92000072","CDM","920","RC","92081","HCPCS","facility","both","","","","120.47","120.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC LIMITED VISUAL FIELD EXAM","92000072","CDM","920","RC","92081","HCPCS","facility","both","","","","322.04","322.04","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 06/30/2022 HC EYE EXAM W ANESTH; LIMITED","92000073","CDM","920","RC","92019","HCPCS","facility","both","","","","2617.58","2617.58","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 06/30/2022 HC EYE EXAM W ANESTH; LIMITED","92000073","CDM","920","RC","92019","HCPCS","facility","both","","","","979.51","979.51","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 06/30/2022 HC EYE EXAM W ANESTH; LIMITED","92000073","CDM","920","RC","92019","HCPCS","facility","both","","","","1382.11","1382.11","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGE, ANTERIOR  SEGMENT","92000074","CDM","920","RC","92132","HCPCS","facility","both","","","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGE, ANTERIOR  SEGMENT","92000074","CDM","920","RC","92132","HCPCS","facility","both","","","","96.39","96.39","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGE, ANTERIOR  SEGMENT","92000074","CDM","920","RC","92132","HCPCS","facility","both","","","","257.64","257.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGE, POSTERIOR, RETINA","92000075","CDM","920","RC","92134","HCPCS","facility","both","","","","120.47","120.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGE, POSTERIOR, RETINA","92000075","CDM","920","RC","92134","HCPCS","facility","both","","","","185.83","185.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGE, POSTERIOR, RETINA","92000075","CDM","920","RC","92134","HCPCS","facility","both","","","","322.04","322.04","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC  GLUCOSE MONITORING CONT 72+ HRS - PROVIDED EQUIPMENT","92000076","CDM","920","RC","95250","HCPCS","facility","both","","","","260.17","260.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC  GLUCOSE MONITORING CONT 72+ HRS - PROVIDED EQUIPMENT","92000076","CDM","920","RC","95250","HCPCS","facility","both","","","","168.65","168.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC  GLUCOSE MONITORING CONT 72+ HRS - PROVIDED EQUIPMENT","92000076","CDM","920","RC","95250","HCPCS","facility","both","","","","450.86","450.86","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OPHTHALMIC BIOMETRY","92000078","CDM","920","RC","92136","HCPCS","facility","both","","","","386.48","386.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OPHTHALMIC BIOMETRY","92000078","CDM","920","RC","92136","HCPCS","facility","both","","","","222.98","222.98","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OPHTHALMIC BIOMETRY","92000078","CDM","920","RC","92136","HCPCS","facility","both","","","","144.56","144.56","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC FUNDUS PHOTOGRAPHY","92000081","CDM","920","RC","92250","HCPCS","facility","both","","","","322.04","322.04","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC FUNDUS PHOTOGRAPHY","92000081","CDM","920","RC","92250","HCPCS","facility","both","","","","120.47","120.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC FUNDUS PHOTOGRAPHY","92000081","CDM","920","RC","92250","HCPCS","facility","both","","","","185.83","185.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC INTERROGATION DEVICE EVALUATION(S), (REMOTE) UP TO 30 DAYS","92000087","CDM","920","RC","93299","HCPCS","facility","both","","","","200.77","200.77","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC PROGRAM DEVICE EVAL, IMPLANT SUBQ LEAD DEFIB SYS","92000092","CDM","920","RC","93261","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC PROGRAM DEVICE EVAL, W/ ITERATIVE ADJ, IMPLANT SUBQ LEAD DEFIB SYS","92000093","CDM","920","RC","93260","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC ELECTRORETINOGRAPHY W INT & REP, FULL FIELD","92000094","CDM","920","RC","92273","HCPCS","facility","both","","","","761","761","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTRORETINOGRAPHY W INT & REP, MULTIFOCAL","92000095","CDM","920","RC","92274","HCPCS","facility","both","","","","410","410","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ELECTRORETINOGRAPHY W INT & REP, PATTERN","92000096","CDM","920","RC","","","facility","both","","","","389","389","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPSCPY EXTND RTA DRAWING & SCL DEPRSN I&R UNI/BI","92000097","CDM","920","RC","92201","HCPCS","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OPSCPY EXTND RTA DRAWING & SCL DEPRSN I&R UNI/BI","92000097","CDM","920","RC","92201","HCPCS","facility","both","","","","72.3","72.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OPSCPY EXTND RTA DRAWING & SCL DEPRSN I&R UNI/BI","92000097","CDM","920","RC","92201","HCPCS","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC OPSCPY EXTND OPTIC NRV/MACULA DRAWING I&R UNI/BI","92000098","CDM","920","RC","92202","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC OPSCPY EXTND OPTIC NRV/MACULA DRAWING I&R UNI/BI","92000098","CDM","920","RC","92202","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC OPSCPY EXTND OPTIC NRV/MACULA DRAWING I&R UNI/BI","92000098","CDM","920","RC","92202","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC REMOTE INTERROG IMP CARD PHYS MONT SYS UP TO 30 DAYS","92000099","CDM","920","RC","93297","HCPCS","facility","both","","","","487","487","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REMOTE INTERROG IMP CARD PHYS MONT SYS UP TO 30 DAYS","92000099","CDM","920","RC","93297","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC REMOTE INTERROG SUB CARD RHYM MONT SYS UP TO 30 DAYS","92000100","CDM","920","RC","93298","HCPCS","facility","both","","","","218.9","218.9","","","","","","","","","","","","","Gross Charge Type: JHH 43 ELECTROCARDIOGRAPHY (EKG/ECG)"
"HC REMOTE INTERROG SUB CARD RHYM MONT SYS UP TO 30 DAYS","92000100","CDM","920","RC","93298","HCPCS","facility","both","","","","487","487","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC IMG RETINA DETECT/MONITOR DISEASE: POC AUTO A/R, UNIL/BILAT","92000103","CDM","920","RC","92229","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC IMG RETINA DETECT/MONITOR DISEASE: POC AUTO A/R, UNIL/BILAT","92000103","CDM","920","RC","92229","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC IMG RETINA DETECT/MONITOR DISEASE: POC AUTO A/R, UNIL/BILAT","92000103","CDM","920","RC","92229","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC WHOLE BODY INTEGUMENTARY PHOTOGRAPHY - SELF-PAY","92000104","CDM","990","RC","96904","HCPCS","facility","both","","","","458","458","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC WHOLE BODY INTEGUMENTARY PHOTOGRAPHY - SELF-PAY","92000104","CDM","990","RC","96904","HCPCS","facility","both","","","","158.86","158.86","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC WHOLE BODY INTEGUMENTARY PHOTOGRAPHY - SELF-PAY","92000104","CDM","990","RC","96904","HCPCS","facility","both","","","","207.59","207.59","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC REM THERAPEUTIC MONITOR, INITIAL SET-UP & PATIENT EDUC USE EQUIP","92000105","CDM","920","RC","98975","HCPCS","facility","both","","","","59","59","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC REMOTE THERAPEUTIC MONITORING MUSCULOSKETAL SYSTEM, EACH 30 DAYS","92000107","CDM","920","RC","98977","HCPCS","facility","both","","","","152","152","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMG, POSTERIOR, RETINA, W/OCTA","92000108","CDM","920","RC","92137","HCPCS","facility","both","","","","408.77","408.77","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMG, POSTERIOR, RETINA, W/OCTA","92000108","CDM","920","RC","92137","HCPCS","facility","both","","","","265.02","265.02","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMG, POSTERIOR, RETINA, W/OCTA","92000108","CDM","920","RC","92137","HCPCS","facility","both","","","","708.48","708.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC INSTILLATION OF FECAL MICROBIOTA SUSPENSION","92000109","CDM","920","RC","","","facility","both","","","","772.98","772.98","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC CAROTID DUPLEX SCAN; BILAT","92100001","CDM","921","RC","93880","HCPCS","facility","both","","","","1215","1215","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CAROTID DUPLEX SCAN; BILAT","92100001","CDM","921","RC","93880","HCPCS","facility","both","","","","2145.48","2145.48","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CAROTID DUPLEX SCAN; UNIL/LIMIT","92100002","CDM","921","RC","93882","HCPCS","facility","both","","","","1352.58","1352.58","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC CAROTID DUPLEX SCAN; UNIL/LIMIT","92100002","CDM","921","RC","93882","HCPCS","facility","both","","","","741","741","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRACRANIAL ARTERY DOPPLER; COMPL","92100003","CDM","921","RC","93886","HCPCS","facility","both","","","","3031.59","3031.59","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC INTRACRANIAL ARTERY DOPPLER; COMPL","92100003","CDM","921","RC","93886","HCPCS","facility","both","","","","3041","3041","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRACRANIAL ARTERY DOPPLER; LIMITED","92100004","CDM","921","RC","93888","HCPCS","facility","both","","","","2031","2031","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INTRACRANIAL ARTERY DOPPLER; LIMITED","92100004","CDM","921","RC","93888","HCPCS","facility","both","","","","1632.39","1632.39","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC UPR/L XTREMITY ART 2 LEVELS","92100005","CDM","921","RC","93922","HCPCS","facility","both","","","","390","390","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC UPR/L XTREMITY ART 2 LEVELS","92100005","CDM","921","RC","93922","HCPCS","facility","both","","","","979.45","979.45","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC UPR/LXTR ART STDY 3+ LVLS","92100006","CDM","921","RC","93923","HCPCS","facility","both","","","","1492.49","1492.49","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC UPR/LXTR ART STDY 3+ LVLS","92100006","CDM","921","RC","93923","HCPCS","facility","both","","","","3241","3241","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LWR XTR VASC STDY BILAT","92100007","CDM","921","RC","93924","HCPCS","facility","both","","","","1290","1290","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC LWR XTR VASC STDY BILAT","92100007","CDM","921","RC","93924","HCPCS","facility","both","","","","1912.26","1912.26","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX LE ART/BPG; BILAT","92100008","CDM","921","RC","93925","HCPCS","facility","both","","","","2891.69","2891.69","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX LE ART/BPG; BILAT","92100008","CDM","921","RC","93925","HCPCS","facility","both","","","","1076","1076","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DUPLEX LE ART/BPG; UNIL/LIMIT","92100009","CDM","921","RC","93926","HCPCS","facility","both","","","","652","652","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DUPLEX LE ART/BPG; UNIL/LIMIT","92100009","CDM","921","RC","93926","HCPCS","facility","both","","","","1679.04","1679.04","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX UE ART/BPG; BILAT","92100010","CDM","921","RC","93930","HCPCS","facility","both","","","","1076","1076","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DUPLEX UE ART/BPG; BILAT","92100010","CDM","921","RC","93930","HCPCS","facility","both","","","","2192.08","2192.08","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX UE ART/BPG; UNIL/LIMIT","92100011","CDM","921","RC","93931","HCPCS","facility","both","","","","1352.58","1352.58","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX UE ART/BPG; UNIL/LIMIT","92100011","CDM","921","RC","93931","HCPCS","facility","both","","","","652","652","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DUPLEX EXT VEINS; BILAT","92100012","CDM","921","RC","93970","HCPCS","facility","both","","","","2145.48","2145.48","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX EXT VEINS; BILAT","92100012","CDM","921","RC","93970","HCPCS","facility","both","","","","1015","1015","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DUPLEX EXT VEINS; UNIL/LIMIT","92100013","CDM","921","RC","93971","HCPCS","facility","both","","","","1305.93","1305.93","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX EXT VEINS; UNIL/LIMIT","92100013","CDM","921","RC","93971","HCPCS","facility","both","","","","846","846","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DUPLEX ARTERIAL FLOW; COMPL","92100014","CDM","921","RC","93975","HCPCS","facility","both","","","","2938.33","2938.33","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX ARTERIAL FLOW; COMPL","92100014","CDM","921","RC","93975","HCPCS","facility","both","","","","1999","1999","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DUPLEX ARTERIAL FLOW; LIMITED","92100015","CDM","921","RC","93976","HCPCS","facility","both","","","","1372.59","1372.59","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX ARTERIAL FLOW; LIMITED","92100015","CDM","921","RC","93976","HCPCS","facility","both","","","","1933","1933","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DUPLEX ARTERIAL FLOW; LIMITED","92100015","CDM","921","RC","93976","HCPCS","facility","both","","","","181.05","181.05","","","","","","","","","","","","","Gross Charge Type: JHH 39 L&D"
"HC DUPLEX A IVC IL/BPG; COMPL","92100016","CDM","921","RC","93978","HCPCS","facility","both","","","","2005.54","2005.54","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX A IVC IL/BPG; COMPL","92100016","CDM","921","RC","93978","HCPCS","facility","both","","","","2032","2032","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DUPLEX A IVC IL/BPG; UNIL/LIM","92100017","CDM","921","RC","93979","HCPCS","facility","both","","","","1259.3","1259.3","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX A IVC IL/BPG; UNIL/LIM","92100017","CDM","921","RC","93979","HCPCS","facility","both","","","","2032","2032","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DUPLEX FLOW PENILE V; COMPL","92100018","CDM","921","RC","93980","HCPCS","facility","both","","","","792.88","792.88","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC DUPLEX FLOW PENILE V; COMPL","92100018","CDM","921","RC","93980","HCPCS","facility","both","","","","1999","1999","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DUPLEX HEMODIALYSIS ACCESS","92100019","CDM","921","RC","93990","HCPCS","facility","both","","","","1206","1206","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DUPLEX HEMODIALYSIS ACCESS","92100019","CDM","921","RC","93990","HCPCS","facility","both","","","","1772.33","1772.33","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC UNLISTED NONINVASIVE VASCULAR DIAGNOSTIC STUDY","92100020","CDM","921","RC","93998","HCPCS","facility","both","","","","419.74","419.74","","","","","","","","","","","","","Gross Charge Type: JHH 45 DIAGNOSTIC IMAGING"
"HC Extremity Study, Complete Bilateral","92100100","CDM","921","RC","93965","HCPCS","facility","both","","","","899","899","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EMG- ONE EXTREMITY","92200001","CDM","922","RC","95860","HCPCS","facility","both","","","","339","339","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EMG- ONE EXTREMITY","92200001","CDM","922","RC","95860","HCPCS","facility","both","","","","208.37","208.37","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EMG-TWO EXTREMITIES","92200002","CDM","922","RC","95861","HCPCS","facility","both","","","","270.87","270.87","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EMG-TWO EXTREMITIES","92200002","CDM","922","RC","95861","HCPCS","facility","both","","","","440","440","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EMG-THREE EXTREMITIES","92200003","CDM","922","RC","95863","HCPCS","facility","both","","","","343.78","343.78","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EMG-THREE EXTREMITIES","92200003","CDM","922","RC","95863","HCPCS","facility","both","","","","560","560","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EMG CRANIAL NERVE - UNILAT","92200004","CDM","922","RC","95867","HCPCS","facility","both","","","","156.29","156.29","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EMG CRANIAL NERVE; BILAT","92200005","CDM","922","RC","95868","HCPCS","facility","both","","","","208.37","208.37","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EMG THORACIC PARASPINAL","92200006","CDM","922","RC","95869","HCPCS","facility","both","","","","208.37","208.37","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC MUSCLE TEST NONPARASPINAL 1 EXT","92200007","CDM","922","RC","95870","HCPCS","facility","both","","","","208.37","208.37","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC EMG SNGL FIBER, ANY/ALL SITES","92200008","CDM","922","RC","95872","HCPCS","facility","both","","","","125.02","125.02","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC NRV CONDUCTION, MOTOR-EA NERVE","92200009","CDM","922","RC","95900","HCPCS","facility","both","","","","138","138","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NCV EA MOTOR NERVE; W F-WAVE","92200010","CDM","922","RC","95903","HCPCS","facility","both","","","","809","809","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NCV EA SENSORY NERVE","92200011","CDM","922","RC","95904","HCPCS","facility","both","","","","809","809","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEUROMUSC JUNCTION TEST EA NRV","92200013","CDM","922","RC","95937","HCPCS","facility","both","","","","135.42","135.42","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC NERVE CONDUCT STUDIES 1-2","92200015","CDM","922","RC","95907","HCPCS","facility","both","","","","125.02","125.02","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC NERVE CONDUCT STUDIES 3-4","92200016","CDM","922","RC","95908","HCPCS","facility","both","","","","166.72","166.72","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC NERVE CONDUCT STUDIES 5-6","92200017","CDM","922","RC","95909","HCPCS","facility","both","","","","197.94","197.94","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC NERVE CONDUCT STUDIES 7-8","92200018","CDM","922","RC","95910","HCPCS","facility","both","","","","260.48","260.48","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC NERVE CONDUCT STUDIES 9-10","92200019","CDM","922","RC","95911","HCPCS","facility","both","","","","291.72","291.72","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC NERVE CONDUCT STUDIES 11-12","92200020","CDM","922","RC","95912","HCPCS","facility","both","","","","291.72","291.72","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC NERVE CONDUCT STUDIES 13 OR MORE","92200021","CDM","922","RC","95913","HCPCS","facility","both","","","","322.98","322.98","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC VISUAL EVOKED POTENTIAL, CHECKERBD/FLASH TEST, CNS, EXCEPT GLAUCOMA","92200051","CDM","922","RC","95930","HCPCS","facility","both","","","","577","577","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC VISUAL EVOKED POTENTIAL, CHECKERBD/FLASH TEST, CNS, EXCEPT GLAUCOMA","92200051","CDM","922","RC","95930","HCPCS","facility","both","","","","322.98","322.98","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC MUSCLE TEST DONE W/NERVE TEST LIMITED","92200052","CDM","922","RC","95885","HCPCS","facility","both","","","","114.59","114.59","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC MUSC TEST DONE W/NERVE TEST COMP","92200053","CDM","922","RC","95886","HCPCS","facility","both","","","","135.42","135.42","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC MUSC TEST DONE W/NERVE TEST NON EXTREMITY","92200054","CDM","922","RC","95887","HCPCS","facility","both","","","","125.02","125.02","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC NEEDLE EMG; FOUR EXTREMITIES","92200056","CDM","922","RC","95864","HCPCS","facility","both","","","","406.29","406.29","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC SOMATOSENSORY TESTING; UPPER & LOWER LIMBS","92200057","CDM","922","RC","95938","HCPCS","facility","both","","","","864.73","864.73","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC CENTRAL MOTOR EVOKED UPPER & LOWER LIMBS","92200058","CDM","922","RC","95939","HCPCS","facility","both","","","","1125.17","1125.17","","","","","","","","","","","","","Gross Charge Type: JHH 44 ELECTROENCEPHALOGRAPHY (EEG)"
"HC ACTINOTHERAPY (UV LIGHT)","94000002","CDM","940","RC","96900","HCPCS","facility","both","","","","168.65","168.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC ACTINOTHERAPY (UV LIGHT)","94000002","CDM","940","RC","96900","HCPCS","facility","both","","","","450.86","450.86","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC ACTINOTHERAPY (UV LIGHT)","94000002","CDM","940","RC","96900","HCPCS","facility","both","","","","260.17","260.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PHOTOCHEMOTHERAPY UVB","94000003","CDM","940","RC","96910","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC PHOTOCHEMOTHERAPY UVB","94000003","CDM","940","RC","96910","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PHOTOCHEMOTHERAPY UVB","94000003","CDM","940","RC","96910","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PHOTOCHEMOTHERAPY PUVA","94000004","CDM","940","RC","96912","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PHOTOCHEMOTHERAPY PUVA","94000004","CDM","940","RC","96912","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PHOTOCHEMOTHERAPY PUVA","94000004","CDM","940","RC","96912","HCPCS","facility","both","","","","319","319","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHOTOCHEMOTHERAPY PUVA","94000004","CDM","940","RC","96912","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 7/1/2018 HCCPR PER 15 MIN","94000005","CDM","940","RC","92950","HCPCS","facility","both","","","","1276","1276","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 7/1/2018 HCCPR PER 15 MIN","94000005","CDM","940","RC","92950","HCPCS","facility","both","","","","53.01","53.01","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC ACUPUNCT W/O STIMUL 15 MIN","94000006","CDM","940","RC","97810","HCPCS","facility","both","","","","218","218","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACUPUNCTURE W/O ELECTRIC STIMULATION, ADDL 15 MIN W/INSERT NEEDLE(S)","94000007","CDM","940","RC","97811","HCPCS","facility","both","","","","166","166","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACUPUNCT W/STIMUL 15 MIN","94000008","CDM","940","RC","97813","HCPCS","facility","both","","","","320","320","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ACUPUNCTURE W/ELECTRIC STIMULATION, ADDL 15 MIN W/INSERT NEEDLE(S)","94000009","CDM","940","RC","97814","HCPCS","facility","both","","","","214","214","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CPR PER SESSION","94000012","CDM","940","RC","92950","HCPCS","facility","both","","","","286.25","286.25","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CPR PER SESSION","94000012","CDM","940","RC","92950","HCPCS","facility","both","","","","2336","2336","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHLEBOTOMY THERAPEUTIC","94030001","CDM","940","RC","99195","HCPCS","facility","both","","","","133.98","133.98","","","","","","","","","","","","","Gross Charge Type: JHH LABS 42"
"HC PHLEBOTOMY THERAPEUTIC","94030001","CDM","940","RC","99195","HCPCS","facility","both","","","","542","542","","","","","","","","","","","","","Gross Charge Type: SMH SOFT LAB FEE SCHEDULE"
"HC PHLEBOTOMY THERAPEUTIC","94030001","CDM","940","RC","99195","HCPCS","facility","both","","","","544","544","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PHLEBOTOMY THERAPEUTIC","94030001","CDM","940","RC","99195","HCPCS","facility","both","","","","414.93","414.93","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC PHLEBOTOMY THERAPEUTIC","94030001","CDM","940","RC","99195","HCPCS","facility","both","","","","104.67","104.67","","","","","","","","","","","","","Gross Charge Type: BMC 42 LABS"
"HC PHLEBOTOMY THERAPEUTIC","94030001","CDM","940","RC","99195","HCPCS","facility","both","","","","294.03","294.03","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC PHLEBOTOMY THERAPEUTIC","94030001","CDM","940","RC","99195","HCPCS","facility","both","","","","785.97","785.97","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC GENETIC COUNSELING ADDITIONAL 30 MIN","94191101","CDM","942","RC","96040","HCPCS","facility","both","","","","272","272","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENETIC COUNSELING FIRST 30 MIN","94191102","CDM","942","RC","96040","HCPCS","facility","both","","","","428","428","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MNT, INDIV, EA 15 MIN, INITIAL ASSESSMENT","94200001","CDM","942","RC","97802","HCPCS","facility","both","","","","63","63","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MNT, INDIV, EA 15 MIN, INITIAL ASSESSMENT","94200001","CDM","942","RC","97802","HCPCS","facility","both","","","","322.04","322.04","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC MNT, INDIV, EA 15 MIN, INITIAL ASSESSMENT","94200001","CDM","942","RC","97802","HCPCS","facility","both","","","","120.47","120.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC MNT, INDIV, EA 15 MIN, INITIAL ASSESSMENT","94200001","CDM","942","RC","97802","HCPCS","facility","both","","","","185.83","185.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC MNT, INDIV, EA 15 MIN, INITIAL ASSESSMENT","94200001","CDM","942","RC","97802","HCPCS","facility","both","","","","1144.44","1144.44","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC MNT, INDIV, EA 15 MIN, INITIAL ASSESSMENT","94200001","CDM","942","RC","97802","HCPCS","facility","both","","","","1014.39","1014.39","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC MNT, INDIV, EA 15 MIN, RE-ASSESSMENT","94200002","CDM","942","RC","97803","HCPCS","facility","both","","","","185.83","185.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC MNT, INDIV, EA 15 MIN, RE-ASSESSMENT","94200002","CDM","942","RC","97803","HCPCS","facility","both","","","","120.47","120.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC MNT, INDIV, EA 15 MIN, RE-ASSESSMENT","94200002","CDM","942","RC","97803","HCPCS","facility","both","","","","63","63","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MNT, INDIV, EA 15 MIN, RE-ASSESSMENT","94200002","CDM","942","RC","97803","HCPCS","facility","both","","","","322.04","322.04","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 03/31/2022 HC DIABETES SELF MGMT, INDIV, EA 30 MIN","94200003","CDM","942","RC","","","facility","both","","","","147.9","147.9","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 03/31/2022 HC DIABETES SELF MGMT, INDIV, EA 30 MIN","94200003","CDM","942","RC","","","facility","both","","","","395.38","395.38","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 03/31/2022 HC DIABETES SELF MGMT, INDIV, EA 30 MIN","94200003","CDM","942","RC","","","facility","both","","","","208.74","208.74","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC TRAIN & EDUCATE, 45 MIN OR MORE","94200004","CDM","942","RC","","","facility","both","","","","65.3","65.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC TRAIN & EDUCATE, 45 MIN OR MORE","94200004","CDM","942","RC","","","facility","both","","","","363.79","363.79","","","","","","","","","","","","","Gross Charge Type: JHH 32 PSYCH. DAY & NIGHT CARE SERV (PDC)"
"HC TRAIN & EDUCATE, 45 MIN OR MORE","94200004","CDM","942","RC","","","facility","both","","","","92.14","92.14","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC TRAIN & EDUCATE, 45 MIN OR MORE","94200004","CDM","942","RC","","","facility","both","","","","174.51","174.51","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC MNT, INDIV, EA 15 MIN, RE-ASSESS, 2ND REF","94200005","CDM","942","RC","","","facility","both","","","","322.04","322.04","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC MNT, INDIV, EA 15 MIN, RE-ASSESS, 2ND REF","94200005","CDM","942","RC","","","facility","both","","","","120.47","120.47","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC MNT, INDIV, EA 15 MIN, RE-ASSESS, 2ND REF","94200005","CDM","942","RC","","","facility","both","","","","185.83","185.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC EDUCATION/TRAINING - NUTRITION 5 VISIT","94200006","CDM","942","RC","","","facility","both","","","","199","199","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC EDUCATION/TRAINING - NUTRITION 6 VISIT","94200007","CDM","942","RC","","","facility","both","","","","255","255","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 01/31/2022 HC DM OP SMT GRP PER 30 MIN","94200025","CDM","942","RC","","","facility","both","","","","64","64","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 01/31/2022 HC DM OP SMT GRP PER 30 MIN","94200025","CDM","942","RC","","","facility","both","","","","112.97","112.97","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 01/31/2022 HC DM OP SMT GRP PER 30 MIN","94200025","CDM","942","RC","","","facility","both","","","","59.64","59.64","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 01/31/2022 HC DM OP SMT GRP PER 30 MIN","94200025","CDM","942","RC","","","facility","both","","","","42.26","42.26","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 01/01/2025 HC GENETIC COUNSELING 30 MIN","94200050","CDM","942","RC","96040","HCPCS","facility","both","","","","125.53","125.53","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"DEAC 01/01/2025 HC GENETIC COUNSELING 30 MIN","94200050","CDM","942","RC","96040","HCPCS","facility","both","","","","786","786","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 01/01/2025 HC GENETIC COUNSELING 30 MIN","94200050","CDM","942","RC","96040","HCPCS","facility","both","","","","72.42","72.42","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"DEAC 01/01/2025 HC GENETIC COUNSELING 30 MIN","94200050","CDM","942","RC","96040","HCPCS","facility","both","","","","52.18","52.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC MEDICAL NUTRITION THERAPY, GROUP, EA 30 MIN","94200051","CDM","942","RC","97804","HCPCS","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC MEDICAL NUTRITION THERAPY, GROUP, EA 30 MIN","94200051","CDM","942","RC","97804","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC MEDICAL NUTRITION THERAPY, GROUP, EA 30 MIN","94200051","CDM","942","RC","97804","HCPCS","facility","both","","","","102","102","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MEDICAL NUTRITION THERAPY, GROUP, EA 30 MIN","94200051","CDM","942","RC","97804","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC SELF-MGMT EDUCATION & TRAIN, INDIV PT, EA 30 MINS","94200052","CDM","942","RC","98960","HCPCS","facility","both","","","","260.17","260.17","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC SELF-MGMT EDUCATION & TRAIN, INDIV PT, EA 30 MINS","94200052","CDM","942","RC","98960","HCPCS","facility","both","","","","168.65","168.65","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC SELF-MGMT EDUCATION & TRAIN, INDIV PT, EA 30 MINS","94200052","CDM","942","RC","98960","HCPCS","facility","both","","","","450.84","450.84","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC SELF-MGMT EDUC/TRAIN, 2-4 PT, EA 30 MIN","94200053","CDM","942","RC","98961","HCPCS","facility","both","","","","65.3","65.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC SELF-MGMT EDUC/TRAIN, 2-4 PT, EA 30 MIN","94200053","CDM","942","RC","98961","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC SELF-MGMT EDUC/TRAIN, 2-4 PT, EA 30 MIN","94200053","CDM","942","RC","98961","HCPCS","facility","both","","","","128.8","128.8","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC SELF-MGMT EDUC/TRAIN, 5-8 PT, EA 30 MIN","94200054","CDM","942","RC","98962","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC SELF-MGMT EDUC/TRAIN, 5-8 PT, EA 30 MIN","94200054","CDM","942","RC","98962","HCPCS","facility","both","","","","65.3","65.3","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC SMOKING/TOBACCO CESSATION COUNSELING; GREATER THAN 3 UP TO 10 MIN","94200055","CDM","942","RC","99406","HCPCS","facility","both","","","","35.78","35.78","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC SMOKING/TOBACCO CESSATION COUNSELING; GREATER THAN 10 MIN","94200056","CDM","942","RC","99407","HCPCS","facility","both","","","","71.59","71.59","","","","","","","","","","","","","Gross Charge Type: JHH 49 RT"
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, INIT 30 MIN","94200057","CDM","942","RC","97550","HCPCS","facility","both","","","","145.38","145.38","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, INIT 30 MIN","94200057","CDM","942","RC","97550","HCPCS","facility","both","","","","61.94","61.94","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, INIT 30 MIN","94200057","CDM","942","RC","97550","HCPCS","facility","both","","","","57.3","57.3","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, INIT 30 MIN","94200057","CDM","942","RC","97550","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, EA ADDT'L 15 MIN","94200058","CDM","942","RC","97551","HCPCS","facility","both","","","","62.5","62.5","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, EA ADDT'L 15 MIN","94200058","CDM","942","RC","97551","HCPCS","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, EA ADDT'L 15 MIN","94200058","CDM","942","RC","97551","HCPCS","facility","both","","","","20.64","20.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, EA ADDT'L 15 MIN","94200058","CDM","942","RC","97551","HCPCS","facility","both","","","","48.46","48.46","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC GROUP CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, MULT SETS","94200059","CDM","942","RC","97552","HCPCS","facility","both","","","","38.21","38.21","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC GROUP CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, MULT SETS","94200059","CDM","942","RC","97552","HCPCS","facility","both","","","","125","125","","","","","","","","","","","","","Gross Charge Type: JHH UN PT/OT/SLP OFFSITE"
"HC GROUP CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, MULT SETS","94200059","CDM","942","RC","97552","HCPCS","facility","both","","","","96.93","96.93","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC GROUP CAREGIVER TRAINING, FUNCT PERF, FACE TO FACE, MULT SETS","94200059","CDM","942","RC","97552","HCPCS","facility","both","","","","41.31","41.31","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC GENETIC COUNSELING EA 30 MIN, TOTAL TIME, ENCOUNTER DATE","94200060","CDM","942","RC","96041","HCPCS","facility","both","","","","714","714","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GENETIC COUNSELING EA 30 MIN, TOTAL TIME, ENCOUNTER DATE","94200060","CDM","942","RC","96041","HCPCS","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC GENETIC COUNSELING EA 30 MIN, TOTAL TIME, ENCOUNTER DATE","94200060","CDM","942","RC","96041","HCPCS","facility","both","","","","128.8","128.8","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC GENETIC COUNSELING EA 30 MIN, TOTAL TIME, ENCOUNTER DATE","94200060","CDM","942","RC","96041","HCPCS","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, INIT 30 MIN","94200061","CDM","942","RC","","","facility","both","","","","57.3","57.3","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, INIT 30 MIN","94200061","CDM","942","RC","","","facility","both","","","","61.96","61.96","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, INIT 30 MIN","94200061","CDM","942","RC","","","facility","both","","","","145.38","145.38","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, EA ADDT'L 15 MIN","94200062","CDM","942","RC","","","facility","both","","","","48.46","48.46","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, EA ADDT'L 15 MIN","94200062","CDM","942","RC","","","facility","both","","","","20.64","20.64","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, EA ADDT'L 15 MIN","94200062","CDM","942","RC","","","facility","both","","","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC GROUP CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, MULT SETS","94200063","CDM","942","RC","","","facility","both","","","","96.92","96.92","","","","","","","","","","","","","Gross Charge Type: JHH 54 SPEECH THERAPY"
"HC GROUP CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, MULT SETS","94200063","CDM","942","RC","","","facility","both","","","","41.32","41.32","","","","","","","","","","","","","Gross Charge Type: JHH 53 OT"
"HC GROUP CAREGIVER TRAINING, SUPPORT CARE, FACE TO FACE, MULT SETS","94200063","CDM","942","RC","","","facility","both","","","","38.21","38.21","","","","","","","","","","","","","Gross Charge Type: JHH 52 PT"
"HC ALCOHOL OR DRUG ASSESSMENT","94400001","CDM","944","RC","","","facility","both","","","","772.94","772.94","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC ALCOHOL OR DRUG ASSESSMENT","94400001","CDM","944","RC","","","facility","both","","","","289.11","289.11","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC ALCOHOL OR DRUG ASSESSMENT","94400001","CDM","944","RC","","","facility","both","","","","445.96","445.96","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC BEHAVIORAL HEALTH COUNSELING &THERAPY PER 15 MINS","94400002","CDM","944","RC","","","facility","both","","","","72.28","72.28","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC BEHAVIORAL HEALTH COUNSELING &THERAPY PER 15 MINS","94400002","CDM","944","RC","","","facility","both","","","","111.49","111.49","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC BEHAVIORAL HEALTH COUNSELING &THERAPY PER 15 MINS","94400002","CDM","944","RC","","","facility","both","","","","193.21","193.21","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC ALCOHOL/DRUG GROUP COUNSELING","94400003","CDM","944","RC","","","facility","both","","","","48.18","48.18","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC ALCOHOL/DRUG GROUP COUNSELING","94400003","CDM","944","RC","","","facility","both","","","","74.32","74.32","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC ALCOHOL/DRUG GROUP COUNSELING","94400003","CDM","944","RC","","","facility","both","","","","128.83","128.83","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC METHADONE TREATMENT, WEEKLY","94400004","CDM","944","RC","","","facility","both","","","","334.48","334.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC METHADONE TREATMENT, WEEKLY","94400004","CDM","944","RC","","","facility","both","","","","579.69","579.69","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC METHADONE TREATMENT, WEEKLY","94400004","CDM","944","RC","","","facility","both","","","","216.84","216.84","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC ALCOHOL/DRUG INTENSIVE OP >3 HR/3 DAYS","94400005","CDM","944","RC","","","facility","both","","","","144.56","144.56","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC ALCOHOL/DRUG INTENSIVE OP >3 HR/3 DAYS","94400005","CDM","944","RC","","","facility","both","","","","222.98","222.98","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC ALCOHOL/DRUG INTENSIVE OP >3 HR/3 DAYS","94400005","CDM","944","RC","","","facility","both","","","","386.48","386.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER A 29 CLINIC"
"HC ASSERTIVE COMMUNITY TX PGM PER DIEM","94400007","CDM","944","RC","","","facility","both","","","","1876.22","1876.22","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC ASSERTIVE COMMUNITY TX PGM PER DIEM","94400007","CDM","944","RC","","","facility","both","","","","1663","1663","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC MENTAL PARTIAL HOSP, HALF DAY VISIT","94400008","CDM","944","RC","","","facility","both","","","","1776.57","1776.57","","","","","","","","","","","","","Gross Charge Type: JHH 32 PSYCH. DAY & NIGHT CARE SERV (PDC)"
"HC MENTAL PARTIAL HOSP, FULL DAY VISIT","94400009","CDM","944","RC","","","facility","both","","","","1776.57","1776.57","","","","","","","","","","","","","Gross Charge Type: JHH 32 PSYCH. DAY & NIGHT CARE SERV (PDC)"
"HC ALCOHOL AND/OR OTHER DRUG ABUSE SERVICES, NOS","94400011","CDM","944","RC","","","facility","both","","","","334.48","334.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC ALCOHOL AND/OR OTHER DRUG ABUSE SERVICES, NOS","94400011","CDM","944","RC","","","facility","both","","","","216.84","216.84","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC ASAM LEVEL 3.1","94400012","CDM","944","RC","","","facility","both","","","","116.38","116.38","","","","","","","","","","","","","Gross Charge Type: JHH SA WILSON HOUSE"
"HC ASAM RESIDENTIAL ROOM & BOARD","94400013","CDM","944","RC","","","facility","both","","","","62.75","62.75","","","","","","","","","","","","","Gross Charge Type: JHH SA WILSON HOUSE"
"HC MEDICATION ASSISTED TREATMENT, METHADONE; WEEKLY BUNDLE","94400014","CDM","944","RC","","","facility","both","","","","334.48","334.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC MEDICATION ASSISTED TREATMENT, METHADONE; WEEKLY BUNDLE","94400014","CDM","944","RC","","","facility","both","","","","216.84","216.84","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC MEDICATION ASSISTED TREATMENT, BUPRENORPHINE(ORAL); WEEKLY BUNDLE","94400015","CDM","944","RC","","","facility","both","","","","334.48","334.48","","","","","","","","","","","","","Gross Charge Type: JHH TIER B 29 CLINIC"
"HC MEDICATION ASSISTED TREATMENT, BUPRENORPHINE(ORAL); WEEKLY BUNDLE","94400015","CDM","944","RC","","","facility","both","","","","216.84","216.84","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"HC INTAKE ACTIVITIES, INCLUDING MEDICAL EXAM","94400016","CDM","944","RC","","","facility","both","","","","289.11","289.11","","","","","","","","","","","","","Gross Charge Type: JHH TIER C 29 CLINIC"
"DEAC 1/1/2022 HC PULMONARY REHAB, 1 HR, PER SESSION","94800001","CDM","948","RC","","","facility","both","","","","185.85","185.85","","","","","","","","","","","","","Gross Charge Type: JHH 50 PULMONARY FUNCTION"
"DEAC 10/19/2022 HC UNJURY PROTEIN SUPPLEMENT","99000001","CDM","990","RC","","","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPURITY MULTIVITAMIN","99000002","CDM","990","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC OPURITY CALCIUM CITRATE","99000003","CDM","990","RC","","","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC ATHLETIC TRAINING SESSION","99000021","CDM","990","RC","","","facility","both","","","","75","75","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NON-BILLABLE (CRITERIA FOR BILLING NOT MET)","99041101","CDM","990","RC","","","facility","both","","","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: JHH UN REGULATED BY DEP"
"HC NON-BILLABLE (CRITERIA FOR BILLING NOT MET)","99041101","CDM","990","RC","","","facility","both","","","","1","1","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CAFETERIA/GUEST TRAY","99100000","CDM","991","RC","","","facility","both","","","","6","6","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC CAFETERIA/GUEST TRAY","99100000","CDM","991","RC","","","facility","both","","","","7","7","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CAFETERIA/GUEST TRAY DISCOUNT","99100001","CDM","991","RC","","","facility","both","","","","18","18","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CAFETERIA/GUEST TRAY DISCOUNT","99100001","CDM","991","RC","","","facility","both","","","","10","10","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC CAFETERIA/GOURMET MEAL","99100002","CDM","991","RC","","","facility","both","","","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC CAFETERIA/GOURMET MEAL","99100002","CDM","991","RC","","","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CAFETERIA/ALA CARTE","99100003","CDM","991","RC","","","facility","both","","","","3","3","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CAFETERIA/ALA CARTE","99100003","CDM","991","RC","","","facility","both","","","","4","4","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC GOURMET MEALS (3 MEALS/DAY)","99100004","CDM","991","RC","","","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC GOURMET MEALS (BRKF)","99100005","CDM","991","RC","","","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC GOURMET MEALS (LNCH)","99100006","CDM","991","RC","","","facility","both","","","","25","25","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC GOURMET MEALS (DIN)","99100007","CDM","991","RC","","","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC TV/RADIO","99400000","CDM","994","RC","","","facility","both","","","","5","5","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NON-PATIENT ROOM RENTALS","99500000","CDM","995","RC","","","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC MARBURG FAMILY NON-PATIENT","99500001","CDM","995","RC","","","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC MARBURG RM - HALFDAY UNREG","99500002","CDM","995","RC","","","facility","both","","","","300","300","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC MARBURG RM - FULLDAY UNREG","99500003","CDM","995","RC","","","facility","both","","","","550","550","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC PRIVATE REGULAR ROOM DIFFERENTIAL","99900011","CDM","999","RC","","","facility","both","","","","465","465","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRIVATE REGULAR ROOM DIFFERENTIAL","99900011","CDM","999","RC","","","facility","both","","","","325","325","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC PRIVATE DELUXE ROOM DIFFERENTIAL","99900013","CDM","999","RC","","","facility","both","","","","1300","1300","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC PRIVATE DELUXE ROOM DIFFERENTIAL","99900013","CDM","999","RC","","","facility","both","","","","535","535","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC PRIVATE SNF ROOM DIFFERENTIAL","99900015","CDM","999","RC","","","facility","both","","","","335","335","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DELUXE SNF ROOM DIFFERENTIAL","99900016","CDM","999","RC","","","facility","both","","","","335","335","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC DELUXE SNF SUITE DIFFERENTIAL","99900017","CDM","999","RC","","","facility","both","","","","335","335","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MARBURG ROOM DIFFERENTIAL RATES","99900018","CDM","999","RC","","","facility","both","","","","375","375","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC MARBURG ROOM DIFFERENTIAL RATES","99900018","CDM","999","RC","","","facility","both","","","","425","425","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC MARBURG SUITE","99900019","CDM","999","RC","","","facility","both","","","","1300","1300","","","","","","","","","","","","","Gross Charge Type: JHH UN PATIENT CONVENIENCE"
"HC BARIATRIC MODIFIED PROGRAM FEE","99900050","CDM","999","RC","","","facility","both","","","","350","350","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC BARIATRIC PROGRAM FEE","99900051","CDM","999","RC","","","facility","both","","","","600","600","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC AQUATICS DROP-IN SESSION","99900100","CDM","999","RC","99900100","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC AQUATIC 10 WEEK,  2X  PER","99900101","CDM","999","RC","99900101","HCPCS","facility","both","","","","160","160","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC AQUATIC 10WEEK SESSION,3X","99900102","CDM","999","RC","99900102","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC AQUATIC 10 WEEK, EMPLOYEE","99900103","CDM","999","RC","99900103","HCPCS","facility","both","","","","100","100","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC AQUATICS PT,PRIVATE PAY 3","99900104","CDM","999","RC","99900104","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC AQUATIC EXERCISE PRGM,NON","99900105","CDM","999","RC","99900105","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC EXERCISE, MAINT PROGRAM W","99900106","CDM","999","RC","99900106","HCPCS","facility","both","","","","200","200","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC PRIVATE TRAINING, 8 SESSI","99900107","CDM","999","RC","99900107","HCPCS","facility","both","","","","280","280","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC INDEPENDENT WALKING 3X","99900108","CDM","999","RC","99900108","HCPCS","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC INDEPENDENT WALKING 2X","99900109","CDM","999","RC","99900109","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/26/2023 HC INDEPENDENT WALKING SAT","99900110","CDM","999","RC","99900110","HCPCS","facility","both","","","","15","15","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC LO INTENSITY AEROBICS 2X","99900111","CDM","999","RC","99900111","HCPCS","facility","both","","","","70","70","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"DEAC 10/19/2022 HC PRIVATE PAY PT 30 MIN","99900112","CDM","999","RC","99900112","HCPCS","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MANUAL THERAPY LYMPH DRAINAGE BY MASSAGE THERAPIST EA 15 MINS","99900113","CDM","999","RC","","","facility","both","","","","29","29","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MASSAGE THERAPY BY MASSAGE THERAPIST EA 15 MINS","99900114","CDM","999","RC","","","facility","both","","","","29","29","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC NEW CONSULT YOGA THERAPY, 75 MINUTES","99900115","CDM","999","RC","","","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC FOLLOW UP YOGA THERAPY, 45 MINUTES","99900116","CDM","999","RC","","","facility","both","","","","80","80","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAGNET THERAPY  DURING ACUPUNCTURE","99900117","CDM","999","RC","","","facility","both","","","","35","35","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC MAGNET THERAPY","99900118","CDM","999","RC","","","facility","both","","","","145","145","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REIKI 90 MINUTES","99900119","CDM","999","RC","","","facility","both","","","","165","165","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REIKI 60 MINUTES","99900120","CDM","999","RC","","","facility","both","","","","110","110","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC REIKI 30 MINUTES","99900121","CDM","999","RC","","","facility","both","","","","60","60","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC INFRARED THERAPY","99900122","CDM","999","RC","","","facility","both","","","","20","20","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC GROUP ACUPUNCTURE","99900123","CDM","999","RC","","","facility","both","","","","50","50","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC SURGERY HEALING EDUCATION/TRAINING","99900124","CDM","999","RC","","","facility","both","","","","40","40","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"HC CT LUNG SCREENING","99913001","CDM","999","RC","","","facility","both","","","","513","513","","","","","","","","","","","","","Gross Charge Type: SMH DEFAULT FEE SCHEDULE"
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","579078.54","579078.54","579078.54","1 through 10","percent of total billed charges","","",""
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","537086.94","491362.6","755483.45","1 through 10","percent of total billed charges","","",""
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","516941.97","373994.28","799983.25","12","percent of total billed charges","","",""
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","1110726.69","1110726.69","1110726.69","1 through 10","percent of total billed charges","","",""
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","777258.73","777258.73","777258.73","1 through 10","percent of total billed charges","","",""
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","306072.5","299566.32","982076.88","1 through 10","percent of total billed charges","","",""
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","392.77","392.77","392.77","1 through 10","percent of total billed charges","","",""
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System With Mcc","001","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","992741.29","992741.29","992741.29","1 through 10","percent of total billed charges","","",""
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","176240.94","176240.94","176240.94","1 through 10","percent of total billed charges","","",""
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Transplant Or Implant Of Heart Assist System Without Mcc","002","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","306754.92","306754.92","306754.92","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","627666.49","217128.7","1579891.26","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","780752.48","285022.38","921903.66","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","365499.71","365499.71","365499.71","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","391700.82","135088.06","681086.36","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","68098.86","68098.86","68098.86","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","412880.52","412880.52","526163.77","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","282589.47","282589.47","282589.47","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","203030.06","203030.06","203030.06","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","468682.83","468682.83","468682.83","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","148862.58","148862.58","148862.58","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","86151.44","44930.77","409496.84","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","738347.15","738347.15","738347.15","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","361964.77","361964.77","361964.77","1 through 10","percent of total billed charges","","",""
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","003","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","268182.71","161127.72","797068.61","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","183823.58","183823.58","183823.58","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","430357.85","430357.85","430357.85","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","151986.2","151986.2","151986.2","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","104811.85","104811.85","104811.85","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","322266.33","322266.33","322266.33","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","24631.34","24631.34","24631.34","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","522838.59","522838.59","522838.59","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","114390.58","114390.58","114390.58","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","374385.57","374385.57","374385.57","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","548439.83","548439.83","548439.83","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","350881.08","350881.08","350881.08","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","189155.1","189155.1","296304.6","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","274567.36","274567.36","274567.36","1 through 10","percent of total billed charges","","",""
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","004","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","445641.76","445641.76","445641.76","1 through 10","percent of total billed charges","","",""
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","203883.17","203883.17","203883.17","1 through 10","percent of total billed charges","","",""
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","809351.05","809351.05","809351.05","1 through 10","percent of total billed charges","","",""
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","912979.78","912979.78","912979.78","1 through 10","percent of total billed charges","","",""
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","412135.4","412135.4","412135.4","1 through 10","percent of total billed charges","","",""
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","255178.28","255178.28","255178.28","1 through 10","percent of total billed charges","","",""
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","269589.3","244169.9","516430.54","1 through 10","percent of total billed charges","","",""
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","261920.46","261920.46","261920.46","1 through 10","percent of total billed charges","","",""
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant With Mcc Or Intestinal Transplant","005","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","151547.46","151547.46","151547.46","1 through 10","percent of total billed charges","","",""
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Liver Transplant Without Mcc","006","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","114091.73","114091.73","114091.73","1 through 10","percent of total billed charges","","",""
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","402322.86","402322.86","402322.86","1 through 10","percent of total billed charges","","",""
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","214425.01","214425.01","214425.01","1 through 10","percent of total billed charges","","",""
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lung Transplant","007","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1110958.16","1110958.16","1110958.16","1 through 10","percent of total billed charges","","",""
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant","008","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone marrow transplant","009","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas Transplant","010","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","181138.88","181138.88","181138.88","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","178398.92","178398.92","178398.92","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","111091.97","111091.97","111091.97","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","216402.37","216402.37","216402.37","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","141881.22","141881.22","141881.22","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","54039.17","54039.17","54039.17","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","87463.6","87463.6","87463.6","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","64692.64","64692.64","64692.64","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","85099.87","85099.87","85099.87","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","64153.63","64153.63","64153.63","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","30200.76","30200.76","30200.76","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","011","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","106242.08","106242.08","106242.08","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","55870.46","55870.46","55870.46","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","98536.07","98536.07","98536.07","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","61063.71","61063.71","61063.71","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","62179.09","62179.09","62179.09","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","88065.77","69471.36","92696.28","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","198511.36","198511.36","198511.36","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","78255.54","78255.54","78255.54","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","012","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","50284.13","50284.13","50284.13","1 through 10","percent of total billed charges","","",""
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","013","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","86502.23","86502.23","87018.69","1 through 10","percent of total billed charges","","",""
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","93142.6","93142.6","93142.6","1 through 10","percent of total billed charges","","",""
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","42955.54","42955.54","42955.54","1 through 10","percent of total billed charges","","",""
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","217474.79","217474.79","217474.79","1 through 10","percent of total billed charges","","",""
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","46198.99","46198.99","46198.99","1 through 10","percent of total billed charges","","",""
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","50189.96","50189.96","99093.91","1 through 10","percent of total billed charges","","",""
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","169925.6","149789.55","202420.33","1 through 10","percent of total billed charges","","",""
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allogeneic Bone Marrow Transplant","014","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","153089.52","113356.75","176487.21","1 through 10","percent of total billed charges","","",""
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","73726.45","66396.4","86021.56","1 through 10","percent of total billed charges","","",""
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant With Cc/Mcc","016","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Autologous Bone Marrow Transplant Without Cc/Mcc","017","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","669040.98","669040.98","669040.98","1 through 10","percent of total billed charges","","",""
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","685247.58","685247.58","685247.58","1 through 10","percent of total billed charges","","",""
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","177024.61","177024.61","177024.61","1 through 10","percent of total billed charges","","",""
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","018","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","239249.47","239249.47","239249.47","1 through 10","percent of total billed charges","","",""
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","019","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","174819.57","174819.57","174819.57","1 through 10","percent of total billed charges","","",""
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","135529.93","135529.93","187921.77","1 through 10","percent of total billed charges","","",""
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","419675.18","419675.18","419675.18","1 through 10","percent of total billed charges","","",""
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","212308.63","212308.63","212308.63","1 through 10","percent of total billed charges","","",""
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","106804.95","106804.95","106804.95","1 through 10","percent of total billed charges","","",""
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","58692.56","58692.56","58692.56","1 through 10","percent of total billed charges","","",""
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","020","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","119518.01","119518.01","119518.01","1 through 10","percent of total billed charges","","",""
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","021","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","21895.4","21895.4","21895.4","1 through 10","percent of total billed charges","","",""
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","48572.97","48572.97","48572.97","1 through 10","percent of total billed charges","","",""
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","26493.55","26493.55","26493.55","1 through 10","percent of total billed charges","","",""
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","022","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","47122.83","47122.83","148922.26","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","250278.9","250278.9","250278.9","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","84354.46","84354.46","283493.94","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","115588.2","86427.74","264673.19","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","59089.56","59089.56","59089.56","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","79858.96","79858.96","79858.96","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","375201.48","375201.48","375201.48","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","73979.81","73979.81","73979.81","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","79860.06","79860.06","89957.53","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","96988.27","96988.27","1399694.56","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","58870.7","56443.07","75420.75","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","181999.32","181999.32","181999.32","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","023","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","49896.67","49896.67","49896.67","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","45677.23","45677.23","45677.23","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","51464.62","51464.62","51464.62","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","101012.7","101012.7","101012.7","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","64737.8","64737.8","64737.8","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","50510.3","50510.3","50510.3","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","29798.34","29798.34","29798.34","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","68185.15","68185.15","68185.15","1 through 10","percent of total billed charges","","",""
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","024","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","52556.43","52556.43","52556.43","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","50873.04","37158.94","103022.34","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","56131.08","35043.92","93005.49","27","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","29490.58","29490.58","29490.58","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","46158.53","27104.62","97709.27","48","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","36179.07","36179.07","37916.97","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","68107.8","68107.8","100789.19","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","49459.72","28381.07","99817.8","65","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","44980.51","30593.3","102651.06","33","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","56382.17","53136.42","72809.87","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","41292.44","41292.44","41292.44","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","47109.72","47109.72","47109.72","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","65324.12","65324.12","65324.12","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","84840.07","46764.14","90137.69","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","49948.82","37867.85","158410.87","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","54130.14","33441.71","106857.38","15","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","48938.44","25502.54","105172.42","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","44610.76","32021.49","120402.65","27","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","44103.58","44103.58","109661.79","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","56989.29","37828.07","91695.53","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Mcc","025","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","72727.74","46116.92","97209.52","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","36423.41","24721","66504.72","13","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","54767.33","54767.33","54767.33","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","42180.31","17114.63","76816.21","13","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","9689.14","9689.14","9689.14","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","43545.05","33648.5","70586.1","25","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","96722.69","96722.69","96722.69","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","43020.31","31023.5","88925.59","15","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","63943.16","63943.16","63943.16","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","59798.91","53695.12","75074.56","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","41009.46","41009.46","41009.46","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","57735.2","36205.32","89789.19","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","31001.23","21952.56","70200.05","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","22659.39","22659.39","22659.39","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","36909.88","26737.32","81728.68","11","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","47214.34","47214.34","47214.34","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures With Cc","026","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","46537.94","17861.18","69806.35","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","56338.16","39111.32","88219.69","17","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","39115.18","39115.18","43046.86","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","50147.44","25085.54","81573.27","20","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","39791.79","20971.93","65349.91","23","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","44251.74","44251.74","44251.74","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","45680.51","36614.33","66414.01","23","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","46049.07","46049.07","46049.07","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","126313.64","126313.64","126313.64","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","42539.94","42539.94","42539.94","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","59596.74","59596.74","59596.74","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","18059.38","18059.38","18059.38","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","28615.92","16395.09","93084","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","36245.87","32354.5","53056.94","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","39369.52","30930.02","57667.29","12","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","87377.78","87377.78","87377.78","1 through 10","percent of total billed charges","","",""
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","027","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","34118.38","31729.52","49690.01","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","110122.73","110122.73","110122.73","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","73019","73019","73019","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","21674.74","21674.74","21674.74","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","129321.42","129321.42","129321.42","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","197910.37","197910.37","197910.37","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","129695.08","129695.08","129695.08","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","67664.36","67664.36","67664.36","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Mcc","028","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","41918.84","41918.84","74706.55","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","78886.92","78886.92","78886.92","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","80991.09","76131.09","136600.93","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","54592.56","54592.56","54592.56","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","49013.15","49013.15","49013.15","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","35573.03","35573.03","46431.95","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","54577.12","54577.12","54577.12","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","45620.16","45620.16","45620.16","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","55434.71","55434.71","55434.71","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","62199.14","62199.14","62199.14","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","38725.61","38725.61","133786.17","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","90003.81","90003.81","90003.81","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","56147.04","56147.04","56147.04","1 through 10","percent of total billed charges","","",""
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures With Cc Or Spinal Neurostimulators","029","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","113832.83","113832.83","113832.83","1 through 10","percent of total billed charges","","",""
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","29598.23","29598.23","29598.23","1 through 10","percent of total billed charges","","",""
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","34848.83","34848.83","34848.83","1 through 10","percent of total billed charges","","",""
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","40421.47","40421.47","40421.47","1 through 10","percent of total billed charges","","",""
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","33504.16","33504.16","33504.16","1 through 10","percent of total billed charges","","",""
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","45236.73","45236.73","45236.73","1 through 10","percent of total billed charges","","",""
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","69154.16","69154.16","69154.16","1 through 10","percent of total billed charges","","",""
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","34236.83","34236.83","34236.83","1 through 10","percent of total billed charges","","",""
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","24217.66","24217.66","36544.32","1 through 10","percent of total billed charges","","",""
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures Without Cc/Mcc","030","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","68443.27","68443.27","68443.27","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","51330.48","47350.57","146358.61","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23020.58","23020.58","23020.58","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","83353.08","83353.08","83353.08","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","37726.47","37726.47","37726.47","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","20734.05","20734.05","20734.05","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Mcc","031","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","33324.59","33324.59","33324.59","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","48961.49","48961.49","48961.49","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23382.24","23382.24","33519.8","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","35216.05","35216.05","35216.05","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","28431.62","28431.62","37517.83","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","59070.94","59070.94","59070.94","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","33805.79","33805.79","33805.79","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","67825.63","67825.63","67825.63","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","53993.75","23797.09","89201.25","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","26979.53","26979.53","26979.53","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","62120.72","62120.72","62120.72","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","36422.75","36422.75","36422.75","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures With Cc","032","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","120419.8","120419.8","120419.8","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","27210.53","27210.53","28869.61","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","32868.75","32868.75","32868.75","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","30814.96","30179.6","38250.35","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","64695.44","64695.44","64695.44","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","16856.16","16856.16","16856.16","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","23070.88","23070.88","23070.88","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","19039.37","19039.37","19039.37","1 through 10","percent of total billed charges","","",""
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures Without Cc/Mcc","033","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","38293.16","38293.16","38293.16","1 through 10","percent of total billed charges","","",""
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Mcc","034","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","32831.45","32831.45","32831.45","1 through 10","percent of total billed charges","","",""
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","38698.41","38698.41","38698.41","1 through 10","percent of total billed charges","","",""
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","17641.08","17641.08","17641.08","1 through 10","percent of total billed charges","","",""
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures With Cc","035","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","24487.42","24487.42","24487.42","1 through 10","percent of total billed charges","","",""
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","21193.2","21193.2","21193.2","1 through 10","percent of total billed charges","","",""
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Carotid Artery Stent Procedures Without Cc/Mcc","036","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","28861.31","28861.31","28861.31","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","48974.41","48974.41","48974.41","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","31735.28","31735.28","31735.28","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","14808.6","14808.6","14808.6","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Mcc","037","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","30505.56","30505.56","30505.56","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","51737.82","51737.82","51737.82","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","126354.45","126354.45","126354.45","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","77789.55","77789.55","77789.55","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","14727.44","14727.44","14727.44","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","47912.23","47912.23","47912.23","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures With Cc","038","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","27039.87","27039.87","27039.87","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","14973.17","14973.17","14973.17","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","53796.37","53796.37","53796.37","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","38868.26","38868.26","46122.7","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","50278.33","31146.91","66144.37","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","7616.29","7616.29","7616.29","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","15073.93","15073.93","15073.93","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","76427.91","76427.91","76427.91","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11836.21","11836.21","11836.21","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","11903.29","11903.29","11903.29","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","17248.65","17248.65","17248.65","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","13976.33","13976.33","13976.33","1 through 10","percent of total billed charges","","",""
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extracranial Procedures Without Cc/Mcc","039","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","22378.83","22378.83","70977.98","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","35142.65","35142.65","35142.65","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","93284.19","41545.59","106936.85","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","61634.65","61634.65","61634.65","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","617348.28","617348.28","617348.28","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","57765.45","57765.45","57765.45","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","56465.51","56465.51","56465.51","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","040","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","79113.24","79113.24","79113.24","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","40749.72","40749.72","40749.72","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","62022.58","62022.58","62022.58","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","39015.76","25093.95","60204.05","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","87202.17","24285.69","104372.89","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","64633.54","64633.54","64633.54","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2171.77","2171.77","2171.77","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","34945.33","34945.33","34945.33","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","51472.77","51472.77","51472.77","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","33848.42","33848.42","33848.42","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","33350.86","33350.86","33350.86","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","26533.3","17626.19","32527.09","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","37272.89","37272.89","37272.89","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","30226","30226","30226","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","041","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","29858.47","29858.47","29858.47","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","38752.31","38752.31","38752.31","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","37098.16","22930.23","74347.18","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","46153.47","27323.65","75964.83","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","4597.41","4597.41","4597.41","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","71825.2","71825.2","71825.2","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","36654.44","36654.44","36654.44","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","51046.19","51046.19","51046.19","1 through 10","percent of total billed charges","","",""
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","042","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hyphema","043","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections","044","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological eye disorders","045","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w CC","046","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age >17 w/o CC","047","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders of the Eye Age 0-17","048","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures","049","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sialoadenectomy","050","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures Except Sialoadenectomy","051","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","56427.75","56427.75","56427.75","1 through 10","percent of total billed charges","","",""
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","8984","8984","8984","1 through 10","percent of total billed charges","","",""
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","23087.61","23087.61","23087.61","1 through 10","percent of total billed charges","","",""
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries With Cc/Mcc","052","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","43908.9","43908.9","43908.9","1 through 10","percent of total billed charges","","",""
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","768.95","768.95","768.95","1 through 10","percent of total billed charges","","",""
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Disorders And Injuries Without Cc/Mcc","053","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","17181.83","17181.83","68440.83","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","14654.44","6001.36","84078.75","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","16738.09","12348.56","178200.97","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","31567.4","8040.71","74362.61","12","percent of total billed charges","","",""
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","21845.23","21845.23","21845.23","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","17429.28","17429.28","17429.28","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","65322.58","65322.58","65322.58","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","33792.21","33792.21","33792.21","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10264.82","9792.91","16150.57","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","50439.4","50439.4","50439.4","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","129365.53","129365.53","129365.53","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms With Mcc","054","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","38210.07","38210.07","38210.07","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","40710.17","40710.17","40710.17","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","20654.75","20654.75","20654.75","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","5946.69","5946.69","5946.69","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","31681.81","31681.81","31681.81","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","15803.85","15803.85","15803.85","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5619.48","5619.48","5619.48","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","15800.97","15800.97","15800.97","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","19061.2","19061.2","19061.2","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","2686.21","2686.21","2686.21","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","12403.16","12403.16","12403.16","1 through 10","percent of total billed charges","","",""
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nervous System Neoplasms Without Mcc","055","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","56595.42","56595.42","56595.42","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","44538.34","44538.34","57162.18","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","41428.24","37791.03","80754","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","34199.92","32433.71","72016.24","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","58103.2","58103.2","58103.2","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","9522.36","9522.36","9522.36","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","15953.28","15953.28","15953.28","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11428.01","11428.01","11428.01","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","67576.76","63566.02","81617.92","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","133832.11","133832.11","133832.11","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","43982.38","43982.38","43982.38","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","54744.92","54744.92","54744.92","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders With Mcc","056","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","24799.61","24799.61","24799.61","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","14578.88","6121.17","67873.55","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","20075.84","10156.42","73992.8","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","24204.2","17728.22","110999.66","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","15305.43","9442.02","48122.08","14","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","7256.75","7256.75","25005.58","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","14502.33","14502.33","14502.33","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","34143.16","6985.44","82242.88","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","12295.72","12295.72","12295.72","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","15494.06","15494.06","15494.06","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","2951.91","2951.91","2951.91","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","17412.87","13038.27","42449.95","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","25151.89","13402.23","43402.17","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","14625.6","3702","16358.05","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","7594","7594","7594","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","23524.07","23524.07","23524.07","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","16846.24","13521.75","34302.85","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","31774.17","31774.17","31774.17","1 through 10","percent of total billed charges","","",""
"Degenerative Nervous System Disorders Without Mcc","057","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","34738.78","34738.78","34738.78","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","46185.8","46185.8","71652.5","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","33845.52","33845.52","33845.52","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11097.15","11097.15","11097.15","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","79062.79","79062.79","79062.79","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Mcc","058","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","30192.45","21798.39","86785.9","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17102.19","17102.19","17102.19","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","68147.96","68147.96","68147.96","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","40055.28","40055.28","40055.28","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14587.33","14587.33","14587.33","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","15309.62","15309.62","26739.29","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia With Cc","059","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","39993.62","39993.62","84166.77","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","17417.39","17417.39","20237.4","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","27990.66","27990.66","27990.66","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","18668.16","8509.3","36813.44","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","19665.05","19665.05","19665.05","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","6374.3","6374.3","6374.3","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","28649.21","28649.21","61569.99","1 through 10","percent of total billed charges","","",""
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","060","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6259.28","6259.28","6259.28","1 through 10","percent of total billed charges","","",""
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","104508.87","104508.87","104508.87","1 through 10","percent of total billed charges","","",""
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","061","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","26510.21","26510.21","26510.21","1 through 10","percent of total billed charges","","",""
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","48989.34","48989.34","48989.34","1 through 10","percent of total billed charges","","",""
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","062","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","36946.22","36946.22","36946.22","1 through 10","percent of total billed charges","","",""
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","063","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","27711.64","16495.34","70191.72","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","48347.7","48347.7","104638","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","127072.26","127072.26","127072.26","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23911.53","20105.59","70852.69","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25026.36","13759.52","84812.29","14","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","46307.24","46307.24","70858.96","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","21540.24","16099.5","51412.65","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","31562.03","18886.87","79224.23","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","19548.46","19548.46","19548.46","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","21373.54","21373.54","21373.54","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","78239.02","78239.02","78239.02","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","79990.26","79990.26","79990.26","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","22776.49","16465.68","68907.97","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","20520.21","17967.28","23967.59","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","40536.67","10460.07","105928.14","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","70371.41","55602.53","85549.8","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","3882.52","3882.52","3882.52","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","31402.78","18860.59","147495.17","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","064","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","33058.24","33058.24","34261.41","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","21891.33","12921.96","26496.78","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","19652.37","16026.14","48946.99","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","160122.73","160122.73","160122.73","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","14571.97","14571.97","14571.97","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","39202.47","39202.47","39202.47","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","39354.09","39354.09","39354.09","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13982.94","13982.94","13982.94","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","11125.6","11125.6","11125.6","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","23296.37","23296.37","23296.37","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","24567.06","24567.06","24567.06","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","7941.46","7941.46","7941.46","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","74339.09","74339.09","74339.09","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","8687.96","6249.88","78385.8","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","30805.34","22220.88","51387.31","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12722.18","8650.94","39487.57","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","14571.39","14571.39","32841.59","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","16895.13","7450.34","44669.15","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","38473.39","38473.39","38473.39","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","12145.37","12145.37","12145.37","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","065","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","18158.4","18158.4","23113.23","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","70588.13","70588.13","70588.13","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","52027.71","52027.71","52027.71","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11600.13","11600.13","11600.13","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","46000.64","46000.64","46000.64","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","18698.46","18698.46","18698.46","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","12734.12","12734.12","12734.12","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","12729.34","12729.34","12729.34","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","9203.05","9203.05","9203.05","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","18255.51","10093.37","19618.82","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7289.85","7289.85","7289.85","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","11260.56","11260.56","11260.56","1 through 10","percent of total billed charges","","",""
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","066","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8987.66","8987.66","8987.66","1 through 10","percent of total billed charges","","",""
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","19698.44","19698.44","19698.44","1 through 10","percent of total billed charges","","",""
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction With Mcc","067","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","8652.24","8652.24","8652.24","1 through 10","percent of total billed charges","","",""
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7925.95","7925.95","7925.95","1 through 10","percent of total billed charges","","",""
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","8053.79","8053.79","8053.79","1 through 10","percent of total billed charges","","",""
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Precerebral Occlusion Without Infarction Without Mcc","068","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","15252.32","15252.32","15252.32","1 through 10","percent of total billed charges","","",""
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","19548.37","19548.37","19548.37","1 through 10","percent of total billed charges","","",""
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16370.18","16370.18","16370.18","1 through 10","percent of total billed charges","","",""
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","19936.31","19936.31","19936.31","1 through 10","percent of total billed charges","","",""
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","19076.67","19076.67","19076.67","1 through 10","percent of total billed charges","","",""
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","774.79","774.79","774.79","1 through 10","percent of total billed charges","","",""
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","7985.06","7985.06","7985.06","1 through 10","percent of total billed charges","","",""
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11855.38","11855.38","11855.38","1 through 10","percent of total billed charges","","",""
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","33617.14","33617.14","33617.14","1 through 10","percent of total billed charges","","",""
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2940.98","2940.98","2940.98","1 through 10","percent of total billed charges","","",""
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient Ischemia Without Thrombolytic","069","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","2045.55","2045.55","2045.55","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","35703.31","35703.31","40809.92","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","45510.36","45510.36","45510.36","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","18307.82","18307.82","18307.82","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7226.75","7226.75","7226.75","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","51865.65","51865.65","51865.65","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","75306.4","75306.4","75306.4","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Mcc","070","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","21890.81","21890.81","21890.81","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","111122.11","111122.11","111122.11","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16625.71","16625.71","16625.71","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","101417.57","101417.57","101417.57","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4704.83","4704.83","4704.83","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","24884.07","24884.07","24884.07","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1181.03","1181.03","1181.03","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders With Cc","071","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16241.76","16241.76","16241.76","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16100.47","16100.47","16100.47","1 through 10","percent of total billed charges","","",""
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cerebrovascular Disorders Without Cc/Mcc","072","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","164376.44","164376.44","164376.44","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","28062.63","28062.63","28062.63","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11639.56","11639.56","11639.56","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","9938.91","9938.91","15286.08","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","27245.33","27245.33","27245.33","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders With Mcc","073","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","45137.02","45137.02","45137.02","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","51036.34","51036.34","51036.34","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15488.25","6567.12","69886.3","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13144.09","9416.61","35339.15","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","16844.91","16844.91","16844.91","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","26757.11","26757.11","58407.49","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","15650.77","11777.95","18645.12","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7934.75","7934.75","7934.75","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","7572.02","7572.02","7572.02","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","7426.4","7426.4","7426.4","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12922.34","2770.85","25736.88","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10219.23","5130.85","27906.97","15","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","7945.73","706.03","62235.8","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","26098.87","14449.84","63427.51","1 through 10","percent of total billed charges","","",""
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial And Peripheral Nerve Disorders Without Mcc","074","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","4043.5","4043.5","4043.5","1 through 10","percent of total billed charges","","",""
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","19060.97","19060.97","19060.97","1 through 10","percent of total billed charges","","",""
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","21522.64","21522.64","21522.64","1 through 10","percent of total billed charges","","",""
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","26202.43","26202.43","26202.43","1 through 10","percent of total billed charges","","",""
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","14070.67","14070.67","14070.67","1 through 10","percent of total billed charges","","",""
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis With Cc/Mcc","075","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8530.99","8530.99","8530.99","1 through 10","percent of total billed charges","","",""
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","7973.28","7973.28","7973.28","1 through 10","percent of total billed charges","","",""
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24374.26","24374.26","24374.26","1 through 10","percent of total billed charges","","",""
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Meningitis Without Cc/Mcc","076","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","59667.62","59667.62","59667.62","1 through 10","percent of total billed charges","","",""
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Mcc","077","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy With Cc","078","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertensive Encephalopathy Without Cc/Mcc","079","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","82558.84","82558.84","82558.84","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","22175.17","22175.17","22175.17","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11900.89","11900.89","11900.89","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","66593.71","66593.71","66593.71","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","24513.09","24513.09","24513.09","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","11040.19","11040.19","11040.19","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9136.15","9136.15","9136.15","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma With Mcc","080","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","21133.17","21133.17","21133.17","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","15538.75","15538.75","15538.75","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13655.04","13655.04","15537.1","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","67767.5","67767.5","67767.5","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","71663.35","71663.35","71663.35","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","13418.23","13418.23","13418.23","1 through 10","percent of total billed charges","","",""
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Nontraumatic Stupor And Coma Without Mcc","081","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","95779.72","95779.72","95779.72","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","40820.28","40820.28","207256.4","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","16316.06","16316.06","16316.06","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","53638.37","53638.37","53638.37","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","46720.13","46720.13","46720.13","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","36724.25","36724.25","36724.25","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","50515","50515","54094.6","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","10372.66","10372.66","10372.66","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","80063.59","80063.59","80063.59","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Mcc","082","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","41369.79","41369.79","48923.93","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13477.54","13477.54","13477.54","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6456.23","6456.23","6456.23","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","4705.99","4705.99","4705.99","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","678.52","678.52","678.52","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","30388.43","30388.43","30388.43","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16408.55","16408.55","16408.55","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","38244.31","38244.31","38244.31","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","18635","18635","18635","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour With Cc","083","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15795.05","15795.05","15795.05","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9638.64","9638.64","9638.64","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","6179.69","6179.69","6179.69","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11425.23","11425.23","11425.23","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","084","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","503.58","503.58","503.58","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","51551.03","51551.03","51551.03","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5050.13","5050.13","5050.13","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","41700.16","41700.16","41700.16","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","25997.54","25997.54","25997.54","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","51748.38","51748.38","51748.38","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Mcc","085","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","49787.71","49787.71","49787.71","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","5613.66","5613.66","5613.66","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","10700.6","10700.6","10700.6","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","15318.4","15318.4","15318.4","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","20346.86","20346.86","20346.86","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","20781.11","20781.11","20781.11","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour With Cc","086","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","20877.12","20877.12","20877.12","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","11118.1","11118.1","11118.1","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","9549.85","9549.85","9549.85","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11212.94","11212.94","11212.94","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","12674","12674","12674","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11781.22","11781.22","11781.22","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","15436.37","15436.37","15436.37","1 through 10","percent of total billed charges","","",""
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","087","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","18047.11","18047.11","18047.11","1 through 10","percent of total billed charges","","",""
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","13333.34","13333.34","13333.34","1 through 10","percent of total billed charges","","",""
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Mcc","088","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion With Cc","089","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concussion Without Cc/Mcc","090","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12848.32","12848.32","12848.32","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","15136.77","15136.77","17048.16","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12100.2","12100.2","22067.82","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17187.68","11338.47","64878.69","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","24733.01","24733.01","24733.01","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","21960.15","18456.97","61138.47","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","26731.53","26731.53","26731.53","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","33848.51","33848.51","59242.55","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","31881.99","31881.99","31881.99","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","43379.34","43379.34","43379.34","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","37580.06","37580.06","37580.06","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","28794.64","17281.98","73372.22","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","42083.24","42083.24","42083.24","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","43807.44","43807.44","43807.44","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","10424.7","10424.7","10424.7","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Mcc","091","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","34002.87","34002.87","57792.27","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","8639.89","8639.89","8639.89","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","26465.33","26465.33","26465.33","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","12769.28","11147.54","16664.67","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","15779.47","6877.42","23470.99","11","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","16771.95","8356.91","101557.99","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","13944.83","13944.83","13944.83","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","41873.66","41873.66","41873.66","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","14516.21","14516.21","14516.21","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","5852.89","5852.89","5852.89","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14310.09","14310.09","29271.6","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9512.45","9512.45","11500.5","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","11887.56","11887.56","11887.56","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","20181.1","20181.1","20181.1","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","27203.84","27203.84","27203.84","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","23475.91","22757.26","33445.9","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System With Cc","092","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","31665.93","31665.93","31665.93","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","16478.25","16478.25","21810.79","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","15548.71","15548.71","19005.89","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","9501.97","6170.07","16433.93","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","12213.87","4473.89","20469.71","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","7287.17","6680.85","26022.75","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14743.46","14743.46","14743.46","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15087.95","5213.75","53985.72","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10434.88","10434.88","76468.99","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","6016.01","6016.01","6016.01","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","19838.61","19838.61","19838.61","1 through 10","percent of total billed charges","","",""
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of Nervous System Without Cc/Mcc","093","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","93104.09","93104.09","95715.85","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","33371.12","33371.12","33371.12","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","30800.57","30800.57","30800.57","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","137762.1","137762.1","137762.1","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Mcc","094","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","74064.55","74064.55","74064.55","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","29682.09","29682.09","29682.09","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","131326.7","131326.7","131326.7","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","9761.68","9761.68","9761.68","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","110875.12","110875.12","110875.12","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System With Cc","095","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","41503.28","41503.28","41503.28","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","45893.71","45893.71","45893.71","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17686.53","17686.53","17686.53","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","27807.81","27807.81","27807.81","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","28637.86","28637.86","28637.86","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1609.7","1609.7","1609.7","1 through 10","percent of total billed charges","","",""
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","096","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","697.9","697.9","697.9","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","37271.89","37271.89","37271.89","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","155177.18","155177.18","271846.45","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","76549.58","76549.58","76549.58","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","130697.72","130697.72","130697.72","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","89411.53","89411.53","89411.53","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","57690.8","57690.8","57690.8","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","190910.81","190910.81","190910.81","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","097","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","13288.71","13288.71","13288.71","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","44404.15","44404.15","44404.15","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","103398.19","103398.19","103398.19","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","41044.51","22092.22","162810.33","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","17184.23","17184.23","17184.23","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","52491","52491","52491","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","67546.86","67546.86","74562.22","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","098","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","56152.07","56152.07","56152.07","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","29787.69","29787.69","47794.25","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","32962.62","32962.62","86739.81","1 through 10","percent of total billed charges","","",""
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","099","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","16592.44","16592.44","16592.44","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","24885.04","10579.27","164545.79","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","10981.9","10981.9","10981.9","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","11847.22","11847.22","11847.22","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13952.26","6552.16","217941.83","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13582.07","6906.1","28882.43","11","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","17218.99","12320.7","32795.94","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","59659.11","59659.11","59659.11","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","30239.03","30239.03","30239.03","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","9355.12","9355.12","9355.12","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","128899.6","128899.6","128899.6","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","22208.87","11299.18","166701.7","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17893.73","12022.55","398927.35","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","33449.28","8432.55","49278.35","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","27326.65","19711.6","28254.55","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","17719.12","17719.12","28659.08","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","11471.98","11471.98","11471.98","1 through 10","percent of total billed charges","","",""
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures With Mcc","100","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","16678.16","14789.6","33933.29","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","15204.27","5657.16","30421.3","38","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","19601.89","19601.89","19601.89","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","16868.53","5830.83","34407.41","37","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","14008.04","14008.04","14008.04","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16057.76","5244.48","29536.67","57","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","18435.24","6153.33","30748.31","31","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","18881.85","18881.85","18881.85","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","27193.99","27193.99","27193.99","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","25783.87","25783.87","25783.87","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","26662.53","26662.53","26662.53","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","14940.09","14940.09","14940.09","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","5728.12","5728.12","5728.12","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","39599.24","39599.24","39599.24","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","9879.82","3105.21","23280.86","30","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10896.89","4959.1","28013.3","67","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","13636.55","5149.73","26752.78","22","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","10541.41","10541.41","10541.41","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","12948.88","12948.88","12948.88","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","11768.86","7071.86","33599","1 through 10","percent of total billed charges","","",""
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Seizures Without Mcc","101","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10748.84","5995.32","23183.06","28","percent of total billed charges","","",""
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","88401.58","88401.58","88401.58","1 through 10","percent of total billed charges","","",""
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12582.77","12582.77","12582.77","1 through 10","percent of total billed charges","","",""
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","230.78","230.78","230.78","1 through 10","percent of total billed charges","","",""
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","17821.7","17821.7","17821.7","1 through 10","percent of total billed charges","","",""
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches With Mcc","102","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","34997.79","34997.79","34997.79","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","13588.44","2051.53","28301.91","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","11903.43","11903.43","11903.43","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","18358.52","7251.28","27492.74","11","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","7234.74","7234.74","7234.74","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10306.79","6021.75","49163.22","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","26561.19","26561.19","26561.19","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","14332.86","7045.27","20503.71","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","17275.73","17275.73","17275.73","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","16098.75","16098.75","16098.75","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2243.85","2243.85","2243.85","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14119.78","7027.26","29731.86","18","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","26357.45","26357.45","26357.45","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","15526.97","15526.97","15526.97","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","17047.45","17047.45","17047.45","1 through 10","percent of total billed charges","","",""
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Headaches Without Mcc","103","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","15583.94","11706.78","30133.69","1 through 10","percent of total billed charges","","",""
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","104","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","105","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass w PTCA","106","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","107","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures","108","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","109","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w CC","110","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Cardiovascular Procedures w/o CC","111","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","112","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","104794","104794","104794","1 through 10","percent of total billed charges","","",""
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24491.29","24491.29","24491.29","1 through 10","percent of total billed charges","","",""
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","47203.03","47203.03","47203.03","1 through 10","percent of total billed charges","","",""
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","83326.06","83326.06","83326.06","1 through 10","percent of total billed charges","","",""
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","99316.13","99316.13","99316.13","1 through 10","percent of total billed charges","","",""
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","46124.12","46124.12","46124.12","1 through 10","percent of total billed charges","","",""
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures With Cc/Mcc","113","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Orbital Procedures Without Cc/Mcc","114","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","27629.96","27629.96","27629.96","1 through 10","percent of total billed charges","","",""
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","59388.99","59388.99","59388.99","1 through 10","percent of total billed charges","","",""
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","3142.35","3142.35","3142.35","1 through 10","percent of total billed charges","","",""
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","34087.19","34087.19","34087.19","1 through 10","percent of total billed charges","","",""
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","11563.16","11563.16","11563.16","1 through 10","percent of total billed charges","","",""
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","15634.31","15634.31","15634.31","1 through 10","percent of total billed charges","","",""
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","50029.25","50029.25","50029.25","1 through 10","percent of total billed charges","","",""
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","37627.77","37627.77","37627.77","1 through 10","percent of total billed charges","","",""
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","10714.78","10714.78","10714.78","1 through 10","percent of total billed charges","","",""
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extraocular Procedures Except Orbit","115","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","33911.92","33911.92","33911.92","1 through 10","percent of total billed charges","","",""
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","11966.86","11966.86","11966.86","1 through 10","percent of total billed charges","","",""
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","41223.24","41223.24","41223.24","1 through 10","percent of total billed charges","","",""
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","39114.28","39114.28","39114.28","1 through 10","percent of total billed charges","","",""
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","59547.96","59547.96","60821.23","1 through 10","percent of total billed charges","","",""
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","93512.02","93512.02","93512.02","1 through 10","percent of total billed charges","","",""
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","24580.49","24580.49","24580.49","1 through 10","percent of total billed charges","","",""
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures With Cc/Mcc","116","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","33277.32","33277.32","33277.32","1 through 10","percent of total billed charges","","",""
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intraocular Procedures Without Cc/Mcc","117","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement","118","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein ligation & stripping","119","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other circulatory system O.R. procedures","120","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","4982.22","4982.22","4982.22","1 through 10","percent of total billed charges","","",""
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","27978.53","27978.53","27978.53","1 through 10","percent of total billed charges","","",""
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","18853.86","18853.86","18853.86","1 through 10","percent of total billed charges","","",""
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","12793.58","12793.58","12793.58","1 through 10","percent of total billed charges","","",""
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","30789.67","30789.67","30789.67","1 through 10","percent of total billed charges","","",""
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","27549.39","27549.39","27549.39","1 through 10","percent of total billed charges","","",""
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","50809.46","50809.46","50809.46","1 through 10","percent of total billed charges","","",""
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","50671.61","50671.61","50671.61","1 through 10","percent of total billed charges","","",""
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections With Cc/Mcc","121","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10427.17","10427.17","10427.17","1 through 10","percent of total billed charges","","",""
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","7465.87","7465.87","7465.87","1 through 10","percent of total billed charges","","",""
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Major Eye Infections Without Cc/Mcc","122","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","60833.18","60833.18","60833.18","1 through 10","percent of total billed charges","","",""
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","17932.87","17932.87","23028.58","1 through 10","percent of total billed charges","","",""
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","70282.64","70282.64","70282.64","1 through 10","percent of total billed charges","","",""
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25449.12","7763.22","83447.79","1 through 10","percent of total billed charges","","",""
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","9125.59","9125.59","9125.59","1 through 10","percent of total billed charges","","",""
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","14588.09","14588.09","14588.09","1 through 10","percent of total billed charges","","",""
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","15722.34","15722.34","15722.34","1 through 10","percent of total billed charges","","",""
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","22437.24","22437.24","49531.49","1 through 10","percent of total billed charges","","",""
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","33825.64","33825.64","73042.36","1 through 10","percent of total billed charges","","",""
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","35148.16","35148.16","35148.16","1 through 10","percent of total billed charges","","",""
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neurological Eye Disorders","123","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","39462.79","39462.79","39462.79","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","4402.3","4402.3","4402.3","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","21388.02","21388.02","21388.02","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","33273.81","33273.81","33273.81","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","81039.58","81039.58","81039.58","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","42146.53","42146.53","42146.53","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","18806.9","18806.9","34041.35","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12756.39","12756.39","12756.39","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","6376.17","6376.17","6376.17","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","12731.71","12731.71","12731.71","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","124","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","12029.73","5938.32","14402.82","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","23923.88","7670.35","36784.79","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13468.06","4904.79","19069.12","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8127.86","3709.85","18449.36","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","23726.85","23726.85","23726.85","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","10189.89","10189.89","10189.89","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","20336.78","20336.78","20336.78","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","74306.98","74306.98","74306.98","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","16846.39","16846.39","16846.39","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","6985.56","6985.56","6985.56","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12650.75","12650.75","15952.18","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8092.15","7816","8153.86","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","10204.29","10204.29","10204.29","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12237.74","9371.51","20283.68","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1131.26","1131.26","9014.6","1 through 10","percent of total billed charges","","",""
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Disorders Of The Eye Without Mcc","125","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","20287.22","20287.22","20287.22","1 through 10","percent of total billed charges","","",""
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute & Subacute Endocarditis","126","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure & Shock","127","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis","128","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W Cc/Mcc Or Major Device","129","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head & Neck Procedures W/O Cc/Mcc","130","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W Cc/Mcc","131","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cranial/Facial Procedures W/O Cc/Mcc","132","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","133","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","134","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","77161.1","77161.1","77161.1","1 through 10","percent of total billed charges","","",""
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","24467.4","24467.4","24467.4","1 through 10","percent of total billed charges","","",""
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","52486.7","52486.7","52486.7","1 through 10","percent of total billed charges","","",""
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures With Cc/Mcc","135","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sinus And Mastoid Procedures Without Cc/Mcc","136","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15332.92","15332.92","15332.92","1 through 10","percent of total billed charges","","",""
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures With Cc/Mcc","137","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures Without Cc/Mcc","138","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11652.41","11652.41","11652.41","1 through 10","percent of total billed charges","","",""
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Salivary Gland Procedures","139","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","188041.95","188041.95","188041.95","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","72592.67","72592.67","72592.67","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","48386.44","48386.44","48386.44","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Mcc","140","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","29233.92","29233.92","29233.92","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","51610.51","51610.51","52298.86","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","94034.42","52715.01","105372.59","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","79399.2","73950.27","125720.06","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","56774.03","56774.03","66623.45","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","20038.31","20038.31","20038.31","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","32794.17","32794.17","32794.17","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","53408.28","53408.28","69002.61","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","50353.34","50353.34","50353.34","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","43908.96","43908.96","43908.96","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures With Cc","141","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","21585.94","21585.94","21585.94","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","72447.23","72447.23","72447.23","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","87047.15","44998.37","116886.28","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","108875.59","45501.43","130106.08","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","117397.88","117397.88","117397.88","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","37216","37216","37216","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","92112.87","92112.87","92112.87","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","72535.05","72535.05","92292.27","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","62930.14","62930.14","62930.14","1 through 10","percent of total billed charges","","",""
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Head And Neck Procedures Without Cc/Mcc","142","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","489.12","489.12","489.12","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","72119.97","72119.97","72119.97","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","19180.46","19180.46","19180.46","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","197749.22","197749.22","197749.22","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","39426.57","39426.57","42108.63","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","143","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","123129.75","123129.75","123129.75","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","36482.36","36482.36","46831.02","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14547.34","14081.35","37955.65","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","59326.29","59326.29","59326.29","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","37606.9","37606.9","37606.9","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13116.85","13116.85","13116.85","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9675.74","8134.9","18601.97","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","21314.61","14148.76","40867.28","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","144","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","21378.97","21378.97","61852.58","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","34799.33","34799.33","34799.33","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","41062.28","35728.7","42813.18","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","27353.28","10724.8","40894.8","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","20417.43","20417.43","20417.43","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","34075.15","13949.33","85999.17","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","36119.25","32192.28","43488.89","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","39200.71","39200.71","39200.71","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4592.96","4592.96","4592.96","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","18882.33","18882.33","18882.33","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","22154.96","22154.96","22154.96","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","7288.01","7288.01","7288.01","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","145","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","29473.15","29473.15","29473.15","1 through 10","percent of total billed charges","","",""
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","29678.31","29678.31","29678.31","1 through 10","percent of total billed charges","","",""
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","65667.48","65667.48","65667.48","1 through 10","percent of total billed charges","","",""
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","29831.25","29831.25","29831.25","1 through 10","percent of total billed charges","","",""
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","25046.48","25046.48","32782.72","1 through 10","percent of total billed charges","","",""
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","38634.27","15882.55","117339.86","1 through 10","percent of total billed charges","","",""
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12866.99","12866.99","12866.99","1 through 10","percent of total billed charges","","",""
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Mcc","146","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","32257.17","32257.17","32257.17","1 through 10","percent of total billed charges","","",""
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","20847.57","20847.57","20847.57","1 through 10","percent of total billed charges","","",""
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","44747.98","44747.98","44747.98","1 through 10","percent of total billed charges","","",""
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","33498.46","33498.46","33498.46","1 through 10","percent of total billed charges","","",""
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","19957.57","19957.57","19957.57","1 through 10","percent of total billed charges","","",""
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy With Cc","147","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","148","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","47112.22","47112.22","47112.22","1 through 10","percent of total billed charges","","",""
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1098.83","1098.83","1098.83","1 through 10","percent of total billed charges","","",""
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2419.42","2419.42","2419.42","1 through 10","percent of total billed charges","","",""
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1290.62","1290.62","1290.62","1 through 10","percent of total billed charges","","",""
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dysequilibrium","149","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis With Mcc","150","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","18528.64","18528.64","18528.64","1 through 10","percent of total billed charges","","",""
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","18773.87","18773.87","18773.87","1 through 10","percent of total billed charges","","",""
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","10296.7","10296.7","10296.7","1 through 10","percent of total billed charges","","",""
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Epistaxis Without Mcc","151","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","5665.32","5665.32","5665.32","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9904.23","9904.23","28765.46","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","2690.09","2690.09","2690.09","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","23007.07","23007.07","23007.07","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","18404.02","18404.02","18404.02","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri With Mcc","152","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6399.93","6399.93","7663.32","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","5413.57","5413.57","5413.57","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","8309.08","6872.99","15566.6","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","8971.74","2818.89","21317.95","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6492.04","5700.11","17356.84","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","2503.77","1531.66","6636.19","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15794.82","15794.82","15794.82","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","8843.31","8843.31","8843.31","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","17714.88","17714.88","17714.88","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","8135.05","6778.99","14487.89","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6292.47","2797.35","24265.71","15","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","14552.69","14552.69","14552.69","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","11164.91","11164.91","11164.91","1 through 10","percent of total billed charges","","",""
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Otitis Media And Uri Without Mcc","153","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8863.12","6752.71","9991.7","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","12586.62","12586.62","12586.62","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","36610.84","36610.84","42619.9","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","59120.38","59120.38","59120.38","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","11363.91","11363.91","11363.91","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","154","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","9630.04","9630.04","9630.04","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","7924.08","7924.08","7924.08","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","5266.27","5266.27","12267.81","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","7374.17","7374.17","7374.17","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","15334.87","15334.87","15334.87","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1842.56","1842.56","15423.17","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","27781.22","27781.22","27781.22","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","155","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","24602.62","24602.62","24602.62","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8594.69","8594.69","8600.19","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","3292.73","3292.73","3292.73","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9359.36","9359.36","9359.36","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","9787.47","9787.47","9787.47","1 through 10","percent of total billed charges","","",""
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","156","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1163.12","1163.12","1163.12","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","16141.64","16141.64","16141.64","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17452.92","17452.92","17452.92","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","14083.75","14083.75","14083.75","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","18936.35","18936.35","18936.35","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","19395.43","19395.43","19395.43","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","28988.75","28988.75","28988.75","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","41656.96","14613.13","60549.82","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10852.47","10852.47","10852.47","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","20778.13","20778.13","20778.13","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Mcc","157","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","4532.58","4532.58","4532.58","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","23043.72","23043.72","23043.72","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","9927.51","9927.51","9927.51","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","28026.19","28026.19","28026.19","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","17435.3","17435.3","17435.3","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9368.68","9368.68","27518.96","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","16407.45","16407.45","16407.45","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases With Cc","158","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","18515.16","18515.16","36492.52","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","11266.53","11266.53","11266.53","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","4249.01","4249.01","4249.01","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","6564","6564","6564","1 through 10","percent of total billed charges","","",""
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Dental And Oral Diseases Without Cc/Mcc","159","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","160","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w CC","161","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","162","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","37617.97","37617.97","37617.97","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","72597.69","36682.05","124146.25","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","151639.35","151639.35","151639.35","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","41221.76","41221.76","41221.76","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","118157.83","118157.83","118157.83","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","96447.04","96447.04","96447.04","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","46220.76","46220.76","46220.76","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","113417.77","71730.72","174641.27","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","182823.97","55091.75","523385.54","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","30625.04","30625.04","30625.04","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","55815.47","55815.47","126837.74","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Mcc","163","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","125878.84","125878.84","125878.84","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","36453.12","32193.48","52777.36","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","52448.64","52448.64","52448.64","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","41156.67","23009.38","56981.09","11","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","34058.06","34058.06","51306.44","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","45194.79","31353.4","52742.11","14","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","36514.35","29507.21","55549.78","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","26812.89","26812.89","26812.89","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","40971.45","40971.45","41110.17","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","27777.87","27777.87","27777.87","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","40156.75","40156.75","40156.75","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","124366.94","124366.94","124366.94","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","152701.55","152701.55","152701.55","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","34486.9","34486.9","53373.03","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","54149.15","54149.15","54149.15","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures With Cc","164","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","36666.21","36666.21","36666.21","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","32341.99","7410.11","46487.9","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","22404.57","22404.57","22404.57","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","28781.5","28781.5","32345.53","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","35598.35","35598.35","35598.35","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","35321.18","32241.21","60438.83","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","40980.84","29108.38","42989.76","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","31539.35","31539.35","37513.59","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","51277.57","51277.57","51277.57","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","31247.57","31247.57","31247.57","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","27532.83","27532.83","27532.83","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","32126.93","32126.93","33074.43","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","35380.84","35380.84","35380.84","1 through 10","percent of total billed charges","","",""
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Procedures Without Cc/Mcc","165","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","44283.57","44283.57","44283.57","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","53994.94","53994.94","53994.94","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","61473.19","61473.19","142448.82","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","77555.58","42937.64","167011.47","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","43433.13","43433.13","43433.13","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Mcc","166","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","87473.91","87473.91","87473.91","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","50756.56","50756.56","50756.56","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","46751.29","46751.29","46751.29","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","20906.38","20906.38","25656.37","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","31368.27","24559.56","31721.43","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","45645.93","29813.7","84148.07","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","26484.2","26484.2","26484.2","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","44538.59","44538.59","55526.49","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","36359.34","36359.34","36359.34","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures With Cc","167","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","44784.31","44784.31","52919.02","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","19451.34","19451.34","19451.34","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","28372.77","28372.77","28372.77","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","18232.36","18232.36","18232.36","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","24223.29","24223.29","24223.29","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","13853.58","13853.58","13853.58","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8948.93","8948.93","8948.93","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","26536.16","26536.16","26536.16","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","20476.26","20476.26","20476.26","1 through 10","percent of total billed charges","","",""
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System O.R. Procedures Without Cc/Mcc","168","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","33559.53","33559.53","33559.53","1 through 10","percent of total billed charges","","",""
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mouth Procedures w/o CC","169","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures w/o CC","171","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","173","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"G.I. hemorrhage w CC","174","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","19470.01","15938.27","74349.09","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","45179.8","25174.23","206726.72","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","14070.97","14070.97","14070.97","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13884.59","12575.53","23095.8","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","33591.08","19902.17","69369.85","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","38646.71","38646.71","38646.71","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","7302.27","7302.27","7302.27","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","33238.1","33238.1","33238.1","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","22229.21","15490.42","32448.62","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","33849.56","9609.91","83087.81","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16448.28","14688.7","23243.34","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","30806.24","8357.48","71929.29","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","17049.86","17049.86","17049.86","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","16338.63","16338.63","22118.7","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","20297.24","20297.24","20297.24","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","175","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","14254.41","9905.27","26378.68","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","12025.58","8246.87","12828.28","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","11171.28","11171.28","11171.28","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11407.49","11407.49","11743.53","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","9561.76","9561.76","9561.76","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13206.98","9618.06","34185.74","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","15910.55","15910.55","15910.55","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","14936.56","14936.56","14936.56","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","18808.28","18808.28","18808.28","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","4903.17","4241.7","24839.56","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","28965.46","28965.46","28965.46","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","17576.97","17576.97","17576.97","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","13836.73","13836.73","13836.73","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","6006.24","6006.24","14984.1","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13570.22","8742.52","43444.4","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","25253.99","25253.99","25253.99","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","15250.87","15250.87","15250.87","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1181.03","1181.03","1181.03","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","22484.27","22484.27","22484.27","1 through 10","percent of total billed charges","","",""
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Embolism Without Mcc","176","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","13003.93","13003.93","13003.93","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","20658.43","18432.29","29204.84","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","24922.78","13307.11","97107.85","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","15447.59","15447.59","15447.59","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","21607.78","6075.84","50862.94","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","35101.97","16547.35","199845.83","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","35113.77","35113.77","35113.77","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","67105.99","67105.99","77828.41","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","16612.85","16612.85","39363.73","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","29172.96","29172.96","29172.96","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","35866.49","35866.49","35866.49","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","24115.22","24115.22","24115.22","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","24790.6","24790.6","24790.6","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","61846.26","61846.26","61846.26","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","20122.16","18275.32","29545.1","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","17199.92","17199.92","17199.92","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","22299.62","10048.88","78380.58","11","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","18226.28","13720.5","26533.04","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","27043.17","13676.41","53635.19","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","50887.63","50887.63","50887.63","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","9919.91","9919.91","9919.91","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Mcc","177","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","22827.54","1828.45","44842.09","11","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","16602.72","16602.72","16602.72","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","26977.32","26977.32","35806.29","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","8949.24","8949.24","8949.24","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","27894.66","20192.32","29459.21","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","20949.88","8814.68","78346.44","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","15679.12","15679.12","15679.12","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","32484.83","32484.83","32484.83","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","11311.39","11311.39","11311.39","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7170.89","7170.89","7170.89","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","7342.24","7342.24","7342.24","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","15580.01","15580.01","15580.01","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","25550.35","25550.35","25550.35","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11910.02","3443.78","65393.66","11","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","14339.97","13972.28","21275.44","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","22739.86","17739.25","31428.14","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations With Cc","178","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","13824.52","4037.7","26455.22","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","9196.28","9196.28","9196.28","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17304.97","17304.97","17304.97","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16292.26","16292.26","92768.07","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7093.55","7093.55","7093.55","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1863.02","1863.02","1863.02","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1417.92","1417.92","1417.92","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","25772.77","25772.77","31378.6","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","4419.68","4419.68","4419.68","1 through 10","percent of total billed charges","","",""
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Infections And Inflammations Without Cc/Mcc","179","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","9916.55","9916.55","9916.55","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","9289.3","9289.3","9289.3","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","37373.35","37373.35","37373.35","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","43631.35","43631.35","43631.35","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","56492.24","56492.24","56492.24","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","14175.74","14175.74","14175.74","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","52438.33","52438.33","52438.33","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","1703.82","1703.82","1703.82","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","42144.86","42144.86","42144.86","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","33737.48","33737.48","33737.48","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Mcc","180","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","25783.77","25783.77","25783.77","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","27379.79","27379.79","27379.79","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15613.57","15613.57","15613.57","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","8680.68","8680.68","8680.68","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms With Cc","181","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","41999.17","41999.17","41999.17","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","4078.05","4078.05","4078.05","1 through 10","percent of total billed charges","","",""
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Neoplasms Without Cc/Mcc","182","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","19045.5","19045.5","19045.5","1 through 10","percent of total billed charges","","",""
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13683.46","13683.46","13683.46","1 through 10","percent of total billed charges","","",""
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","10594.84","10594.84","10594.84","1 through 10","percent of total billed charges","","",""
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Mcc","183","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5554.51","5554.51","5554.51","1 through 10","percent of total billed charges","","",""
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12266.84","12266.84","12266.84","1 through 10","percent of total billed charges","","",""
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma With Cc","184","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","13521.51","13521.51","13521.51","1 through 10","percent of total billed charges","","",""
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","2719.18","2719.18","2719.18","1 through 10","percent of total billed charges","","",""
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Chest Trauma Without Cc/Mcc","185","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","3120.19","3120.19","3120.19","1 through 10","percent of total billed charges","","",""
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","27343.96","16778.65","27734.13","1 through 10","percent of total billed charges","","",""
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","40323.93","40323.93","40323.93","1 through 10","percent of total billed charges","","",""
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","33629.5","33629.5","33629.5","1 through 10","percent of total billed charges","","",""
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","28300.19","28300.19","28300.19","1 through 10","percent of total billed charges","","",""
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Mcc","186","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","21579.63","21579.63","23286.3","1 through 10","percent of total billed charges","","",""
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17645.07","17645.07","17645.07","1 through 10","percent of total billed charges","","",""
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","18408.59","18408.59","18408.59","1 through 10","percent of total billed charges","","",""
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","44596.66","44596.66","44596.66","1 through 10","percent of total billed charges","","",""
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","10445.38","10445.38","10445.38","1 through 10","percent of total billed charges","","",""
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion With Cc","187","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","28124.1","28124.1","28124.1","1 through 10","percent of total billed charges","","",""
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","13278.55","13278.55","13278.55","1 through 10","percent of total billed charges","","",""
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","4025.77","4025.77","4025.77","1 through 10","percent of total billed charges","","",""
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pleural Effusion Without Cc/Mcc","188","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","36168.77","13593.92","161422.54","1 through 10","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","16195.63","7365.48","59984.89","18","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","17343.12","17343.12","21004.61","1 through 10","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","14139.18","6932.34","87603.46","19","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","18143.41","18143.41","18143.41","1 through 10","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","18928.05","7368.08","59929.38","34","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","24073.35","6928.8","139619.44","16","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","13906.52","13448.19","15027.28","1 through 10","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","39769.95","12147.61","45607.65","1 through 10","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","23727.1","23727.1","53411.91","1 through 10","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","12664.95","12664.95","17730.25","1 through 10","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","10532.46","10126.01","61379.12","1 through 10","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14339.08","7778.39","45497.42","25","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15433.1","6063.29","39143.77","55","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","13827.96","5023.73","65013.04","11","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","22000.27","12818.66","33423.33","12","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","12313.03","4072.44","28114.54","12","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","8755.05","8755.05","8755.05","1 through 10","percent of total billed charges","","",""
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pulmonary Edema And Respiratory Failure","189","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","13065.92","7199.26","28758.4","28","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","17667.84","12245.62","30037.1","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","15815.46","15815.46","24364.15","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","10286.54","10286.54","10286.54","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24945.37","24945.37","24945.37","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","17157.93","17157.93","17157.93","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","21061.63","21061.63","21061.63","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","15081.92","11337.87","21779.44","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","20768.75","20768.75","33153.32","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","10426.72","10426.72","10426.72","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12167.86","8379.82","33258.12","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14233.5","10036.81","28226.81","13","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","12110.21","4068.22","27624.71","11","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","14942.79","3707.43","24078.33","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","18984.6","18984.6","18984.6","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Mcc","190","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12177.44","10875.34","68743.15","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12248.05","12248.05","12248.05","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","28224.03","28224.03","28224.03","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","14510.45","14510.45","14510.45","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","12333.58","12333.58","12333.58","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","15388.61","15388.61","15388.61","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","14264.37","14264.37","14264.37","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","8872.46","8872.46","8872.46","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","10902.25","10902.25","10902.25","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5532.73","3024.17","12740.51","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","3500.51","1652.5","10085.87","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","3086.49","3086.49","3086.49","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","12977.76","12977.76","15846.65","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease With Cc","191","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6303.15","6303.15","14797.83","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","6714.07","6714.07","6714.07","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","844.21","844.21","844.21","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","13146.06","13146.06","13146.06","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2752.38","2752.38","2752.38","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","12198.39","12198.39","12198.39","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","15431.32","15431.32","15431.32","1 through 10","percent of total billed charges","","",""
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","192","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","20318.19","18431.62","57220.39","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","19398.48","9517.72","80781.1","11","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","18006.4","18006.4","18006.4","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17103.07","10342.82","51012.3","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","14217.85","13828.76","36488.32","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","18170.27","10110.69","50235.38","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","26030.4","9010.43","137438.49","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","19936.97","19936.97","21646.8","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","26907.29","25440.81","41030.22","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","41540.46","41540.46","41540.46","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","5342.13","5342.13","5342.13","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","13914.82","13914.82","13914.82","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","11610.75","11610.75","11610.75","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","17754.45","17754.45","17754.45","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","24338.7","22010.05","64954.22","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11748.91","4552.79","31262.97","21","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","20153.1","20153.1","34108.85","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","11083.14","9430.54","53026.52","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","16138.28","16138.28","16774.99","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","11694.86","11694.86","11694.86","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Mcc","193","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10411.19","9947.93","15788.4","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","10836.02","10836.02","15178.29","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","9439.24","6106.03","14332","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15729.11","8959.21","36302.62","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10557.91","9459.41","25466.92","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","15968.26","15968.26","15968.26","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","13648.32","9125.23","74648.56","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","18802.06","18802.06","18802.06","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","9560.47","6314.45","22313.44","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","8855.59","8855.59","8855.59","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","6928.87","6928.87","6928.87","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","15826.43","15826.43","15826.43","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13201.9","3568.42","24604.46","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11693.44","6456.6","18826.08","24","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7435.18","4451.82","22436.54","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","13077.13","11387.23","30609.77","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","8289.67","2065.5","18820.82","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","17915.13","17915.13","17915.13","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy With Cc","194","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8261.41","5968.96","15609.35","13","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","24026.34","24026.34","24026.34","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17536.77","17536.77","17536.77","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13664.38","6590.27","14690.24","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","5241.25","5241.25","5241.25","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","7563.6","7563.6","7563.6","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5420.21","4872.25","7395.71","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","8829.8","8829.8","8829.8","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","8235.11","8235.11","8235.11","1 through 10","percent of total billed charges","","",""
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Simple Pneumonia And Pleurisy Without Cc/Mcc","195","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","7293.45","5243.57","21589.15","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","35141","35141","73080.04","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","20707.72","20707.72","20707.72","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","40390.37","26815.73","44871.76","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","77735.94","77735.94","77735.94","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","41098.52","41098.52","45795.56","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","20209.99","20209.99","24367.8","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","154569.62","154569.62","154569.62","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","70059.4","70059.4","70059.4","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","57325.85","13327.33","99908.86","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","40485.33","40485.33","40485.33","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Mcc","196","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","23406.83","23406.83","23406.83","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","38386.79","38386.79","38386.79","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","30982.01","30982.01","30982.01","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11410.94","11410.94","11410.94","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","16414.63","16414.63","16414.63","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9457.46","9457.46","9457.46","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease With Cc","197","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","24791.79","24791.79","24791.79","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","6489.94","6489.94","6489.94","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","2006.44","2006.44","2006.44","1 through 10","percent of total billed charges","","",""
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Interstitial Lung Disease Without Cc/Mcc","198","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","14375.17","14375.17","14375.17","1 through 10","percent of total billed charges","","",""
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","79255.91","79255.91","79255.91","1 through 10","percent of total billed charges","","",""
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","34672.64","34672.64","34672.64","1 through 10","percent of total billed charges","","",""
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Mcc","199","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","16057.4","16057.4","16057.4","1 through 10","percent of total billed charges","","",""
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","8023.28","8023.28","8023.28","1 through 10","percent of total billed charges","","",""
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","14176.57","14176.57","14570.7","1 through 10","percent of total billed charges","","",""
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15242.98","15242.98","15242.98","1 through 10","percent of total billed charges","","",""
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10238.07","10238.07","10238.07","1 through 10","percent of total billed charges","","",""
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","12712.33","12712.33","12712.33","1 through 10","percent of total billed charges","","",""
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","6986.9","6986.9","6986.9","1 through 10","percent of total billed charges","","",""
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","4015.78","4015.78","4015.78","1 through 10","percent of total billed charges","","",""
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11098.75","11098.75","11098.75","1 through 10","percent of total billed charges","","",""
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax With Cc","200","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","14148.86","14148.86","14148.86","1 through 10","percent of total billed charges","","",""
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","10848.06","10848.06","10848.06","1 through 10","percent of total billed charges","","",""
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","9393.37","9393.37","9393.37","1 through 10","percent of total billed charges","","",""
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","8418.61","8418.61","8418.61","1 through 10","percent of total billed charges","","",""
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14143.33","14143.33","14143.33","1 through 10","percent of total billed charges","","",""
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","11267.57","11267.57","11267.57","1 through 10","percent of total billed charges","","",""
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1100","1100","1100","1 through 10","percent of total billed charges","","",""
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pneumothorax Without Cc/Mcc","201","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","10380.29","10380.29","10380.29","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","13170.04","9729.72","26582.25","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","9876.66","9876.66","9876.66","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","8531.29","5286.19","56681.81","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","28393.46","28393.46","28393.46","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9305.15","7113.65","12206.91","12","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","11913.22","7618.08","19799.4","11","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","21586.87","21586.87","21586.87","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","9615.88","4244.16","13929.31","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","15301.67","15301.67","15301.67","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","15493.24","15493.24","15493.24","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14461.26","5384.74","31921.8","18","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10853.02","5026.96","30690.19","60","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","4570.35","3457.67","9586.98","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","22352.03","11493.64","26772.12","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","11260.49","4884.12","25631.24","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma With Cc/Mcc","202","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","11770.97","6578.78","30564.93","22","percent of total billed charges","","",""
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","4496.7","3877.2","6897.27","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","7622.86","7622.86","14564.4","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8044.82","6633.94","8879.03","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","9197.58","9197.58","12056.55","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","7011.66","7011.66","7011.66","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","7191.55","1222.77","11363.75","15","percent of total billed charges","","",""
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7528.09","4280.3","12069.07","43","percent of total billed charges","","",""
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","9044.82","9044.82","9044.82","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","8995.6","8995.6","10770.52","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5164.81","5164.81","5164.81","1 through 10","percent of total billed charges","","",""
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bronchitis And Asthma Without Cc/Mcc","203","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9426.74","2268.07","24502.1","18","percent of total billed charges","","",""
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2774.76","2774.76","2774.76","1 through 10","percent of total billed charges","","",""
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","9846.5","9846.5","31305.28","1 through 10","percent of total billed charges","","",""
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","9937.67","9937.67","9937.67","1 through 10","percent of total billed charges","","",""
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9889.79","9889.79","9889.79","1 through 10","percent of total billed charges","","",""
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3089.55","3089.55","3089.55","1 through 10","percent of total billed charges","","",""
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","10948.36","10948.36","10948.36","1 through 10","percent of total billed charges","","",""
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1810.01","1810.01","1810.01","1 through 10","percent of total billed charges","","",""
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory Signs And Symptoms","204","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","41574.49","41574.49","41574.49","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","24501.46","24501.46","28564.84","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","39386.96","39386.96","39386.96","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23470.86","19027.65","175072.48","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","33400.69","23252.5","90918.67","12","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","26756.01","26756.01","26756.01","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","32071.96","30617.18","112913.07","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","46170.13","46170.13","46170.13","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","21642.92","21642.92","21642.92","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","20442.03","20442.03","57784.05","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","9178.82","9178.82","9178.82","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","26870.17","26870.17","26870.17","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11095.13","11095.13","12495.82","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","48677.79","48677.79","48677.79","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses With Mcc","205","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","40097.71","40097.71","40097.71","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","10099.14","6209.37","36440.69","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","15178.2","13288.93","36736.73","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","38523.39","38523.39","38523.39","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","4780.91","4780.91","4780.91","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","9853.92","9853.92","9853.92","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","11465.34","11465.34","11465.34","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","6014.28","6014.28","6014.28","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","26777.86","26777.86","26777.86","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7117.19","7117.19","7117.19","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","8853.57","8853.57","8853.57","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","16215.17","16215.17","16607.81","1 through 10","percent of total billed charges","","",""
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Respiratory System Diagnoses Without Mcc","206","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8400.98","8400.98","8400.98","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","850998.78","850998.78","850998.78","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","153688.17","66564.42","315898.37","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","142596.85","137936.01","191865.26","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","361974.5","361974.5","361974.5","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","74492.22","74492.22","74492.22","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","267115.93","267115.93","267115.93","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","113786.49","113786.49","113786.49","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","109497.31","109497.31","109497.31","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","88878.64","64331.53","1113616.4","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","206791.55","206791.55","206791.55","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","64829.76","64829.76","64829.76","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","85476.88","85476.88","85476.88","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","261612.35","261612.35","261612.35","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support >96 Hours","207","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","311621.64","311621.64","311621.64","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","64029.63","64029.63","64029.63","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","15516.88","9410.48","101722.76","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","45295.87","36143.15","60157.2","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24872.17","11618.27","36879.99","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","46040.59","46040.59","46040.59","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","30052.74","30052.74","30052.74","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","639604.55","639604.55","639604.55","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","214986.74","214986.74","214986.74","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","32841.2","32841.2","32841.2","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","17221.35","11468.65","28806.04","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17156.3","10648.76","32398.33","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","17481.61","10919.11","112561.86","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","46122.09","46122.09","74862.47","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","15799.73","15799.73","15799.73","1 through 10","percent of total billed charges","","",""
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Respiratory System Diagnosis With Ventilator Support <=96 Hours","208","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","39930.04","37975.04","45052.49","1 through 10","percent of total billed charges","","",""
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complex Aortic Arch Procedures","209","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w CC","210","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","211","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","167566.16","167566.16","167566.16","1 through 10","percent of total billed charges","","",""
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","294106.16","294106.16","294106.16","1 through 10","percent of total billed charges","","",""
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Aortic And Mitral Valve Procedures","212","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Abdominal Aorta With Iliac Branch Procedures","213","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","214","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","177655.19","177655.19","177655.19","1 through 10","percent of total billed charges","","",""
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","142591.09","142591.09","142591.09","1 through 10","percent of total billed charges","","",""
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","225123.17","225123.17","225123.17","1 through 10","percent of total billed charges","","",""
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Heart Assist System Implant","215","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","520049.99","520049.99","520049.99","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","100283.71","100283.71","100283.71","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","243632.72","243632.72","243632.72","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","96995.97","96995.97","96995.97","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","91831.45","91831.45","91831.45","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","160577.86","160577.86","160577.86","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","154249.65","154249.65","154249.65","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","179890.96","179890.96","179890.96","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","272433.62","272433.62","272433.62","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","321286.6","321286.6","321286.6","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","216","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","90801.39","90801.39","90801.39","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","76911.03","76911.03","153442.94","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","110025.83","110025.83","110025.83","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","145498.26","145498.26","145498.26","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","217","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","47167.24","47167.24","47167.24","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","75397.45","75397.45","75397.45","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","218","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","85749.43","83230.89","94457.46","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","74680.7","74680.7","114701.63","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","95712.88","47764.34","154086.62","15","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","92932.87","71793.65","230758.52","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","190336.62","190336.62","190336.62","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","134439.6","134439.6","134439.6","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","60406.14","60406.14","60406.14","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","90322.5","58260.82","115579.43","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","175629.13","175629.13","175629.13","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","119607.35","119607.35","119607.35","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","128073.77","120350.96","135461.9","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","90430.25","50304.37","181954.97","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","151395.66","151395.66","195346.15","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","122281.5","122281.5","122281.5","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","219","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","87618.8","87618.8","87618.8","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","72359.28","49983.05","110091.68","12","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","69569.11","55972.94","109815.06","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","72905.18","51168.2","100581.39","23","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","64538.89","49701.12","123038.7","18","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","63549.43","50666.95","89678.32","12","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","68922.22","47468.72","177572.29","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","98828.67","53286.35","197541.01","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","134447.4","134447.4","134447.4","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","59266.23","59266.23","72475.22","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","66006.51","63109.12","169497.73","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","78913.69","78913.69","78913.69","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","73517.23","49689.5","80462.11","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","313.91","313.91","313.91","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","65718.08","56748.2","83812.98","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","220","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","69771.75","69771.75","69771.75","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","52346.93","52346.93","52346.93","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","53237.87","53237.87","53237.87","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","62173.87","62173.87","62173.87","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","56269.05","56269.05","56269.05","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","125696.54","125696.54","125696.54","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","88248.22","88248.22","88248.22","1 through 10","percent of total billed charges","","",""
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","221","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","222","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","223","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","224","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","225","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","226","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","227","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","63061.94","63061.94","63061.94","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","78485.8","71497.85","261412.5","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","87509.93","87509.93","87509.93","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","56989.99","48985.33","80029.34","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","154682.95","154682.95","154682.95","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","40338.58","40338.58","40338.58","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures With Mcc","228","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","288897.02","288897.02","288897.02","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","49984.46","49984.46","50048.41","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","51693.11","44927.14","88365.15","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","51090.27","46041.25","59911.61","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","54871.34","54871.34","132363.75","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","92544.02","92544.02","92544.02","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","42735.64","42735.64","42735.64","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","71177.98","52381.4","93183.73","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","62986.21","62986.21","62986.21","1 through 10","percent of total billed charges","","",""
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Cardiothoracic Procedures Without Mcc","229","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","56608.25","56608.25","56608.25","1 through 10","percent of total billed charges","","",""
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other cardiothoracic procedures w/o CC/MCC","230","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca With Mcc","231","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","45481.78","45481.78","45481.78","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Ptca Without Mcc","232","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","85013.22","85013.22","85013.22","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","76234.24","76234.24","76234.24","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","71493.68","71493.68","71493.68","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","87971.69","75382.65","122830.18","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","118422.99","118422.99","118422.99","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","98291.15","98291.15","98291.15","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","93881.06","93881.06","93881.06","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","171660.15","171660.15","171660.15","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","233","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","70761.66","70761.66","70761.66","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","158884.78","158884.78","158884.78","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","75788.01","72906.21","110014.04","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","77232.52","77232.52","77232.52","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","75772.41","75772.41","91338.97","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","75731","75731","75731","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","86274.28","86274.28","91213.95","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","88732.21","88732.21","88732.21","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","75019.61","75019.61","75019.61","1 through 10","percent of total billed charges","","",""
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","234","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","85207.58","85207.58","85207.58","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","87900.93","87900.93","87900.93","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","56234.9","56234.9","56234.9","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","95451.97","95451.97","95451.97","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","99869.78","54552.18","149934.93","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","78565.76","78565.76","82446.58","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","94103.49","94103.49","97761.47","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","96374.37","63096.39","129393.17","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","78653.81","78653.81","78653.81","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","102718.41","51318.72","219037.42","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","72153.04","72153.04","72153.04","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","118491.92","118491.92","118491.92","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","109237.12","109237.12","109237.12","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization With Mcc","235","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","66347.26","66347.26","88302.37","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","59350.21","59350.21","59350.21","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","47230.55","47230.55","79175.9","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","74645.07","61864.83","98120.25","12","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","60588.1","51098.12","83907.69","14","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","57511.11","57511.11","95537.58","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","104398.91","104398.91","104398.91","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","62444.83","62444.83","71744.54","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","53227.06","43999.52","82406.35","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","74056.02","74056.02","74056.02","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","84839.45","84839.45","84839.45","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","58383.52","58383.52","58383.52","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","51727.84","51727.84","51727.84","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","74562.57","74562.57","90030.84","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","69858.36","58620.01","79623.47","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","77432.44","77432.44","77432.44","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","64000.27","53468.83","101761.12","1 through 10","percent of total billed charges","","",""
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Bypass Without Cardiac Catheterization Without Mcc","236","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","53433.24","53433.24","53433.24","1 through 10","percent of total billed charges","","",""
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w MCC","237","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major cardiovasc procedures w/o MCC","238","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","24074.57","24074.57","24074.57","1 through 10","percent of total billed charges","","",""
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","36812.45","36812.45","36812.45","1 through 10","percent of total billed charges","","",""
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","76838.76","76838.76","76838.76","1 through 10","percent of total billed charges","","",""
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","239","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","30697.44","30697.44","30697.44","1 through 10","percent of total billed charges","","",""
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13878.7","13878.7","13878.7","1 through 10","percent of total billed charges","","",""
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","27610.29","27610.29","27610.29","1 through 10","percent of total billed charges","","",""
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","240","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","241","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","59244.83","59244.83","62016.89","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","65232.48","65232.48","65232.48","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Mcc","242","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","29879.87","29879.87","29879.87","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","60524.16","60524.16","60524.16","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","33058.54","33058.54","33058.54","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","28131.35","20681.43","52357.94","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","33202.68","33202.68","33202.68","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","49785.72","49785.72","49785.72","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","33100.35","33100.35","33100.35","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","35580.99","35580.99","35580.99","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant With Cc","243","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","34299.71","34299.71","34299.71","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","25123.76","25123.76","25123.76","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","172518.6","172518.6","172518.6","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","818.87","818.87","818.87","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","29384.57","29384.57","29384.57","1 through 10","percent of total billed charges","","",""
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","244","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Generator Procedures","245","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","246","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","247","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","248","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","249","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","121822.61","121822.61","121822.61","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","250","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","251","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","64339.7","64339.7","64339.7","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","36731.39","32029.18","53099.47","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","145532.31","145532.31","145532.31","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","31399.27","31399.27","83947.61","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","72985.67","72985.67","72985.67","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","46996.9","41268.56","81504.44","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","65254.54","65254.54","65254.54","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","63406.04","63406.04","63406.04","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Mcc","252","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","83005.22","83005.22","83005.22","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","50002.37","50002.37","50002.37","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","24230.34","24230.34","24230.34","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","29253.66","29253.66","52841.61","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","39013.07","39013.07","39013.07","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","62209.68","62209.68","62209.68","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","32711.88","32711.88","32711.88","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","27431.98","27431.98","27431.98","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","29461.77","28268.84","34569.19","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","41449.32","23430.99","97483.47","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","23134.93","23134.93","23134.93","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","48742.91","48742.91","48742.91","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","65051.56","65051.56","65051.56","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures With Cc","253","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","26800.65","26800.65","26800.65","1 through 10","percent of total billed charges","","",""
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Vascular Procedures Without Cc/Mcc","254","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","52059.25","52059.25","52059.25","1 through 10","percent of total billed charges","","",""
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","255","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","33204.48","33204.48","33204.48","1 through 10","percent of total billed charges","","",""
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","33369.06","33369.06","33369.06","1 through 10","percent of total billed charges","","",""
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","256","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","257","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","26269.51","26269.51","26269.51","1 through 10","percent of total billed charges","","",""
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement With Mcc","258","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Device Replacement Without Mcc","259","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","39547.2","39547.2","39547.2","1 through 10","percent of total billed charges","","",""
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","5961.97","5961.97","5961.97","1 through 10","percent of total billed charges","","",""
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","164494.91","164494.91","164494.91","1 through 10","percent of total billed charges","","",""
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Mcc","260","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","53052.8","53052.8","53052.8","1 through 10","percent of total billed charges","","",""
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","37495.96","37495.96","37495.96","1 through 10","percent of total billed charges","","",""
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","31663.71","31663.71","31663.71","1 through 10","percent of total billed charges","","",""
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","11264.49","11264.49","11264.49","1 through 10","percent of total billed charges","","",""
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","62783.7","62783.7","62783.7","1 through 10","percent of total billed charges","","",""
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17935.17","17935.17","17935.17","1 through 10","percent of total billed charges","","",""
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","67184.08","67184.08","67184.08","1 through 10","percent of total billed charges","","",""
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement With Cc","261","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","262","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","47718.46","47718.46","47718.46","1 through 10","percent of total billed charges","","",""
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13376.66","13376.66","13376.66","1 through 10","percent of total billed charges","","",""
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vein Ligation And Stripping","263","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","39311.86","39311.86","39311.86","1 through 10","percent of total billed charges","","",""
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","109146.33","109146.33","210461.54","1 through 10","percent of total billed charges","","",""
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","49394.22","49394.22","49394.22","1 through 10","percent of total billed charges","","",""
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","30877.26","30877.26","30877.26","1 through 10","percent of total billed charges","","",""
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","983.61","983.61","983.61","1 through 10","percent of total billed charges","","",""
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System O.R. Procedures","264","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","86020.76","86020.76","127853.22","1 through 10","percent of total billed charges","","",""
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","56025.76","56025.76","56025.76","1 through 10","percent of total billed charges","","",""
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aicd Lead Procedures","265","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","134443.82","134443.82","134443.82","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","345222.48","345222.48","345222.48","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","340191.72","340191.72","340191.72","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","184686.74","184686.74","184686.74","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","80726.6","80726.6","80726.6","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","149627.11","149627.11","149627.11","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","194999.01","194999.01","194999.01","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","266","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","59893.49","53597.8","64984.78","11","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","58990.69","58990.69","58990.69","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","64565.54","64565.54","76342.58","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","61425.89","61425.89","61425.89","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","61980.61","56688.18","66941.95","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","59412.63","59412.63","67289.5","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","51317.64","45849.64","75378.89","12","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","56833.82","56833.82","56833.82","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","76181.07","76181.07","76181.07","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","53455.31","47968.65","69394.11","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","57035.34","57035.34","57035.34","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","61948.19","57010.01","88438.29","1 through 10","percent of total billed charges","","",""
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","267","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","49531.4","49531.4","49531.4","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","78324.34","78324.34","78324.34","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","153611.5","153611.5","153611.5","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","66033.73","66033.73","66033.73","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","268","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","38691.13","38691.13","38691.13","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","86907.19","86907.19","86907.19","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","122058.45","122058.45","122058.45","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","64871.59","64871.59","64871.59","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","49098.64","49098.64","49098.64","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","39642.37","39642.37","39642.37","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","57262.73","57262.73","57262.73","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","92755.26","92755.26","92755.26","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","21209.39","21209.39","21209.39","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","52924.92","52924.92","52924.92","1 through 10","percent of total billed charges","","",""
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","269","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","46639.21","46639.21","46639.21","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","104816.32","104816.32","237395.81","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","49991.17","49991.17","124774.69","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","131106.38","41147.7","222425.55","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","84035.25","84035.25","84035.25","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","48173.74","48173.74","48173.74","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","120797.07","120797.07","120797.07","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","40325.77","40325.77","40325.77","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","96295.72","96295.72","96295.72","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","60460.05","60460.05","70925.41","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","69540.93","69540.93","69540.93","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","50067.89","15240.42","224328.71","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","15396.41","15396.41","15396.41","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Mcc","270","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","106904.55","106904.55","157734.54","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","22693.42","22693.42","22693.42","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","73339.34","73339.34","73339.34","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","49122.78","49122.78","88737.09","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","40755.44","26841.91","65820.31","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","32895.8","32895.8","32895.8","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","27078.7","27078.7","27078.7","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","43577.13","43577.13","43577.13","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","47272.18","47272.18","47272.18","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","51087.69","51087.69","51087.69","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","66252.7","66252.7","66252.7","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","49879.41","49879.41","49879.41","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","19747.18","19747.18","19747.18","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures With Cc","271","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","36501.8","36501.8","36501.8","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","51731.47","51731.47","51731.47","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8473.46","8473.46","8473.46","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","21005.25","21005.25","21005.25","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","20174.85","20174.85","20174.85","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","33738.76","33738.76","33738.76","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","79670.3","79670.3","79670.3","1 through 10","percent of total billed charges","","",""
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Major Cardiovascular Procedures Without Cc/Mcc","272","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","121556.41","121556.41","121556.41","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","68182.18","68182.18","68182.18","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","58351.67","58351.67","69659.42","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","114019.85","114019.85","114019.85","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","54675.75","54675.75","54675.75","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","45889.91","45889.91","45889.91","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","81252.63","81252.63","81252.63","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","41393.81","41393.81","41393.81","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","23211.52","23211.52","23211.52","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","61129.5","61129.5","61129.5","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures With Mcc","273","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","47077.95","47077.95","60282.99","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","84035.55","76008.95","92061.33","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","34729.19","31817.24","85313.83","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","43091.86","36957.72","61793.14","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","31355.95","31355.95","31355.95","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","35262.05","35262.05","35262.05","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","30961.67","30552.34","33889.2","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","42152.63","42152.63","42152.63","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","35643.22","29325.54","45524.63","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","43554.26","43554.26","64317.98","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","77529.57","49576.25","110456.68","1 through 10","percent of total billed charges","","",""
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous And Other Intracardiac Procedures Without Mcc","274","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","161950.46","161950.46","161950.46","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","101246.72","101246.72","101246.72","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","275","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","99205.5","99205.5","99205.5","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","93673.18","93673.18","93673.18","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","176856.29","176856.29","176856.29","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","66975.59","66975.59","66975.59","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","80853.66","80853.66","80853.66","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","276","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","41391.13","41391.13","41391.13","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","36023.26","36023.26","36023.26","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","108641.36","108641.36","132259.69","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","53891.83","53891.83","90460.47","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","65455.68","65455.68","115625.22","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","58907.62","58907.62","119299.83","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","73942.91","73942.91","73942.91","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","134156.79","134156.79","134156.79","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","123837.36","123837.36","123837.36","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","76591.61","76591.61","76591.61","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","48975.45","48975.45","48975.45","1 through 10","percent of total billed charges","","",""
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Defibrillator Implant Without Mcc","277","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","278","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","279","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","38916.29","29693.83","60207.44","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","14855.85","14855.85","14855.85","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","24574.81","24574.81","24574.81","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14663.52","14663.52","20984.02","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","21104.69","21104.69","21104.69","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","41765.14","41765.14","41765.14","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","49964.75","49964.75","49964.75","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","60508.76","60508.76","60508.76","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","28703.44","27133.32","167507.16","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","31412.01","31412.01","31412.01","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","71184.79","71184.79","71184.79","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","43913.45","43913.45","43913.45","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","42054.12","29048.81","53554.43","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","11857.69","11857.69","11857.69","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","52713.04","15731.39","105145.94","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","33829.25","17967.04","63898.47","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","60651.63","60651.63","60651.63","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","20472.31","20472.31","20472.31","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Mcc","280","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","19635.72","14389.95","155072.82","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","16443.65","8382.92","47423.92","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","13531.8","13531.8","13531.8","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","22320.78","22320.78","22320.78","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","26873.92","26873.92","26873.92","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","19585.16","19585.16","19585.16","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","27795.57","27795.57","27795.57","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15594","15594","15594","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","14942.35","14942.35","14942.35","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","16876.78","14471.54","21150.04","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13214.8","13214.8","41601.96","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","13113.78","13113.78","13113.78","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","18074.96","18074.96","18074.96","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive With Cc","281","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","16174.57","13745.21","18745.64","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6481.96","6481.96","6481.96","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","6094.29","6094.29","6094.29","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5639.35","5639.35","5639.35","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","20497.7","20497.7","20497.7","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","282","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1956.45","1956.45","1956.45","1 through 10","percent of total billed charges","","",""
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Mcc","283","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired With Cc","284","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Myocardial Infarction, Expired Without Cc/Mcc","285","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","66870.22","40101.42","146917.74","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","76287.28","76287.28","76287.28","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","33504.44","24185.71","89317.24","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","58562.5","28739.06","185407.18","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","219094.13","219094.13","219094.13","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","29814.93","29814.93","29814.93","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","41894.56","41894.56","122485.16","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","16391.6","16391.6","16391.6","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","30167.91","7346.36","92676.56","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","64055.55","64055.55","64055.55","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","64506.98","64506.98","64506.98","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","71447.66","35344.63","80563.63","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","3600","3600","3600","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","48265","24200.32","134003.21","14","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","78226.59","52363.97","117024.24","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","61923.97","43529.28","131963.4","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","286","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","50971.97","35317.59","58806.77","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","68948.62","68948.62","68948.62","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","13397.67","13397.67","13397.67","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","62778.71","62778.71","158605.09","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14571.27","7100.1","27484.66","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","51042.82","51042.82","51042.82","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","19683.06","19683.06","19683.06","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","13563.89","13563.89","13563.89","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","39011.32","39011.32","39011.32","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","27629.26","27629.26","27629.26","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","23359.79","23359.79","23359.79","1 through 10","percent of total billed charges","","",""
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","287","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","17010.42","1186.08","17816.83","1 through 10","percent of total billed charges","","",""
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","31395.38","31395.38","31395.38","1 through 10","percent of total billed charges","","",""
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","159065.73","159065.73","159065.73","1 through 10","percent of total billed charges","","",""
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","40709.76","40709.76","40709.76","1 through 10","percent of total billed charges","","",""
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6155.46","6155.46","35670.87","1 through 10","percent of total billed charges","","",""
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","8030.29","8030.29","8030.29","1 through 10","percent of total billed charges","","",""
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Mcc","288","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","13358.7","13358.7","13358.7","1 through 10","percent of total billed charges","","",""
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","34298.45","34298.45","34298.45","1 through 10","percent of total billed charges","","",""
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","13094.12","13094.12","13094.12","1 through 10","percent of total billed charges","","",""
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12530.69","12530.69","12530.69","1 through 10","percent of total billed charges","","",""
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis With Cc","289","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute And Subacute Endocarditis Without Cc/Mcc","290","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","21580.65","7614.78","56818.78","19","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","36309.65","14685.86","81120.18","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","11219.43","6462.44","24541.94","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","14148.25","11480.63","76069.33","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","12146.2","8947.9","26818.92","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24185.5","14446.27","57942.13","17","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","14122.64","14122.64","14122.64","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","31176.21","31176.21","31176.21","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","37824.35","13971.23","61140.7","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15193.56","13113.56","73471.53","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","22306.26","9427.02","60242.28","14","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","78109.76","78109.76","78109.76","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","24009.56","18451.68","96468.99","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","15189.62","11074.43","45817.75","16","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16559.68","6841.43","52313.45","27","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","17280.24","4935.65","49152.84","23","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","30579.33","21250.28","303192.81","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","4617.51","1889.65","6564.21","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","17740.64","12896.72","35175.14","11","percent of total billed charges","","",""
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Mcc","291","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","24787.73","5391.25","45967.03","12","percent of total billed charges","","",""
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","15669.36","15669.36","15669.36","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24428.05","24428.05","37616.4","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","29652.54","29652.54","29652.54","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10437.17","8066.14","41830.14","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1186.13","1186.13","1186.13","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1254.02","1254.02","1254.02","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock With Cc","292","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","35109.43","35109.43","35109.43","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","5558.96","5558.96","5558.96","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","2698.9","2698.9","2698.9","1 through 10","percent of total billed charges","","",""
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Heart Failure And Shock Without Cc/Mcc","293","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6479.45","6479.45","6479.45","1 through 10","percent of total billed charges","","",""
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14038.03","14038.03","14038.03","1 through 10","percent of total billed charges","","",""
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis With Cc/Mcc","294","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","9387.68","9387.68","9387.68","1 through 10","percent of total billed charges","","",""
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Deep Vein Thrombophlebitis Without Cc/Mcc","295","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","12812.86","12812.86","12812.86","1 through 10","percent of total billed charges","","",""
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Mcc","296","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained With Cc","297","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrest, Unexplained Without Cc/Mcc","298","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","39719.97","39719.97","69600.66","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","50355.38","50355.38","50355.38","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17793.4","16180.49","57019.76","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16258.76","9863.08","17136.97","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","115642.85","115642.85","115642.85","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","35744.3","35744.3","35744.3","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","84060.92","84060.92","84060.92","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","33892.19","33892.19","33892.19","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","27420.43","27420.43","36034.2","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","222555.22","222555.22","222555.22","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17596.98","14048.12","49227.03","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","27056.6","7488.21","33807.28","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","46800.72","46800.72","46800.72","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","31699.82","31699.82","31699.82","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Mcc","299","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","52895.91","52895.91","52895.91","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","6015.66","6015.66","6015.66","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","26110.34","26110.34","112696.26","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","36190.98","36190.98","36190.98","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","44685.14","24457.13","51783.6","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11844.93","5584.73","85925.14","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","48871.19","48871.19","48871.19","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","9980.76","9980.76","12616.25","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14065.07","13903.2","24564.62","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5353.57","5353.57","10265.64","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","23096.41","20719.52","27108.2","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","845.42","845.42","845.42","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders With Cc","300","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","11878.38","11878.38","28300.97","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","5765.97","5765.97","5765.97","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8391.46","8391.46","16215.87","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","6071.85","6071.85","6071.85","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","7579.73","7579.73","7579.73","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1842.56","1842.56","1842.56","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12107.59","12107.59","22127.96","1 through 10","percent of total billed charges","","",""
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peripheral Vascular Disorders Without Cc/Mcc","301","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","7187.73","7187.73","7187.73","1 through 10","percent of total billed charges","","",""
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","27161.09","27161.09","27161.09","1 through 10","percent of total billed charges","","",""
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","10914.64","10914.64","10914.64","1 through 10","percent of total billed charges","","",""
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","34342.72","34342.72","34342.72","1 through 10","percent of total billed charges","","",""
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17440.41","17440.41","17440.41","1 through 10","percent of total billed charges","","",""
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","3231.38","3231.38","3231.38","1 through 10","percent of total billed charges","","",""
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis With Mcc","302","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12125.61","12125.61","12125.61","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","8172.38","8172.38","8172.38","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","10266.55","9490.71","20793.19","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","9823.26","9823.26","9823.26","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","26182.48","26182.48","26182.48","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","4719.97","4045.01","5398.77","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","14624.79","14624.79","14624.79","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","6066.46","6066.46","6066.46","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","10547.86","10547.86","10547.86","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8835.09","8835.09","28450.92","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","4215.59","2101.18","8268.21","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10997.46","10997.46","10997.46","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","15803.91","15803.91","15803.91","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1279.59","1279.59","1279.59","1 through 10","percent of total billed charges","","",""
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Atherosclerosis Without Mcc","303","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9307.43","6421.76","54665.01","1 through 10","percent of total billed charges","","",""
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","19873.01","19873.01","19873.01","1 through 10","percent of total billed charges","","",""
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","60050.08","60050.08","60050.08","1 through 10","percent of total billed charges","","",""
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","54605.8","54605.8","54605.8","1 through 10","percent of total billed charges","","",""
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","14899.93","14899.93","14899.93","1 through 10","percent of total billed charges","","",""
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","18987.07","18987.07","18987.07","1 through 10","percent of total billed charges","","",""
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","22031.55","17852.02","23445.87","1 through 10","percent of total billed charges","","",""
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","20876.82","12515.12","37746.09","1 through 10","percent of total billed charges","","",""
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","31007.03","31007.03","31007.03","1 through 10","percent of total billed charges","","",""
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","523.15","523.15","523.15","1 through 10","percent of total billed charges","","",""
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension With Mcc","304","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","19382.11","12651.02","37383.54","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","32921.48","32921.48","32921.48","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","1663.8","1663.8","1663.8","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","18604.02","18604.02","18604.02","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","7955.18","7955.18","7955.18","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","5865.36","5865.36","5865.36","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","12318.84","12318.84","12318.84","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","9831.67","9831.67","9831.67","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","12130.34","12130.34","12130.34","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11320.29","8136.18","20851.72","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9275.76","3863.27","13142.37","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2466.32","2466.32","2466.32","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","2548.69","2548.69","2548.69","1 through 10","percent of total billed charges","","",""
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hypertension Without Mcc","305","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","27600.38","27600.38","202927.22","1 through 10","percent of total billed charges","","",""
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","138510.29","138510.29","138510.29","1 through 10","percent of total billed charges","","",""
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","25323.73","25323.73","25323.73","1 through 10","percent of total billed charges","","",""
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","76169.74","76169.74","76169.74","1 through 10","percent of total billed charges","","",""
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","36695.86","36695.86","36695.86","1 through 10","percent of total billed charges","","",""
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders With Mcc","306","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1313.51","1313.51","1313.51","1 through 10","percent of total billed charges","","",""
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2507.5","2507.5","2507.5","1 through 10","percent of total billed charges","","",""
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5798.19","5798.19","5798.19","1 through 10","percent of total billed charges","","",""
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","45781.96","45781.96","45781.96","1 through 10","percent of total billed charges","","",""
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","8948.02","8948.02","8948.02","1 through 10","percent of total billed charges","","",""
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Congenital And Valvular Disorders Without Mcc","307","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","22877.47","22877.47","22877.47","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","48478.63","48478.63","48478.63","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","26938.73","26938.73","26938.73","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25187.61","16685.09","98870.87","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","80781.68","80781.68","80781.68","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","48024.39","48024.39","48024.39","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","9103.37","9103.37","9103.37","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","16527.55","16527.55","16527.55","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","10872.77","10872.77","10872.77","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9256.8","5031.91","18937.03","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","13179.22","13179.22","13179.22","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Mcc","308","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","184784.4","184784.4","184784.4","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","13113.56","5955.92","27228.69","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","13059.04","7957.7","25374.9","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","12077.25","9847.07","34223.62","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9985.74","6898.07","35918","14","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","8725.26","8725.26","8725.26","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","9851.08","4339.45","38397.66","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","3823.22","2484.57","7342.04","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","9342.56","8974.53","16390.87","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","7553.02","7553.02","7553.02","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","10431.73","10431.73","10431.73","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","545","545","545","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10734.33","10734.33","16667.62","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","9210.09","9210.09","9371.34","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7644.77","3928.76","9606.08","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","6144.8","6144.8","6144.8","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","12512.55","9105","14546.56","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders With Cc","309","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6031.34","2633.97","12343.02","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","11392.35","11392.35","11392.35","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","6865.63","6260.79","10877.03","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","10056.24","10056.24","10056.24","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11166.91","9723.3","13837.87","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5824.27","5824.27","5824.27","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9689.93","6341.82","15595.16","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","4991.44","1397.2","10278.68","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","4464.34","4464.34","4464.34","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","4907.71","4907.71","8915.11","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","9721.62","9721.62","9721.62","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15574.88","15574.88","15574.88","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7479.7","7479.7","8783.5","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","9214.7","9214.7","9214.7","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","25489.61","25489.61","25489.61","1 through 10","percent of total billed charges","","",""
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","310","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6286.87","1638.59","15554.3","1 through 10","percent of total billed charges","","",""
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","3566.92","3566.92","3566.92","1 through 10","percent of total billed charges","","",""
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","2374.28","2374.28","2374.28","1 through 10","percent of total billed charges","","",""
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1098.83","1098.83","1098.83","1 through 10","percent of total billed charges","","",""
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","18742.75","18742.75","18742.75","1 through 10","percent of total billed charges","","",""
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Angina Pectoris","311","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","12384.75","6065.85","18346.63","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","19506.24","19506.24","19506.24","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","1350.47","1350.47","1350.47","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11181.3","9918.82","24030.31","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8151.34","8151.34","8151.34","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","2606.94","2606.94","2606.94","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","14651.06","13340.46","125714.64","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","21491.44","11567.41","33826.65","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","12310.4","12310.4","12848.1","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","4692.51","4692.51","4692.51","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","14080.4","14080.4","14080.4","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","10967.41","9122.47","39210.9","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11159.51","6257.09","22013.55","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12177.05","5182.01","69572.34","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","6628.21","6628.21","8804.17","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","23214.51","23214.51","23214.51","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","8352.93","7380.75","20624.22","1 through 10","percent of total billed charges","","",""
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Syncope And Collapse","312","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6001.69","6001.69","6001.69","1 through 10","percent of total billed charges","","",""
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","5480.78","5480.78","5480.78","1 through 10","percent of total billed charges","","",""
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","5161.66","5161.66","5161.66","1 through 10","percent of total billed charges","","",""
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","14860.94","14860.94","14860.94","1 through 10","percent of total billed charges","","",""
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","27644.23","27644.23","27644.23","1 through 10","percent of total billed charges","","",""
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","4082.01","4082.01","4082.01","1 through 10","percent of total billed charges","","",""
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3085.77","1163.12","7697.45","1 through 10","percent of total billed charges","","",""
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","16427.36","16427.36","33265","1 through 10","percent of total billed charges","","",""
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1492.98","1492.98","1492.98","1 through 10","percent of total billed charges","","",""
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","2839.45","2839.45","2839.45","1 through 10","percent of total billed charges","","",""
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chest Pain","313","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9974.24","9974.24","9974.24","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","14287.31","14287.31","21560.9","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","56319.16","56319.16","56319.16","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","22423.18","13368.55","36303.88","11","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","23822.24","22815.87","44824.08","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","41465.08","17900.68","288613.5","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","34980.99","34980.99","34980.99","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","40898.45","40898.45","40898.45","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","21538.83","21538.83","21963.33","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","10559.7","10559.7","10559.7","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","40019.99","40019.99","53926.89","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14535.68","11482.94","86187.98","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","33128.26","17678.6","66057.06","12","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","48879.09","43074.28","123995.27","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","23548.41","18621.64","33015.63","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","22860.54","22860.54","22860.54","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","25232.47","25232.47","25232.47","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Mcc","314","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","44837.2","24886.61","52841.63","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","15690.04","4679.72","28634.09","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","15248.08","14587.91","22271.67","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","20817.02","20817.02","20817.02","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","14568.54","4765.69","28105.94","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","20562.19","11577.66","35628.95","20","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","20943.64","10802.38","62116.85","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","11410.6","11410.6","11410.6","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","28845.6","28845.6","28845.6","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","22640.81","22640.81","22640.81","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","67873.71","67873.71","67873.71","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","7707.82","7707.82","7707.82","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","19630.56","4080.78","57277.54","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","46264.15","46264.15","46264.15","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","21373.91","8814.28","34307.44","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","4579.92","4579.92","4579.92","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses With Cc","315","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","30989.84","14294.5","82652.98","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","16883.76","16883.76","16883.76","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","22729.24","22729.24","22729.24","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","3992.92","3992.92","3992.92","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","23276.47","23276.47","23276.47","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5978.23","5978.23","5978.23","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5635.15","5635.15","5635.15","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","16221.72","8911.77","25821.05","1 through 10","percent of total billed charges","","",""
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Circulatory System Diagnoses Without Cc/Mcc","316","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12371.65","12371.65","12371.65","1 through 10","percent of total billed charges","","",""
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","66372.72","66372.72","66372.72","1 through 10","percent of total billed charges","","",""
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","35782.87","35782.87","35782.87","1 through 10","percent of total billed charges","","",""
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","69737.35","69737.35","69737.35","1 through 10","percent of total billed charges","","",""
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","68050.46","68050.46","68050.46","1 through 10","percent of total billed charges","","",""
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","317","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy Without Intraluminal Device","318","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","55231.58","55231.58","55231.58","1 through 10","percent of total billed charges","","",""
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures With Mcc","319","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","29186.14","29186.14","29186.14","1 through 10","percent of total billed charges","","",""
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endovascular Cardiac Valve Procedures Without Mcc","320","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","64550.84","64550.84","64550.84","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","24345.4","24345.4","24345.4","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","50560.04","50560.04","50560.04","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","36322.87","36322.87","36322.87","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","45384.14","45384.14","45384.14","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","85821.61","85821.61","85821.61","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","140011.71","140011.71","140011.71","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","23721.22","23721.22","23721.22","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","137076.72","137076.72","137076.72","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","321","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","16661.65","16661.65","16661.65","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","33215.68","33215.68","33215.68","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","34321.19","21805.27","60639.34","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","36703.7","36703.7","38880.31","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","34240.98","34240.98","34240.98","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","25825","25825","25825","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","34261.66","34261.66","34261.66","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","16980.21","16980.21","41356.51","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","20850.52","20850.52","20850.52","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","38922.31","38922.31","38922.31","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","18214.98","18214.98","18214.98","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","35785.7","35785.7","35785.7","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","18866.73","18866.73","18866.73","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","22179.75","22179.75","22179.75","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","47754.43","47754.43","47754.43","1 through 10","percent of total billed charges","","",""
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","322","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","98243.13","98243.13","98243.13","1 through 10","percent of total billed charges","","",""
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","323","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","52411.1","52411.1","52411.1","1 through 10","percent of total billed charges","","",""
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","33114.49","33114.49","33114.49","1 through 10","percent of total billed charges","","",""
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","36572.16","36572.16","36572.16","1 through 10","percent of total billed charges","","",""
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","44859.32","44859.32","44859.32","1 through 10","percent of total billed charges","","",""
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","324","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coronary Intravascular Lithotripsy Without Intraluminal Device","325","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","26095.61","26095.61","80691.9","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","66994.28","66994.28","147931.06","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","115855.42","115855.42","185996.54","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","82359.74","65899.02","124312.68","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","148710.89","148710.89","148710.89","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","342921","342921","342921","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","79687.01","79687.01","79687.01","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","110320.74","110320.74","110320.74","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","63121.6","37183.98","103618.74","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","112678.68","66425.52","193301.74","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Mcc","326","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","56228.57","56228.57","56228.57","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","117239.35","50053.99","144301.32","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","59994.62","26980.41","83359.65","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","77880.62","44777.9","88267.65","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","47854.51","26959.19","82929.76","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","51366.3","51366.3","51366.3","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","54757.46","54757.46","54757.46","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","32807.74","32807.74","32807.74","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","42957.12","42957.12","42957.12","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","43956.98","22253.6","98191.89","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","46960.22","46960.22","46960.22","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","112850.19","112850.19","112850.19","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures With Cc","327","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","29781.74","29781.74","29781.74","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","35239.42","20987.58","59118.47","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","30594.08","24685","31362.95","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","37954.92","37954.92","37954.92","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","48950.58","48950.58","53381.18","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","20838.99","20838.99","20838.99","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","23341.41","23341.41","23341.41","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12422.1","12422.1","12422.1","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","11756.24","11756.24","22407.59","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","708.65","708.65","708.65","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","8197.51","8197.51","8197.51","1 through 10","percent of total billed charges","","",""
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","328","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","11989.7","11989.7","11989.7","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","51396.13","46957.25","66485.54","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","73083","73083","77179.19","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","99251.7","35687.51","156447.51","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","30697.75","30697.75","30697.75","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","37018.2","26974.66","420696.97","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","67035.65","56837.11","117162.37","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","36944.19","36944.19","36944.19","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","78834.72","78834.72","78834.72","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","48579.19","48579.19","48579.19","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","73116.57","64307.44","363084.66","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","181477.23","181477.23","181477.23","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","49633.18","23682.73","239956.59","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","36905.03","30368.88","115196.66","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Mcc","329","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","65553.8","58188.15","299667.14","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","41853.91","17377.62","84086.79","13","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","44666.52","44666.52","44666.52","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","40835.22","21499.01","87564.24","20","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","42828.6","21315.14","65385.69","34","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","32143.75","26812.74","71292.64","12","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","41950.45","41950.45","41950.45","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","30796.69","30796.69","30796.69","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","39799.05","39799.05","39799.05","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","111934.97","111934.97","111934.97","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","47759.54","47759.54","47759.54","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","54625.43","54625.43","66862.97","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","37707.35","21204.92","105738.34","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","29778.58","22598.83","34008.8","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","41321.97","27232.86","66563.88","14","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","76045.3","76045.3","76045.3","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures With Cc","330","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","47655.08","42584.64","107219.64","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","36977.8","36977.8","36977.8","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","41610.4","20262.09","49892.19","12","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","29344.82","23706.49","38303.39","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","20110.21","20110.21","20110.21","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","37109.93","18030.81","45510.74","17","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","36443.27","25414.3","49450","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","38138","38138","38138","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","35056.17","35056.17","35056.17","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","45647.25","45647.25","45647.25","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","18873.69","18873.69","18873.69","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","28258.29","23215.86","35508.71","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","26007.14","26007.14","26007.14","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","38157.52","38157.52","38362.06","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","31314.04","31314.04","31314.04","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","43087.55","43087.55","48084.15","1 through 10","percent of total billed charges","","",""
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small And Large Bowel Procedures Without Cc/Mcc","331","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","29237.59","29237.59","29237.59","1 through 10","percent of total billed charges","","",""
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Mcc","332","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","78024.07","78024.07","78024.07","1 through 10","percent of total billed charges","","",""
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection With Cc","333","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","29175.38","29175.38","29175.38","1 through 10","percent of total billed charges","","",""
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rectal Resection Without Cc/Mcc","334","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","196215.87","196215.87","196215.87","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","74455.01","74455.01","74455.01","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","36263.55","36263.55","36263.55","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","100212.99","100212.99","100212.99","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","111028.62","111028.62","111028.62","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","22115.02","22115.02","22115.02","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Mcc","335","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","119467.14","119467.14","119467.14","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","59706.08","59706.08","59706.08","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","58466.04","53078.09","65761.45","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","35491.78","35491.78","72449.54","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","46597.39","46597.39","46597.39","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","39873.36","39873.36","39873.36","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","20870.01","20870.01","20966.81","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis With Cc","336","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","54783.23","54783.23","54783.23","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","36729.54","36729.54","36729.54","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","24831.76","24831.76","24831.76","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","24499.92","24499.92","24499.92","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","20140.04","20140.04","20140.04","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","22642.64","22642.64","22642.64","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","34444.14","34444.14","34444.14","1 through 10","percent of total billed charges","","",""
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Peritoneal Adhesiolysis Without Cc/Mcc","337","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","14174.46","14174.46","14174.46","1 through 10","percent of total billed charges","","",""
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Mcc","338","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis With Cc","339","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","340","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Mcc","341","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis With Cc","342","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","343","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","34500.96","34500.96","34500.96","1 through 10","percent of total billed charges","","",""
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","135144.54","135144.54","135144.54","1 through 10","percent of total billed charges","","",""
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","19051.46","19051.46","19051.46","1 through 10","percent of total billed charges","","",""
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Mcc","344","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13275.2","13275.2","13275.2","1 through 10","percent of total billed charges","","",""
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures With Cc","345","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","78709.92","78709.92","78709.92","1 through 10","percent of total billed charges","","",""
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","24624.28","24624.28","24624.28","1 through 10","percent of total billed charges","","",""
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","15883.84","15883.84","15883.84","1 through 10","percent of total billed charges","","",""
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Small And Large Bowel Procedures Without Cc/Mcc","346","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10302.86","10302.86","10302.86","1 through 10","percent of total billed charges","","",""
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","141407.19","141407.19","141407.19","1 through 10","percent of total billed charges","","",""
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15898.79","15898.79","15898.79","1 through 10","percent of total billed charges","","",""
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Mcc","347","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","16465.1","16465.1","16465.1","1 through 10","percent of total billed charges","","",""
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1758.13","1758.13","1758.13","1 through 10","percent of total billed charges","","",""
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17801.2","17801.2","17801.2","1 through 10","percent of total billed charges","","",""
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures With Cc","348","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Anal And Stomal Procedures Without Cc/Mcc","349","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Mcc","350","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","20598.91","20598.91","20598.91","1 through 10","percent of total billed charges","","",""
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13260.08","13260.08","13260.08","1 through 10","percent of total billed charges","","",""
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","40198.12","40198.12","40198.12","1 through 10","percent of total billed charges","","",""
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","22521.19","22521.19","22521.19","1 through 10","percent of total billed charges","","",""
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","11922.08","11922.08","11922.08","1 through 10","percent of total billed charges","","",""
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","47904","47904","47904","1 through 10","percent of total billed charges","","",""
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10728.59","10728.59","10728.59","1 through 10","percent of total billed charges","","",""
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures With Cc","351","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10484.23","10484.23","10484.23","1 through 10","percent of total billed charges","","",""
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","10914.01","10914.01","10914.01","1 through 10","percent of total billed charges","","",""
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10994.13","10994.13","10994.13","1 through 10","percent of total billed charges","","",""
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","9219.4","9219.4","9219.4","1 through 10","percent of total billed charges","","",""
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","352","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","67800.22","67800.22","67800.22","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","90646.89","90646.89","90646.89","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","28150.37","28150.37","28150.37","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","271490.19","271490.19","271490.19","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","13453.84","13453.84","13453.84","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Mcc","353","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","26727.06","26727.06","26727.06","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13684.93","13684.93","13684.93","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","32482","32482","32482","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral With Cc","354","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","62677.75","62677.75","62677.75","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","28982.61","28982.61","28982.61","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","10362.15","10362.15","10362.15","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16093.68","16093.68","16093.68","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","20574.03","20574.03","20574.03","1 through 10","percent of total billed charges","","",""
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","355","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","42457.84","42457.84","42457.84","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","81719.53","81719.53","81719.53","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","53159.29","53159.29","231867.89","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","54847.16","54847.16","54847.16","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Mcc","356","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","38635.94","38635.94","38635.94","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","34489.3","33426.38","71259.96","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","44547.36","44547.36","44547.36","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","65627.39","65627.39","87703.99","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","73981.5","73981.5","73981.5","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","22750.57","22750.57","22750.57","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","18429.27","18429.27","18429.27","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures With Cc","357","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","39380.73","39380.73","39380.73","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17505.51","17505.51","17505.51","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","51308.22","51308.22","51308.22","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","17910.79","17910.79","17910.79","1 through 10","percent of total billed charges","","",""
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System O.R. Procedures Without Cc/Mcc","358","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","11276.73","11276.73","11276.73","1 through 10","percent of total billed charges","","",""
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","22512.24","22512.24","22512.24","1 through 10","percent of total billed charges","","",""
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","359","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","360","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopy & Incisional Tubal Interruption","361","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endoscopic Tubal Interruption","362","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization & Radio-Implant, for Malignancy","363","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization Except for Malignancy","364","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures","365","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, female reproductive system w CC","366","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System w/o CC","367","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","57106.56","57106.56","57106.56","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","65921.86","65921.86","65921.86","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","18890.48","18890.48","18890.48","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","50247.38","50247.38","50247.38","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","43665.92","43665.92","43665.92","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","42146.17","42146.17","42146.17","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Mcc","368","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","76018.36","76018.36","76018.36","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","6644.32","6644.32","6644.32","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","8990.11","8990.11","8990.11","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","16096.56","16096.56","22309.1","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","38660.16","38660.16","38660.16","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11156.53","11156.53","11156.53","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","33162.36","33162.36","33162.36","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","97312.38","97312.38","97312.38","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders With Cc","369","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","18116.73","12878.53","19968.35","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","26046.3","26046.3","26046.3","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","24385.01","24385.01","24385.01","1 through 10","percent of total billed charges","","",""
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Esophageal Disorders Without Cc/Mcc","370","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","37586.04","37586.04","37586.04","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23105.68","23105.68","23105.68","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17074.56","16031.87","108946.43","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","19807.54","19807.54","19807.54","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","14816.44","14816.44","14816.44","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","26483.85","26483.85","26483.85","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","34887.26","19049.42","38240.61","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","39784.79","39784.79","39784.79","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","13469.05","13469.05","13469.05","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","112579.65","112579.65","112579.65","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","371","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","33041.91","33041.91","33041.91","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12950.09","12950.09","12950.09","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","22589.36","7548.2","71172.2","12","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","10830.89","10830.89","10830.89","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","15937.73","8023.97","20023.26","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","12541.45","12541.45","22139.47","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","23925.41","15769.23","72715.85","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","15780.04","15780.04","15780.04","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","372","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","26149.08","26149.08","26149.08","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","15851.01","15851.01","15851.01","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17274.58","17274.58","17274.58","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","12831.34","12831.34","12831.34","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","19054.76","18746.06","37225.77","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","9771.16","9771.16","9771.16","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10603.61","10603.61","13725.53","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","36496.93","36496.93","36496.93","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","20041.85","20041.85","20041.85","1 through 10","percent of total billed charges","","",""
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","373","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","43822.48","43822.48","43822.48","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","48232.22","48232.22","48232.22","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","21572.5","21572.5","21572.5","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","93730.15","93730.15","93730.15","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","29454.2","16104.78","239178.45","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","28197.09","28197.09","28197.09","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","44561.38","44561.38","44561.38","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","31189.76","31189.76","31189.76","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","19064.98","19064.98","19064.98","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13498.82","13498.82","13498.82","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","30393.31","22265.41","63318.06","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","49843.98","49843.98","49843.98","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","104891.15","104891.15","104891.15","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","116443.28","116443.28","116443.28","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Mcc","374","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","59114.05","59114.05","59114.05","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","14371.34","14371.34","14371.34","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","6046.33","6046.33","6046.33","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","10728.22","10728.22","10728.22","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","21929.46","15639.09","29520.96","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14187.48","9925.66","47045.51","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","28432.18","20882.38","61117.1","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","56953.07","56953.07","56953.07","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","29956.31","29956.31","29956.31","1 through 10","percent of total billed charges","","",""
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy With Cc","375","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Digestive Malignancy Without Cc/Mcc","376","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","19231.78","19231.78","56786.56","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","55752.15","55752.15","75409.96","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","21700.24","17998.57","183912.51","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","46117.7","46117.7","46117.7","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5577.64","5577.64","5577.64","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","24551.77","24551.77","41873.68","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","33682.01","33682.01","33682.01","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","61540.44","61540.44","61540.44","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","14973.69","13394.39","17599.53","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","37253.49","37253.49","37253.49","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","24131.62","24131.62","116947.87","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13096.45","13096.45","13096.45","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5862.59","5862.59","11218.77","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","28640.26","28640.26","28640.26","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Mcc","377","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","34965.36","34965.36","34965.36","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","38702.99","38702.99","38951.72","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","10698.53","10698.53","10698.53","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","7292.89","7292.89","7292.89","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","14823.68","13138.77","73225.1","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","14827.43","14827.43","14827.43","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","29369.8","16569.23","44202.68","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","73117.96","73117.96","73117.96","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","14305.19","10856.74","28334.93","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","12827.26","12827.26","12827.26","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","32578.75","32578.75","32578.75","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","13247.3","13247.3","13247.3","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","5643.02","5643.02","5643.02","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6879.61","3312.56","20647.59","11","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","10441.69","7550.88","32886.95","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","23577.61","19102.75","31705.4","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","56843.82","56843.82","56843.82","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage With Cc","378","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","8853.08","8853.08","8853.08","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","7994.95","7750.63","16168.53","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6098.41","6098.41","6098.41","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","24678.94","24678.94","24678.94","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10219.46","10219.46","10219.46","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2754.75","2754.75","2754.75","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Hemorrhage Without Cc/Mcc","379","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","23487.7","23487.7","23487.7","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","58219.54","58219.54","58219.54","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","37057.29","37057.29","37057.29","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","28865.08","28865.08","28865.08","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Mcc","380","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","25051.07","25051.07","25051.07","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","41058.95","41058.95","41058.95","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","31231.39","31231.39","31231.39","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","61130.2","61130.2","61130.2","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","10093.24","10093.24","10093.24","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","14653.67","14653.67","14653.67","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10065.27","10065.27","10065.27","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","33718.69","33718.69","33718.69","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer With Cc","381","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","11093.89","11093.89","11093.89","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15777.36","15777.36","15777.36","1 through 10","percent of total billed charges","","",""
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complicated Peptic Ulcer Without Cc/Mcc","382","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","124943.55","124943.55","124943.55","1 through 10","percent of total billed charges","","",""
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","28327.97","28327.97","28327.97","1 through 10","percent of total billed charges","","",""
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","12501.95","12501.95","12501.95","1 through 10","percent of total billed charges","","",""
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer With Mcc","383","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","7268.64","7268.64","7268.64","1 through 10","percent of total billed charges","","",""
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","5008.23","5008.23","5008.23","1 through 10","percent of total billed charges","","",""
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9838.27","9838.27","30860.97","1 through 10","percent of total billed charges","","",""
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uncomplicated Peptic Ulcer Without Mcc","384","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","33106.87","33106.87","33106.87","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","18910.72","18910.72","45952.67","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14706.28","14706.28","14858.7","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","27509.04","27509.04","27509.04","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","52034.14","52034.14","52034.14","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12508.41","12508.41","40260.19","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","52848.28","52848.28","52848.28","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","41275.26","41275.26","41275.26","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Mcc","385","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","55565.57","55565.57","55565.57","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","47108.4","47108.4","47108.4","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","30688.87","30688.87","30688.87","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17749.94","7281.67","47973.36","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","19549.63","19549.63","20155.84","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","49311.78","49311.78","49311.78","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","24561.89","22483.69","71036.18","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","21204.22","21204.22","29042.13","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","8551.87","8551.87","8551.87","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","33380.3","33380.3","33380.3","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease With Cc","386","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","22606.63","22606.63","22606.63","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","6267.56","6267.56","6267.56","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12197.22","12197.22","12197.22","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","8567.83","7282.95","43801.69","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10207.57","9655.31","46585.84","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","6708.95","6708.95","38945.98","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15713.11","15713.11","15713.11","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","22361.63","22361.63","22361.63","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","17316.1","17316.1","17316.1","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4644.2","4644.2","4644.2","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","15401.9","15401.9","19140.83","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","14646.42","14646.42","14646.42","1 through 10","percent of total billed charges","","",""
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammatory Bowel Disease Without Cc/Mcc","387","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","26382.49","26382.49","26382.49","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","16319.65","16319.65","16319.65","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","110834.2","110834.2","110834.2","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23334.34","23334.34","60933.6","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","22929.96","22929.96","22929.96","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","42394.06","42394.06","42394.06","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","127243.52","127243.52","127243.52","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","85984.36","85984.36","87892.48","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","13226.13","13226.13","13226.13","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","27708.34","27708.34","27708.34","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","30592.04","30592.04","30592.04","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","17128.41","17128.41","17128.41","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Mcc","388","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","22113.86","6079.16","63413.87","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","10818.97","9658.62","13713.78","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","41240.74","6986.11","41919.92","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17575.64","8574.17","22000.55","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","12095.6","11456.02","24993.58","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","13071.8","13071.8","13071.8","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","135209.57","135209.57","135209.57","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","11389.84","7634.83","26727.75","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","22775.13","22775.13","22775.13","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","21791.45","21791.45","21791.45","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","74629.67","74629.67","74629.67","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10787.81","10475.75","51479.11","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5983.37","5983.37","5983.37","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","37857.93","37857.93","37857.93","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","19920.19","19920.19","19920.19","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction With Cc","389","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12836.46","10048.56","18428.19","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","10451.37","10451.37","10451.37","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9193.73","7477.43","14093.89","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","11831.89","11831.89","11831.89","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","10145.76","10145.76","10145.76","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","13060.95","13060.95","13060.95","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","9812.65","9812.65","9812.65","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13889.29","13889.29","21898.34","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","21906.86","11121.36","32231.89","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","15717.54","15717.54","15717.54","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","5264.44","5264.44","5264.44","1 through 10","percent of total billed charges","","",""
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gastrointestinal Obstruction Without Cc/Mcc","390","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","27771.51","17840.97","56506.82","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","14182.17","14182.17","14182.17","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","22945.79","11416.88","108965.04","13","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","17891.56","17891.56","17891.56","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","18829.06","9383.37","54531.14","12","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","57190.5","57190.5","57190.5","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","41918.59","29075.06","73161.95","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","51172.73","51172.73","51172.73","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","17192.11","9159.85","79332.82","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","27390.9","27390.9","27390.9","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","18288.64","18288.64","18288.64","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","25915.51","25915.51","25915.51","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","62838.89","62838.89","62838.89","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16944.6","7987.55","63227.84","16","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","13140.95","2771.3","38720.88","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","21658.31","10384.68","63852.75","11","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","13238.17","13238.17","35323.07","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","33590.86","33590.86","33590.86","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","391","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","50440.24","11556.22","62241.12","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","13406.28","5277.52","17348.86","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12241.38","7150.2","29869.95","20","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","6182.99","6182.99","6182.99","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","14624.93","7205.3","27083.78","18","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","10258.86","10258.86","10258.86","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11173.6","7063.61","29919.16","32","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","11853.33","6111.5","36480.3","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","14176.91","12693.6","19944.1","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","12591.08","12467.18","22527.21","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","39491.36","39491.36","39491.36","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","15231.16","15231.16","15231.16","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","10317.57","1516.34","27808.74","17","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","4664.6","4664.6","4664.6","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8673.8","3000.19","18607.01","51","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10310.96","6235.91","22910.12","13","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","19609.41","2565.03","213345.83","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","8661.39","3106.85","14610.4","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","12658.78","5774.83","57412.07","1 through 10","percent of total billed charges","","",""
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","392","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9609.89","1467.41","24259.87","19","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","15941.78","15941.78","15941.78","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","11179.78","9697.58","23770.56","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","26613.13","26613.13","31324.71","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","35066.52","22303.48","88191.78","12","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","6038.53","6038.53","31269.9","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","33184.4","33184.4","33184.4","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","25245.4","25245.4","25245.4","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","14985.16","14985.16","19139.4","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","14176.98","8847.05","90743.05","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","31168.8","31168.8","31168.8","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","34763.81","34763.81","34763.81","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","17111.89","17111.89","43376.8","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13383.32","2681.9","270970.05","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","40896.57","40896.57","40896.57","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","14071.82","14071.82","21535.43","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Mcc","393","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","29944.24","16619.17","30734.97","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","27587","27587","27587","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","20125.05","6764.12","62426.18","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","12043.52","6985.88","46399.36","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10153.6","6154.52","41027.67","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","967.8","967.8","5228.93","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","27111.15","27111.15","27111.15","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","11517.93","9673.88","48285.57","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","16015.42","16015.42","16015.42","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","2295.34","2295.34","12052.78","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","24396.15","24396.15","24396.15","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","37208.8","37208.8","37208.8","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13389.95","4424.66","47080.75","17","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","18906.83","18906.83","22170.66","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12115.29","12115.29","18077.22","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","37450.44","37450.44","37450.44","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","30722.49","26885.88","40315.78","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses With Cc","394","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","15686.69","15686.69","15686.69","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","1245.56","1245.56","7735.45","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10164.49","9095.19","13874.75","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","5074.29","5074.29","5074.29","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","2689.9","2689.9","2689.9","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","4831.23","3874.65","17571.47","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","6460.45","6460.45","6460.45","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","5484.4","5484.4","5484.4","1 through 10","percent of total billed charges","","",""
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Digestive System Diagnoses Without Cc/Mcc","395","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","7369.34","7369.34","7369.34","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Age 0-17","396","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","68131.62","68131.62","68131.62","1 through 10","percent of total billed charges","","",""
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","91318.55","91318.55","91318.55","1 through 10","percent of total billed charges","","",""
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","39234.87","39234.87","39234.87","1 through 10","percent of total billed charges","","",""
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Mcc","397","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","26174.29","26174.29","26174.29","1 through 10","percent of total billed charges","","",""
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","47046.11","47046.11","47046.11","1 through 10","percent of total billed charges","","",""
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13936.49","13936.49","17016.78","1 through 10","percent of total billed charges","","",""
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25997.04","25997.04","25997.04","1 through 10","percent of total billed charges","","",""
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","10119.94","10119.94","10119.94","1 through 10","percent of total billed charges","","",""
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","22052.97","13836.72","27316.22","1 through 10","percent of total billed charges","","",""
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","49442.55","49442.55","96102.67","1 through 10","percent of total billed charges","","",""
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","16720.5","16720.5","16720.5","1 through 10","percent of total billed charges","","",""
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures With Cc","398","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1842.56","1842.56","1842.56","1 through 10","percent of total billed charges","","",""
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","7055.09","1010.53","28452.67","1 through 10","percent of total billed charges","","",""
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","18519.54","17855.8","36723.64","1 through 10","percent of total billed charges","","",""
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16764.59","10650.8","62615.88","1 through 10","percent of total billed charges","","",""
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","22427.99","22427.99","23986.68","1 through 10","percent of total billed charges","","",""
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","19813.5","10210.82","60441.13","1 through 10","percent of total billed charges","","",""
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","27619.16","27619.16","27619.16","1 through 10","percent of total billed charges","","",""
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16631.93","7172.73","27533.38","20","percent of total billed charges","","",""
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","27287.87","13593.62","78928.95","1 through 10","percent of total billed charges","","",""
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","10163.01","10163.01","10163.01","1 through 10","percent of total billed charges","","",""
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Appendix Procedures Without Cc/Mcc","399","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","16869","9385.4","28594.82","1 through 10","percent of total billed charges","","",""
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","400","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w other O.R. proc w CC","401","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","50920.8","50920.8","50920.8","1 through 10","percent of total billed charges","","",""
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","58583.8","58583.8","58583.8","1 through 10","percent of total billed charges","","",""
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","71203.77","65488.32","101725.43","1 through 10","percent of total billed charges","","",""
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","60460.98","50638.71","75866.16","1 through 10","percent of total billed charges","","",""
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","66977.58","66977.58","66977.58","1 through 10","percent of total billed charges","","",""
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","45767.46","45767.46","45767.46","1 through 10","percent of total billed charges","","",""
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","76363.82","76363.82","76363.82","1 through 10","percent of total billed charges","","",""
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","68519.44","68519.44","68519.44","1 through 10","percent of total billed charges","","",""
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","59821.68","59821.68","59821.68","1 through 10","percent of total billed charges","","",""
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","49243.72","49243.72","49243.72","1 through 10","percent of total billed charges","","",""
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","47964.26","47964.26","51475.95","1 through 10","percent of total billed charges","","",""
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","402","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & non-acute leukemia w CC","403","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma & Non-Acute Leukemia w/o CC","404","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","129503.68","69841.23","510315.68","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","199501.67","70656.98","466726.48","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","73029.14","45824.62","136286.91","11","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","112193.8","112193.8","112193.8","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","81824.09","81824.09","113502.17","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","67853.45","67853.45","67853.45","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","77951.49","72790.12","115836.51","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","143892.46","143892.46","143892.46","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","50138.83","50138.83","50138.83","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","66076.19","66076.19","66076.19","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","105062.54","100163.45","133365.96","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","80695.94","80695.94","264711.85","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Mcc","405","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","28189.4","28189.4","28189.4","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","57872.76","39070.81","94189.2","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","58308.31","37125.58","83280.42","15","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","53752.02","41708.3","77247.88","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","60483.87","60483.87","60483.87","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","60241.95","41222.82","89836.78","16","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","66352.85","66352.85","66352.85","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","62055.31","47432.16","78842.24","12","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","59648.84","59648.84","86301.44","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","62380.24","62380.24","62380.24","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","90161.44","90161.44","90161.44","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","46348.18","46348.18","46348.18","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","38529.58","26975.36","57720.82","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","62924.36","43859.45","100556.11","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","42368.67","35658.33","133160.26","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","51570.44","51570.44","51570.44","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures With Cc","406","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","28723.53","28723.53","28723.53","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","59207","59207","59207","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","34026.09","34026.09","34026.09","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","38710.3","34397.11","38806.82","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","32160.21","25477.99","54997.99","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","61477.65","61477.65","61477.65","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","18882.22","18882.22","18882.22","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","23960.2","23960.2","23960.2","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","59786.15","59786.15","59786.15","1 through 10","percent of total billed charges","","",""
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","407","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","94010.01","94010.01","94010.01","1 through 10","percent of total billed charges","","",""
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","8263.35","8263.35","8263.35","1 through 10","percent of total billed charges","","",""
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","113762.75","113762.75","113762.75","1 through 10","percent of total billed charges","","",""
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","408","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","67704.63","67704.63","67704.63","1 through 10","percent of total billed charges","","",""
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","51223.85","51223.85","51223.85","1 through 10","percent of total billed charges","","",""
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","38450.83","38450.83","38450.83","1 through 10","percent of total billed charges","","",""
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","409","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","27101.05","27101.05","27101.05","1 through 10","percent of total billed charges","","",""
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","410","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Mcc","411","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. With Cc","412","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy With C.D.E. Without Cc/Mcc","413","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","100879.16","100879.16","100879.16","1 through 10","percent of total billed charges","","",""
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","414","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","51246.97","51246.97","51246.97","1 through 10","percent of total billed charges","","",""
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","415","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","416","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","30914.43","30914.43","30914.43","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","55891.5","55891.5","55891.5","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15179.81","15179.81","15179.81","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","417","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","39489.22","39489.22","39489.22","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","39920.04","30968.3","54601.78","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25966.32","22531.56","27877.99","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","46746.71","46746.71","46746.71","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","30776.7","30776.7","30776.7","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","24195.2","24195.2","24195.2","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","38690.68","38690.68","38690.68","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. With Cc","418","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","32869.69","32869.69","32869.69","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","10389.82","10389.82","10389.82","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17859.26","17859.26","32921.66","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","27420.6","27420.6","27420.6","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","26436.41","26436.41","26436.41","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","24791.83","24791.83","24791.83","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2182.51","2182.51","2182.51","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","22301.29","22301.29","30394.51","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","19864.76","19864.76","19864.76","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","32685.21","32685.21","32685.21","1 through 10","percent of total billed charges","","",""
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","419","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","23792.5","19797.37","30115.89","1 through 10","percent of total billed charges","","",""
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Mcc","420","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","16943.85","16943.85","16943.85","1 through 10","percent of total billed charges","","",""
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures With Cc","421","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","23241.46","23241.46","23241.46","1 through 10","percent of total billed charges","","",""
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14786.77","14786.77","14786.77","1 through 10","percent of total billed charges","","",""
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","422","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","54070.05","54070.05","54070.05","1 through 10","percent of total billed charges","","",""
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","146956.59","146956.59","146956.59","1 through 10","percent of total billed charges","","",""
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","61741.15","61741.15","61741.15","1 through 10","percent of total billed charges","","",""
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","60673.76","60673.76","60673.76","1 through 10","percent of total billed charges","","",""
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","550504.66","550504.66","550504.66","1 through 10","percent of total billed charges","","",""
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","423","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","27870.75","27870.75","27870.75","1 through 10","percent of total billed charges","","",""
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","49905.9","49905.9","49905.9","1 through 10","percent of total billed charges","","",""
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","27208.6","27208.6","27208.6","1 through 10","percent of total billed charges","","",""
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","424","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","42246.04","42246.04","42246.04","1 through 10","percent of total billed charges","","",""
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","425","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","275730.17","275730.17","275730.17","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","347227.04","347227.04","347227.04","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","70039.56","70039.56","70039.56","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","70026.42","70026.42","70026.42","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","272862.49","272862.49","272862.49","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","299534.38","299534.38","299534.38","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","78309.92","78309.92","78309.92","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","130905.36","130905.36","130905.36","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","385660.24","385660.24","385660.24","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","426","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","105161.76","105161.76","105161.76","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","82942.63","82565.53","213469.01","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","117101.55","117101.55","117101.55","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","69225.19","69225.19","69225.19","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","53556.39","53556.39","53556.39","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","73993.87","73993.87","137104.08","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","91978.51","91978.51","119643.33","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","102984.37","102984.37","102984.37","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","111662.72","111662.72","111662.72","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","46140.66","46140.66","46140.66","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","95238.6","95238.6","95238.6","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","427","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","128897.46","128897.46","128897.46","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","91490.51","91490.51","91490.51","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","77815.83","77815.83","77815.83","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","118455.28","118455.28","118455.28","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","72373.83","72373.83","72373.83","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","45052.86","45052.86","45052.86","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","91470.77","91470.77","91470.77","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","91840.56","91840.56","91840.56","1 through 10","percent of total billed charges","","",""
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","428","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","105984.49","105984.49","105984.49","1 through 10","percent of total billed charges","","",""
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","133201.07","133201.07","133201.07","1 through 10","percent of total billed charges","","",""
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","82876.56","82876.56","82876.56","1 through 10","percent of total billed charges","","",""
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","102517.73","102517.73","102517.73","1 through 10","percent of total billed charges","","",""
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","429","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","138742.48","138742.48","138742.48","1 through 10","percent of total billed charges","","",""
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","110744.32","110744.32","110744.32","1 through 10","percent of total billed charges","","",""
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","68537.89","68537.89","68537.89","1 through 10","percent of total billed charges","","",""
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","107429.26","107429.26","107429.26","1 through 10","percent of total billed charges","","",""
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","430","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Childhood Mental Disorders","431","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","18963.61","18963.61","32180.79","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","53264.96","14698.95","125306.07","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","34704.44","34704.44","34704.44","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","41671.99","32404.48","48222.85","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","42019.4","19192.52","83453.66","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","97299.65","97299.65","97299.65","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","17526.33","16421.23","35748.59","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","11497.19","11497.19","11497.19","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","22103.15","22103.15","22103.15","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","36613.83","36613.83","36613.83","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","15978.27","15978.27","15978.27","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","23925.39","18156.31","73066.29","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","34812.53","16995.58","89348.16","11","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","21616.75","13300.76","29358.99","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","32801.87","32801.87","32801.87","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","32643.1","23631.02","122293.96","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Mcc","432","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","48152.07","42142.35","58535.39","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","10607.7","4407.7","20166.74","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","35867.82","19442.93","55012.53","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","28275.94","20685.64","98696.97","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","38039.72","38039.72","38039.72","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","39387.94","39387.94","39387.94","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","733.7","733.7","733.7","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12580.28","7870.29","49101.22","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","19591.65","19591.65","19591.65","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12661.7","12661.7","12661.7","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","50086.08","50086.08","50086.08","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis With Cc","433","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11692.35","11692.35","11692.35","1 through 10","percent of total billed charges","","",""
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","434","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","22764.8","10280.42","39928.24","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","28584.23","6861.84","39566.87","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","30032.08","16330.86","83128.53","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17549.58","14589.53","32583.15","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","15129.73","15129.73","15129.73","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","36510.75","36510.75","48553.87","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","40036.85","40036.85","40036.85","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","83121.01","83121.01","83121.01","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","24778.91","13678.2","65040.09","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","19317.8","19317.8","54586.39","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","435","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","19290.4","19290.4","19290.4","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","21099.9","21099.9","21099.9","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8833.67","8833.67","8833.67","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","17324.63","17324.63","17324.63","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","7023.26","7023.26","7023.26","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","13038.23","13038.23","13038.23","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","25464.39","25464.39","25464.39","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","23362.32","23362.32","23362.32","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","22913.04","22913.04","22913.04","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas With Cc","436","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","4454.59","4454.59","4454.59","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","1819.14","1819.14","1819.14","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","27635.54","27635.54","27635.54","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","10720.92","10720.92","10720.92","1 through 10","percent of total billed charges","","",""
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","437","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","27505.49","27505.49","67484.19","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","20616.97","20616.97","20616.97","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","32209.92","32209.92","61018.52","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","23488.43","23488.43","94600.31","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","29444.91","29444.91","29444.91","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","18823.7","18823.7","18823.7","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","79573.64","79573.64","79573.64","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","30798.03","30798.03","30798.03","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10978.7","10956.15","72269.98","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","59124.22","59124.22","59124.22","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","6843.86","6843.86","6843.86","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","20322.45","20322.45","20322.45","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Mcc","438","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","23557.08","17791.45","81993.53","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","12270.12","12270.12","12270.12","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","19791.16","9785.92","45921.29","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","27650.79","27650.79","27650.79","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","50807.29","50807.29","50807.29","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","10514.97","10514.97","10514.97","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","18927.47","18927.47","18927.47","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","18475.48","4361.57","26749.57","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17005.26","5469.71","26455.82","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","6811.94","6811.94","6811.94","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","15974.91","15974.91","15974.91","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","33695.99","33695.99","62739.1","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy With Cc","439","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","58777.18","23277.26","70918.18","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","15447.12","15447.12","15447.12","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","7251.17","7251.17","7251.17","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","28736.94","28736.94","28736.94","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","10718.12","10718.12","10718.12","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","10983.32","10983.32","10983.32","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3721.98","3721.98","10616.84","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","23973.1","23973.1","23973.1","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","2954.8","2954.8","2954.8","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","14155.49","14155.49","14155.49","1 through 10","percent of total billed charges","","",""
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","440","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9951.31","9951.31","9951.31","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","31352.57","29456.14","94219.98","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","26164.83","20161.81","90382.79","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","32276.25","12957.8","138458.31","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","36137.36","18422.55","75513.59","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","130419.08","86950.77","132131.92","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","107734.22","107734.22","107734.22","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","161953.52","161953.52","161953.52","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","41999.81","33563.95","43089.29","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","51829.01","32271.95","322417.74","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","29250","26879.16","59413.71","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","29809.79","24112.35","38266.42","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","22428.5","22428.5","28027.59","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","29555.79","29555.79","29555.79","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","441","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","40212.51","22567.52","191183.08","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","22425.02","22425.02","58440.64","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","19381.36","19381.36","25495.72","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","19349.83","10519.67","48987.55","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10087.7","8979.99","26273.76","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","205867.69","205867.69","205867.69","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","24998.57","24998.57","43973.46","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","23193.57","23193.57","23193.57","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","25663.96","25663.96","25663.96","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14800.47","8347.73","23456.91","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12021.15","6728.76","42418.89","14","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","14859.36","14859.36","14859.36","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","442","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","32136.79","28393.65","39714.76","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13264.88","5540.64","26401.77","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","25457.45","25457.45","25457.45","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1098.83","1098.83","1098.83","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8804.98","8804.98","9992.19","1 through 10","percent of total billed charges","","",""
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","443","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","14303.32","14303.32","15265.22","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","36937.54","23358.29","105149.3","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23170.48","14762.94","62682.57","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","44480.81","44480.81","64930.82","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","17986.41","17986.41","17986.41","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","37830.44","18386.48","50993.65","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","47315.13","47315.13","47315.13","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","25983.7","25983.7","25983.7","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","27932.85","18897.49","28895.08","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","18877.48","14287.67","27870.32","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","25137.68","25137.68","25137.68","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","33922.44","33922.44","33922.44","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Mcc","444","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","19741.79","19741.79","19741.79","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","15635.4","15635.4","36294.96","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","22720.58","22720.58","22720.58","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17328.1","12261.51","28944.68","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","26791.55","26791.55","26791.55","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","44214.17","44214.17","44214.17","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","44324.84","44324.84","44324.84","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","13632.66","13632.66","13632.66","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12556.94","12556.94","12556.94","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","25464.46","25464.46","25464.46","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","19080.87","19080.87","19080.87","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","17408.7","17408.7","17408.7","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract With Cc","445","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12304.9","12304.9","17247.91","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","16307.33","16307.33","16307.33","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","18247.79","18247.79","27162.57","1 through 10","percent of total billed charges","","",""
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of The Biliary Tract Without Cc/Mcc","446","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","233775.8","233775.8","233775.8","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","73959.86","73959.86","73959.86","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","130447.66","130447.66","130447.66","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","109853.6","109853.6","109853.6","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","208985.46","208985.46","251692.3","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","447","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","81154.26","81154.26","93331.95","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","88098.89","57957.37","134729.04","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","73632.96","44246.18","186178.13","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","113074.94","113074.94","113074.94","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","79570.23","79570.23","79570.23","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","73150.05","52021.22","76236.53","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","49629.46","49629.46","49629.46","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","66624.04","66624.04","66624.04","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","66556.09","66556.09","66556.09","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","89032.58","89032.58","89032.58","1 through 10","percent of total billed charges","","",""
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Multiple Level Spinal Fusion Except Cervical Without Mcc","448","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning & toxic Effects of Drugs Age >17 w CC","449","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","105739.82","105739.82","105739.82","1 through 10","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","43780.97","43780.97","43780.97","1 through 10","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","450","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","74781.54","74781.54","74781.54","1 through 10","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","56918.44","56918.44","56918.44","1 through 10","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","50911.49","50911.49","50911.49","1 through 10","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","52051","40484.37","63297","1 through 10","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","55921.09","55921.09","55921.09","1 through 10","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","49463.9","32657.74","81832.04","12","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","27317.55","27317.55","27317.55","1 through 10","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","36980.42","36980.42","36980.42","1 through 10","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","71699.06","71699.06","71699.06","1 through 10","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","40829.61","40829.61","79123.1","1 through 10","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","60521.07","49494.24","65221.62","1 through 10","percent of total billed charges","","",""
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Single Level Spinal Fusion Except Cervical Without Mcc","451","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications of treatment w CC","452","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Mcc","453","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion With Cc","454","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","455","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","122646.4","122646.4","122646.4","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","235085.65","235085.65","235085.65","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","138708.73","138708.73","138708.73","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","118682.83","118682.83","118682.83","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","135561.75","116212.23","210460.79","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","139322.76","139322.76","139322.76","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","98556.44","98556.44","98556.44","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","114953.66","114953.66","114953.66","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","207935.53","162226.97","214454.79","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","98085.91","98085.91","98085.91","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","143426.75","143426.75","143426.75","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","61541.21","61541.21","61541.21","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","456","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","99440.26","99440.26","99440.26","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","90622.23","82293.6","118956.4","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","92030.95","83341.06","103434.24","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","107583.99","107583.99","107583.99","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","109403.46","109403.46","147434.38","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","87690.55","87690.55","87690.55","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","101170.49","101170.49","101170.49","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","164838.23","164838.23","204938.19","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","78759.68","78759.68","78759.68","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","62100.19","62100.19","69516.77","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","79852.94","79852.94","113076.29","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","25975.74","25975.74","132895.18","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","457","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","115267.9","115267.9","115267.9","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","29757.87","29757.87","29757.87","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","64464.23","60600.29","73210.4","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","66867.28","61775.55","78260.69","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","79197.04","67503.89","93894.57","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","76685.63","65932.18","103208.14","12","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","63227.51","63227.51","65909.23","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","68667.01","66827.73","108025.74","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","75448.82","75448.82","75448.82","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","458","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","66574.18","66238.74","77813.63","1 through 10","percent of total billed charges","","",""
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical With Mcc","459","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Fusion Except Cervical Without Mcc","460","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","461","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","158998.04","158998.04","158998.04","1 through 10","percent of total billed charges","","",""
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","462","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","580182.01","580182.01","580182.01","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","71267.93","71267.93","71267.93","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","82395.39","82395.39","82395.39","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","164946.43","164946.43","164946.43","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","59324.99","59324.99","59324.99","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","42261.49","42261.49","42261.49","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","463","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","21461.53","21461.53","21461.53","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","127155.69","127155.69","145675.08","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","202267.98","202267.98","202267.98","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","46343.41","25535.17","67169.63","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","64724.86","64724.86","64724.86","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","15033.36","15033.36","15033.36","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","156442.34","156442.34","156442.34","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","43548.81","32453.95","91634.28","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","79585.87","79585.87","81950.12","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","33987.31","33987.31","33987.31","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","25265.08","25265.08","25265.08","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","464","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","38829.91","24109.89","79966.24","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","80880.2","80880.2","112567","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","77953.29","77953.29","77953.29","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23558.44","20295.95","58777.74","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","23909.37","17105.88","81111.01","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","56623.17","56623.17","56623.17","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","33061.37","33061.37","33061.37","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","34971.82","34971.82","34971.82","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","30389.09","30389.09","30389.09","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5767.69","5767.69","5767.69","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","15779.19","15779.19","15779.19","1 through 10","percent of total billed charges","","",""
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","465","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","66731.89","66731.89","66731.89","1 through 10","percent of total billed charges","","",""
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Mcc","466","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","69781.06","69781.06","69781.06","1 through 10","percent of total billed charges","","",""
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","56312.07","56312.07","56312.07","1 through 10","percent of total billed charges","","",""
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","75171.5","75171.5","75171.5","1 through 10","percent of total billed charges","","",""
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","91464.69","91464.69","91464.69","1 through 10","percent of total billed charges","","",""
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","62151.08","62151.08","62151.08","1 through 10","percent of total billed charges","","",""
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","39329.3","39329.3","39329.3","1 through 10","percent of total billed charges","","",""
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","97021.89","97021.89","97021.89","1 through 10","percent of total billed charges","","",""
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement With Cc","467","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","100952.55","100952.55","100952.55","1 through 10","percent of total billed charges","","",""
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","73525.8","73525.8","73525.8","1 through 10","percent of total billed charges","","",""
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Revision Of Hip Or Knee Replacement Without Cc/Mcc","468","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","35788.63","35788.63","35788.63","1 through 10","percent of total billed charges","","",""
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","469","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","27214.42","27214.42","27214.42","1 through 10","percent of total billed charges","","",""
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","67725.43","60400.9","114623.95","1 through 10","percent of total billed charges","","",""
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","36364.36","34301.46","49377.72","1 through 10","percent of total billed charges","","",""
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","102959.04","102959.04","102959.04","1 through 10","percent of total billed charges","","",""
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","56232.72","56232.72","56232.72","1 through 10","percent of total billed charges","","",""
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","35369.44","35369.44","35369.44","1 through 10","percent of total billed charges","","",""
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","29847.21","29847.21","29847.21","1 through 10","percent of total billed charges","","",""
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","105086.54","105086.54","105086.54","1 through 10","percent of total billed charges","","",""
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","119652.08","119652.08","119652.08","1 through 10","percent of total billed charges","","",""
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","470","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","22597.34","22597.34","22597.34","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","106296.08","106296.08","106296.08","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","61680.91","61680.91","61680.91","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","130344.42","130344.42","130344.42","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","71849.19","71849.19","283475.96","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","148329.81","148329.81","148329.81","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Mcc","471","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","45712.19","45712.19","45712.19","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","68129.87","68129.87","100058.54","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","45081.74","28079.31","117903.46","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","45829.78","45829.78","45829.78","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","48562.87","48562.87","48562.87","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","42622.36","29297.38","110305.61","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","44181.53","44181.53","44181.53","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","92641.34","92641.34","92641.34","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","183341.33","183341.33","183341.33","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","62626.95","62626.95","69138.93","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","55002.63","55002.63","55002.63","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","44996.47","44996.47","44996.47","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","45872.38","45872.38","46009.26","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","43287.34","25668.16","70433.37","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","55913.19","55913.19","55913.19","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion With Cc","472","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","66175.54","66175.54","66175.54","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","34538.86","18897.8","60725.88","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","23956.52","23956.52","30754.44","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","23711.52","23711.52","23711.52","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","31051.14","31051.14","31051.14","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","38904.93","38904.93","38904.93","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","61098.14","61098.14","61098.14","1 through 10","percent of total billed charges","","",""
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cervical Spinal Fusion Without Cc/Mcc","473","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","110057.79","110057.79","110057.79","1 through 10","percent of total billed charges","","",""
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","43594.08","43594.08","43594.08","1 through 10","percent of total billed charges","","",""
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","29515.89","29515.89","29515.89","1 through 10","percent of total billed charges","","",""
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17874.1","17874.1","17874.1","1 through 10","percent of total billed charges","","",""
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","68191.65","68191.65","68191.65","1 through 10","percent of total billed charges","","",""
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","474","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","71663.37","71663.37","71663.37","1 through 10","percent of total billed charges","","",""
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","23035.39","23035.39","53844.06","1 through 10","percent of total billed charges","","",""
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","45783.15","45783.15","45783.15","1 through 10","percent of total billed charges","","",""
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","475","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","20639.92","20639.92","20639.92","1 through 10","percent of total billed charges","","",""
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","476","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","30835.62","30835.62","30835.62","1 through 10","percent of total billed charges","","",""
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","34589.51","34589.51","34589.51","1 through 10","percent of total billed charges","","",""
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","28136.08","28136.08","28136.08","1 through 10","percent of total billed charges","","",""
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","106347.95","106347.95","106347.95","1 through 10","percent of total billed charges","","",""
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","118541.84","118541.84","118541.84","1 through 10","percent of total billed charges","","",""
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1153.88","1153.88","1153.88","1 through 10","percent of total billed charges","","",""
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","477","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","37403.36","37403.36","91340.77","1 through 10","percent of total billed charges","","",""
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","46524.98","46524.98","46524.98","1 through 10","percent of total billed charges","","",""
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","38070.25","38070.25","117066.96","1 through 10","percent of total billed charges","","",""
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","36818.6","36818.6","43431.54","1 through 10","percent of total billed charges","","",""
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","46131.69","46131.69","46131.69","1 through 10","percent of total billed charges","","",""
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","478","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","30141.41","30141.41","30141.41","1 through 10","percent of total billed charges","","",""
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","479","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","63132.9","63132.9","63132.9","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","43867.39","43867.39","43867.39","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","62328.38","62328.38","80695.35","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","37656.98","37656.98","37656.98","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","46139.69","46139.69","46139.69","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","84621.96","84621.96","84621.96","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","48635.56","48635.56","48635.56","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","42688.45","42688.45","42688.45","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","58159.58","58159.58","58159.58","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","32433.72","32433.72","55250.24","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","81270.62","57153.37","128802.96","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","103962.45","103962.45","103962.45","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Mcc","480","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","47153.53","47153.53","47153.53","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","30522.4","24052.35","71972.43","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","51748.44","51748.44","51748.44","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16942.09","16942.09","16942.09","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","64412.17","64412.17","64412.17","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","52461.1","52461.1","52461.1","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","42840.85","42840.85","42840.85","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","43550.17","43550.17","43550.17","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","31866.56","31866.56","31866.56","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","40944.26","40944.26","40944.26","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","41276.52","41276.52","41276.52","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","41532.82","39354.72","51737.31","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","38526.96","38526.96","50497.56","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","19073.65","19073.65","19073.65","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","47033.3","47033.3","47033.3","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint With Cc","481","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","42998.47","42998.47","42998.47","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","34532.46","34532.46","34532.46","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","28071.92","28071.92","34142.75","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","33939.17","23042.61","47121.5","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","26958.1","23238.98","32735.56","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","24588.99","24588.99","24588.99","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","25813.67","25813.67","25813.67","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","39253.23","28604.32","44608.9","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10353.81","10353.81","10353.81","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","41367.01","41367.01","41367.01","1 through 10","percent of total billed charges","","",""
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","482","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","31827.67","27381.59","42446.74","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","70889.25","70889.25","70889.25","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","32694.85","27574.65","77776.55","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","27095.81","27095.81","27095.81","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","30057.42","25169.59","47544.12","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","24264.18","24264.18","24264.18","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","29499.2","29499.2","29499.2","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","89219.14","89219.14","89219.14","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","48784.91","48784.91","76628.48","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","27525.11","22311.28","75043.29","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","46725.13","46725.13","46725.13","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","28646.64","27840.34","29479.97","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","37091.38","37091.38","61056.15","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","34187.14","34187.14","34187.14","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","31562.94","28199.6","52248.78","1 through 10","percent of total billed charges","","",""
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","483","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","484","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","107959.03","107959.03","107959.03","1 through 10","percent of total billed charges","","",""
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Mcc","485","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","48967.16","48967.16","48967.16","1 through 10","percent of total billed charges","","",""
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection With Cc","486","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","3724.06","3724.06","3724.06","1 through 10","percent of total billed charges","","",""
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","15324.65","15324.65","15324.65","1 through 10","percent of total billed charges","","",""
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","487","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","52244.57","52244.57","52244.57","1 through 10","percent of total billed charges","","",""
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","23160.84","23160.84","23160.84","1 through 10","percent of total billed charges","","",""
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","26006.63","26006.63","26006.63","1 through 10","percent of total billed charges","","",""
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","488","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","37318.77","37318.77","37318.77","1 through 10","percent of total billed charges","","",""
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","489","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","490","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back & neck proc exc spinal fusion w/o CC/MCC","491","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","68065.7","68065.7","68065.7","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","46647.65","46647.65","46647.65","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","74552.82","74552.82","74552.82","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","60530.25","60530.25","60530.25","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","33842.51","33842.51","33842.51","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","492","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","209176.62","209176.62","209176.62","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","85872.27","85872.27","85872.27","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","69736.96","69736.96","69736.96","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","83521.25","83521.25","83521.25","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24390.7","24390.7","94799.08","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","38875.76","38875.76","38875.76","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","39506.64","39506.64","114816.04","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","44109.92","44109.92","44109.92","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","58565.73","58565.73","58565.73","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","32231.73","32231.73","32231.73","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","39447.53","39447.53","39447.53","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","733.7","733.7","733.7","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","39923.98","31961.05","56696.31","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","41662.55","41662.55","41662.55","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","61886.59","61886.59","61886.59","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","63478.27","63478.27","63478.27","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","39846.08","39846.08","39846.08","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","493","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","22548.06","22548.06","22548.06","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12735.31","12735.31","49543.27","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11508.66","11508.66","21999.88","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","33942.61","14600.52","143025.42","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","31058.56","31058.56","31058.56","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","12993.39","12993.39","12993.39","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","28017.57","28017.57","28017.57","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1186.08","1186.08","1186.08","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","25894.41","21191.13","83543.4","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","25744.81","25744.81","43767.53","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","4707.84","4707.84","4707.84","1 through 10","percent of total billed charges","","",""
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","494","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","24966.37","24966.37","24966.37","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","42859.38","42859.38","42859.38","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","6643.75","6643.75","6643.75","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","495","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16667.67","16667.67","16667.67","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","49258.52","49258.52","49258.52","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","39512.55","39512.55","39512.55","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","496","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","24980.59","24980.59","24980.59","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23302.54","23302.54","23302.54","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","22851.37","22851.37","31573.4","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","52784.88","52784.88","52784.88","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","18075.34","18075.34","18075.34","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","497","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","32573","32573","32573","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","27023.9","27023.9","27023.9","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","56405.55","56405.55","56405.55","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","19718.87","19718.87","34107.15","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","498","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16668.03","16668.03","16668.03","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","47903.56","47903.56","47903.56","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12341.84","12341.84","12341.84","1 through 10","percent of total billed charges","","",""
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","499","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","560287.7","560287.7","560287.7","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","58516.06","58516.06","58516.06","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","343339.71","343339.71","343339.71","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","55479.8","55479.8","55479.8","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","211.36","211.36","211.36","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Mcc","500","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","24189.08","24189.08","24189.08","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","32209.6","32209.6","32209.6","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","22979.37","22979.37","22979.37","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","64103","62873.06","67058.83","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","23487.02","23487.02","23487.02","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","81075.28","81075.28","81075.28","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","32452.06","32452.06","32452.06","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","57145.21","57145.21","57145.21","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","18074.53","18074.53","18074.53","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","46603.04","29684.91","46803.77","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","57730.53","57730.53","57730.53","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","25943.42","25943.42","25943.42","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures With Cc","501","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","51726.65","51726.65","51726.65","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","15580.59","15580.59","17459.11","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15962.85","15962.85","15962.85","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","22308.84","22308.84","22308.84","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","45276.69","45276.69","93327.37","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","36462.33","36462.33","36462.33","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","68513.46","68513.46","68513.46","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","20997.53","20997.53","20997.53","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","42365.07","29045.78","50664.8","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","22058.44","22058.44","22058.44","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","65862.69","65862.69","65862.69","1 through 10","percent of total billed charges","","",""
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Soft Tissue Procedures Without Cc/Mcc","502","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","14419.97","14419.97","14419.97","1 through 10","percent of total billed charges","","",""
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","30245.58","30245.58","32099.68","1 through 10","percent of total billed charges","","",""
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","58661","58661","58661","1 through 10","percent of total billed charges","","",""
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Mcc","503","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","69603.98","69603.98","69603.98","1 through 10","percent of total billed charges","","",""
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","44452.13","44452.13","44452.13","1 through 10","percent of total billed charges","","",""
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","10112.69","10112.69","10112.69","1 through 10","percent of total billed charges","","",""
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","35995.24","35995.24","35995.24","1 through 10","percent of total billed charges","","",""
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","50774.58","50774.58","50774.58","1 through 10","percent of total billed charges","","",""
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures With Cc","504","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11379.24","11379.24","11379.24","1 through 10","percent of total billed charges","","",""
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","33477.53","33477.53","33477.53","1 through 10","percent of total billed charges","","",""
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","21995.02","21995.02","21995.02","1 through 10","percent of total billed charges","","",""
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Foot Procedures Without Cc/Mcc","505","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Thumb Or Joint Procedures","506","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","38182.2","38182.2","38182.2","1 through 10","percent of total billed charges","","",""
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","507","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","508","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Arthroscopy","509","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","89552.16","89552.16","89552.16","1 through 10","percent of total billed charges","","",""
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","510","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","27423.43","27423.43","27423.43","1 through 10","percent of total billed charges","","",""
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","38484.55","38484.55","38484.55","1 through 10","percent of total billed charges","","",""
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","169094.84","169094.84","169094.84","1 through 10","percent of total billed charges","","",""
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","511","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25200.33","25200.33","25200.33","1 through 10","percent of total billed charges","","",""
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15912.79","15912.79","15912.79","1 through 10","percent of total billed charges","","",""
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","9746.6","9746.6","9746.6","1 through 10","percent of total billed charges","","",""
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","15496.9","15496.9","15496.9","1 through 10","percent of total billed charges","","",""
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","512","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","53145.82","53145.82","53145.82","1 through 10","percent of total billed charges","","",""
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","25236.43","25236.43","25236.43","1 through 10","percent of total billed charges","","",""
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","66855.63","66855.63","66855.63","1 through 10","percent of total billed charges","","",""
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","25123.46","25123.46","25123.46","1 through 10","percent of total billed charges","","",""
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","513","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","36503.13","36503.13","36503.13","1 through 10","percent of total billed charges","","",""
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","514","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","152941.86","152941.86","152941.86","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","84011.48","84011.48","84011.48","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","109487.94","109487.94","109487.94","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","39726.62","39726.62","39726.62","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","59850.57","59850.57","59850.57","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","101977.32","101977.32","101977.32","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","27255.55","27255.55","49851.66","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","93777.88","93777.88","93777.88","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","515","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","69588.1","69588.1","69588.1","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","26900.72","26900.72","26900.72","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","48464.25","48464.25","92738.7","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","47420.66","47420.66","47420.66","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","34369.27","34369.27","34369.27","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","37264.45","21852.63","76820.92","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","28304.57","28304.57","53560.71","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","18644.68","18644.68","50385.33","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","49138.58","49138.58","49138.58","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","31217.84","31217.84","31217.84","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","65055.93","46518.79","65913.63","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","20522.72","20522.72","48987.36","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","33796.54","33796.54","33796.54","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","71477.36","71477.36","71477.36","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","72545.96","72545.96","112032.12","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","516","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","15051.07","15051.07","15051.07","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","23880.96","23880.96","48286.01","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","25904.54","25904.54","29380.57","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","22167.13","16391.63","44280.4","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","21806.77","13684.05","102229.16","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","15387.9","15387.9","15387.9","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","31120.28","31120.28","42786.86","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","14906.74","14906.74","14906.74","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","83622.64","83622.64","83622.64","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","16750.75","16750.75","16750.75","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","20598.64","20598.64","20598.64","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","16851.21","16851.21","16851.21","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","22218.7","22218.7","22218.7","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","517","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","124020.43","124020.43","124020.43","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","27894.53","27894.53","27894.53","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","172324.19","172324.19","172324.19","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","53659.72","53659.72","53659.72","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","518","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","60312.97","29339.71","71463.31","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","35086.18","35086.18","35086.18","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","38040.48","36955.33","45622.62","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","41024.21","26324.45","52783.15","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","35862.66","35862.66","52912.3","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","43822.58","43822.58","43822.58","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","50289.2","50289.2","50289.2","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","15572.22","15572.22","15572.22","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","36412.55","23341.43","80159.61","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion With Cc","519","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","37002.12","37002.12","37002.12","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","30672.55","30672.55","30672.55","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","42310.07","27519.02","48886.43","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","40196","27263.99","60607.95","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","35260.04","17283.68","54369.12","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","30383.47","23064.6","41401.15","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","12546.58","12546.58","12546.58","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13882.25","13882.25","13882.25","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","18936.36","18936.36","18936.36","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","45158.5","45158.5","45158.5","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","37002.08","20371.77","70961.6","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","16799.99","16799.99","16799.99","1 through 10","percent of total billed charges","","",""
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","520","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","54187.2","54187.2","54187.2","1 through 10","percent of total billed charges","","",""
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","114851.72","114851.72","114851.72","1 through 10","percent of total billed charges","","",""
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","62632.95","62632.95","62632.95","1 through 10","percent of total billed charges","","",""
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","40811.84","40811.84","40811.84","1 through 10","percent of total billed charges","","",""
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","521","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","62821.29","62821.29","62821.29","1 through 10","percent of total billed charges","","",""
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","55616.41","55616.41","55616.41","1 through 10","percent of total billed charges","","",""
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","32541.72","32541.72","32541.72","1 through 10","percent of total billed charges","","",""
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","28613.97","28613.97","28613.97","1 through 10","percent of total billed charges","","",""
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","40418.47","40418.47","40418.47","1 through 10","percent of total billed charges","","",""
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","34476.16","34476.16","34476.16","1 through 10","percent of total billed charges","","",""
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","40676.31","40676.31","40676.31","1 through 10","percent of total billed charges","","",""
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","43559.98","43559.98","43559.98","1 through 10","percent of total billed charges","","",""
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","522","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","523","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transient ischemia","524","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other heart assist system implant","525","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","526","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"No Longer Valid","527","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Intracranial Vascular Proc w Pdx Hemorrhage","528","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular shunt procedures w CC","529","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ventricular Shunt Procedures w/o CC","530","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w CC","531","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Spinal Procedures w/o CC","532","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur With Mcc","533","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","6446.14","6446.14","6446.14","1 through 10","percent of total billed charges","","",""
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Femur Without Mcc","534","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","17073.14","17073.14","17073.14","1 through 10","percent of total billed charges","","",""
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis With Mcc","535","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","14060.43","14060.43","14060.43","1 through 10","percent of total billed charges","","",""
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","10625.52","10625.52","10625.52","1 through 10","percent of total billed charges","","",""
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","3050.58","3050.58","3050.58","1 through 10","percent of total billed charges","","",""
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","10083.21","10083.21","44537.31","1 through 10","percent of total billed charges","","",""
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fractures Of Hip And Pelvis Without Mcc","536","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","7284.97","7284.97","7284.97","1 through 10","percent of total billed charges","","",""
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","537","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","538","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","22241.28","22241.28","22241.28","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","28796.24","28796.24","38601.1","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","13436.72","13436.72","13436.72","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","4563.59","4563.59","4563.59","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Mcc","539","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12384.55","12384.55","12384.55","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","4462.1","4462.1","4462.1","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","750","750","750","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","85.34","85.34","85.34","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","10202.02","10202.02","10202.02","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","27661.53","27661.53","27661.53","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","17513.54","9486.55","32246.18","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16366.41","16366.41","55951.4","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","17568.48","17568.48","17568.48","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","5042.47","2482.83","6366.55","1 through 10","percent of total billed charges","","",""
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis With Cc","540","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","27616.09","27616.09","27616.09","1 through 10","percent of total billed charges","","",""
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","22117.84","22117.84","22117.84","1 through 10","percent of total billed charges","","",""
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","21701.34","21701.34","21701.34","1 through 10","percent of total billed charges","","",""
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7784.66","7784.66","7784.66","1 through 10","percent of total billed charges","","",""
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","317.05","317.05","317.05","1 through 10","percent of total billed charges","","",""
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Osteomyelitis Without Cc/Mcc","541","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12069.92","12069.92","12069.92","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","35087.91","35087.91","35087.91","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","18764.22","18764.22","18764.22","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","74241.1","74241.1","74241.1","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","135888.86","135888.86","135888.86","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","24928.75","24928.75","24928.75","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","28162.71","28162.71","28162.71","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","542","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","45659.53","11573.76","51157.12","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","29635.76","29635.76","29635.76","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","18833.41","18833.41","18833.41","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13194.39","8114.53","58737.59","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","16076","16076","16076","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","50456.65","50456.65","50456.65","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","20478.27","20478.27","20478.27","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15485.75","15485.75","15485.75","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","27028.5","27028.5","41784.84","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","543","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","33453.89","33453.89","33453.89","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11899.26","11899.26","12645.62","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","30959.15","30959.15","30959.15","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9387.56","9387.56","9387.56","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","28383.75","28383.75","28383.75","1 through 10","percent of total billed charges","","",""
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","544","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","33785.84","33785.84","33785.84","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","123490.74","123490.74","123490.74","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","136258.37","136258.37","136258.37","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","85722.37","31036.21","407769.19","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","51743.57","26172.82","256222.95","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","9087.1","9087.1","9087.1","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","49395.86","49395.86","49395.86","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","13459.35","13459.35","13459.35","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","59484.46","59484.46","59484.46","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","114953.93","114953.93","114953.93","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","104223.73","104223.73","104223.73","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15174.11","14998.09","111653.71","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","167524.9","167524.9","167524.9","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","16686.64","16686.64","16686.64","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Mcc","545","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","76507.95","76507.95","76507.95","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","42005.2","42005.2","42005.2","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","56976.09","56976.09","56976.09","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","30018.23","12706.08","196944.44","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25470.28","14148.55","26589.91","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","18057.04","18057.04","18057.04","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","39082.77","39082.77","39082.77","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","11823.49","11823.49","11823.49","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","47843.04","47843.04","47843.04","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","12278.55","12278.55","12278.55","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","44721.73","44721.73","44721.73","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","10166.56","10166.56","10166.56","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","16319.32","16319.32","23397.31","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16874.15","9756.83","351620.7","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","13869.76","13869.76","13869.76","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","44507.59","44334.32","193889.8","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders With Cc","546","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15461.64","15461.64","15461.64","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","3250.99","3250.99","3250.99","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","190199.83","190199.83","190199.83","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","9330.04","9330.04","9330.04","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11641.58","11641.58","11641.58","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","62017.87","62017.87","62017.87","1 through 10","percent of total billed charges","","",""
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Connective Tissue Disorders Without Cc/Mcc","547","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","5148.31","5148.31","5148.31","1 through 10","percent of total billed charges","","",""
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Mcc","548","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","12234.39","12234.39","12234.39","1 through 10","percent of total billed charges","","",""
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12375.7","12375.7","12375.7","1 through 10","percent of total billed charges","","",""
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","19118.86","19118.86","19118.86","1 through 10","percent of total billed charges","","",""
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","11639.39","11639.39","11639.39","1 through 10","percent of total billed charges","","",""
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis With Cc","549","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","18612.55","18612.55","18612.55","1 through 10","percent of total billed charges","","",""
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","2190.37","2190.37","2190.37","1 through 10","percent of total billed charges","","",""
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septic Arthritis Without Cc/Mcc","550","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","18071.85","18071.85","18071.85","1 through 10","percent of total billed charges","","",""
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","26625.16","26625.16","26625.16","1 through 10","percent of total billed charges","","",""
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","3410.23","3410.23","3410.23","1 through 10","percent of total billed charges","","",""
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","110098.74","110098.74","110098.74","1 through 10","percent of total billed charges","","",""
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","28782.98","28782.98","28782.98","1 through 10","percent of total billed charges","","",""
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","12978.62","12978.62","12978.62","1 through 10","percent of total billed charges","","",""
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","37226.06","37226.06","37226.06","1 through 10","percent of total billed charges","","",""
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","9392.73","9392.73","9392.73","1 through 10","percent of total billed charges","","",""
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","19177.79","19177.79","19177.79","1 through 10","percent of total billed charges","","",""
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems With Mcc","551","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","37240.08","37240.08","37240.08","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","14103.98","5801.28","107102.33","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","27742.67","27742.67","61326.41","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","26566.88","26566.88","26566.88","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","110189.68","110189.68","110189.68","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17045.66","17045.66","28074.64","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","20631.51","20631.51","20631.51","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","20663.98","11435.17","21213.16","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","39912.33","39912.33","39912.33","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","3345.63","3345.63","31374.52","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12926.17","5316.74","24868.95","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","9477.93","6226.75","10298.65","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","12408.23","12408.23","12408.23","1 through 10","percent of total billed charges","","",""
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Medical Back Problems Without Mcc","552","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9021.66","9021.66","9021.66","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","14553.93","14553.93","14553.93","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","7256.54","7256.54","7256.54","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","49133.75","49133.75","49133.75","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","23737.8","23737.8","55617.4","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1153.88","1153.88","1153.88","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","71209.78","71209.78","71209.78","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies With Mcc","553","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","697.9","697.9","697.9","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","13581.57","13581.57","13581.57","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","14045.05","14045.05","14045.05","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","9580.63","9580.63","9580.63","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","31515.57","31515.57","31515.57","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","15935.25","15935.25","15935.25","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1162.41","1162.41","1162.41","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","6156.01","6156.01","6156.01","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","8606.33","8606.33","8606.33","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","12501.25","12501.25","12501.25","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","35245.17","35245.17","35245.17","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3223.46","1982.02","5396.76","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1876.15","1876.15","1876.15","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","14356.98","14356.98","14356.98","1 through 10","percent of total billed charges","","",""
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Bone Diseases And Arthropathies Without Mcc","554","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","690.99","690.99","690.99","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","29238.26","29238.26","29238.26","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","73551.41","73551.41","73551.41","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","555","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","4986.81","4986.81","4986.81","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","984.24","984.24","984.24","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","28978.63","28978.63","28978.63","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15762.55","15762.55","15762.55","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","3794.5","3794.5","3794.5","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","24802.04","24802.04","24802.04","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","18486.88","18486.88","18486.88","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","3373.67","1625.09","14342.55","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","37326.48","37326.48","37326.48","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","17508.45","17508.45","17508.45","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","556","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","821.98","821.98","821.98","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","42433.63","42433.63","42433.63","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","47812.2","47812.2","47812.2","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16408.9","16408.9","16408.9","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","16104.27","16104.27","16104.27","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","82913.82","82913.82","82913.82","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","26415.41","26415.41","26415.41","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","37342.24","37342.24","37342.24","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis With Mcc","557","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","45688.98","45688.98","45688.98","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","30781.5","30781.5","33823.37","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","6404.08","6404.08","6404.08","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","2806.4","2806.4","2806.4","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","6458.55","6458.55","6458.55","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","18209.64","12457.36","31364.37","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15089.21","4875.45","22603.78","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2715.21","2715.21","2715.21","1 through 10","percent of total billed charges","","",""
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Tendonitis, Myositis And Bursitis Without Mcc","558","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8374.03","6883.59","9673.18","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","24902.81","24902.81","40777.11","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","31460.71","31460.71","31460.71","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","62492.36","62492.36","62492.36","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","14078.2","14078.2","28306.15","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","21233.39","21233.39","21233.39","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","27782.7","27782.7","27782.7","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","559","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","26096.79","26096.79","26096.79","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","57276.58","57276.58","57276.58","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","39579.16","30834.58","50339.13","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","60171.93","60171.93","60171.93","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","27952.49","27952.49","27952.49","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","37618.71","37618.71","37618.71","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","28537.23","28537.23","28537.23","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","26221.62","26221.62","26221.62","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","20942.63","18519.66","21988.46","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","72848.35","72848.35","112487.61","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","16017.21","16017.21","28540.81","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue With Cc","560","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","8963.46","8963.46","8963.46","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","19395.91","19395.91","19395.91","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","33976.68","33976.68","33976.68","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","21881.19","21881.19","21881.19","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13521.43","13521.43","13521.43","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","24770.1","24770.1","24770.1","1 through 10","percent of total billed charges","","",""
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","561","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","15304.51","15304.51","15304.51","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","22131.51","22131.51","22131.51","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","29789.35","29789.35","29789.35","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","8864.01","8864.01","8864.01","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17953.85","17953.85","17953.85","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","562","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1163.12","1163.12","1163.12","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","7693.63","7693.63","18643.38","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","12950.06","12950.06","12950.06","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","12173.85","12173.85","12173.85","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","5288.51","5288.51","5288.51","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","10699.24","10699.24","10699.24","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","690.99","690.99","8947.3","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13246.81","5409.83","25974.64","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","7789.31","7789.31","7789.31","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7801.32","7801.32","30987.42","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","5878.7","5878.7","5878.7","1 through 10","percent of total billed charges","","",""
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","563","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","15753.69","15753.69","15753.69","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","165400.29","165400.29","165400.29","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","564","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","814.53","814.53","814.53","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","20683.36","20683.36","20683.36","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","33454.45","33454.45","33454.45","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","565","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","5886.57","5886.57","5886.57","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","3868.61","3868.61","3868.61","1 through 10","percent of total billed charges","","",""
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","566","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","567","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","568","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Small & Large Bowel Procedures w CC w Major Gi Dx","569","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","33427.12","33427.12","90735.42","1 through 10","percent of total billed charges","","",""
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Mcc","570","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","58222.16","58222.16","58222.16","1 through 10","percent of total billed charges","","",""
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","121084.18","121084.18","121084.18","1 through 10","percent of total billed charges","","",""
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","12654.06","12654.06","12654.06","1 through 10","percent of total billed charges","","",""
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","55720.13","55720.13","55720.13","1 through 10","percent of total billed charges","","",""
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","22473.44","22473.44","22473.44","1 through 10","percent of total billed charges","","",""
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","27523.19","27523.19","27523.19","1 through 10","percent of total billed charges","","",""
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","92054.03","92054.03","92054.03","1 through 10","percent of total billed charges","","",""
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement With Cc","571","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","39228.09","39228.09","39228.09","1 through 10","percent of total billed charges","","",""
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","15694.13","15694.13","15694.13","1 through 10","percent of total billed charges","","",""
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","51495.85","46125.14","70779.01","1 through 10","percent of total billed charges","","",""
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","42519.86","42519.86","42519.86","1 through 10","percent of total billed charges","","",""
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10222.14","10222.14","10222.14","1 through 10","percent of total billed charges","","",""
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Debridement Without Cc/Mcc","572","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","119890.95","119890.95","119890.95","1 through 10","percent of total billed charges","","",""
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","33627.37","33627.37","33627.37","1 through 10","percent of total billed charges","","",""
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","67165.66","67165.66","67165.66","1 through 10","percent of total billed charges","","",""
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","137034.73","137034.73","137034.73","1 through 10","percent of total billed charges","","",""
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","573","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","60593.89","60593.89","60593.89","1 through 10","percent of total billed charges","","",""
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","44541.42","44541.42","44541.42","1 through 10","percent of total billed charges","","",""
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis With Cc","574","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","575","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","576","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","78531.25","78531.25","78531.25","1 through 10","percent of total billed charges","","",""
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","19439.81","19439.81","19439.81","1 through 10","percent of total billed charges","","",""
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","95349.36","95349.36","95349.36","1 through 10","percent of total billed charges","","",""
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","68685.08","68685.08","68685.08","1 through 10","percent of total billed charges","","",""
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","40410.32","40410.32","40410.32","1 through 10","percent of total billed charges","","",""
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","27728.26","27728.26","27728.26","1 through 10","percent of total billed charges","","",""
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","577","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","29564.41","29564.41","29564.41","1 through 10","percent of total billed charges","","",""
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","20591.29","20591.29","20591.29","1 through 10","percent of total billed charges","","",""
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","34450.35","34450.35","34450.35","1 through 10","percent of total billed charges","","",""
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","44219.66","44219.66","44219.66","1 through 10","percent of total billed charges","","",""
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","578","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","87625.05","87625.05","87625.05","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","51369.01","51369.01","51369.01","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","17726.3","17726.3","17726.3","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","59947.56","59947.56","59947.56","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","579","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","52203.3","52203.3","52203.3","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","18732.22","18732.22","18732.22","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","15088.11","15088.11","15941.24","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","24394.56","24394.56","24394.56","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","21428.4","21428.4","21428.4","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","580","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","10541.27","10541.27","10541.27","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","6214.92","6214.92","6214.92","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","15132.55","15132.55","45893.21","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","16246.79","16246.79","16246.79","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","33425.5","33425.5","33425.5","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12860.19","12860.19","13605.51","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","19761.45","19761.45","19761.45","1 through 10","percent of total billed charges","","",""
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","581","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","11080.93","11080.93","11080.93","1 through 10","percent of total billed charges","","",""
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy With Cc/Mcc","582","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","41656.56","41656.56","41656.56","1 through 10","percent of total billed charges","","",""
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","58029.55","58029.55","58029.55","1 through 10","percent of total billed charges","","",""
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","52068.44","52068.44","52068.44","1 through 10","percent of total billed charges","","",""
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","35108.4","35108.4","35108.4","1 through 10","percent of total billed charges","","",""
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Mastectomy For Malignancy Without Cc/Mcc","583","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","44958.24","44958.24","44958.24","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","45806.03","39517.03","53643.84","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","51709.05","42919.12","63938.54","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","16551.88","16551.88","16551.88","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","27678.5","27678.5","27678.5","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","584","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","48617.37","44455.76","52036.44","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","43373.93","39946.39","68107.2","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","41344.99","39360.3","57088.6","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","43533.85","36961.97","54899.72","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","46498.21","44717.48","62425.72","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","46674.22","46674.22","46674.22","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","41110.11","41110.11","41110.11","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","41418.1","41418.1","67566.89","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","44793.95","44793.95","44793.95","1 through 10","percent of total billed charges","","",""
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","585","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Mcc","592","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","24821.16","24821.16","24821.16","1 through 10","percent of total billed charges","","",""
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","6308.33","6308.33","6308.33","1 through 10","percent of total billed charges","","",""
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","21037.73","21037.73","21037.73","1 through 10","percent of total billed charges","","",""
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","12885.78","12885.78","12885.78","1 through 10","percent of total billed charges","","",""
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1151.6","1151.6","1151.6","1 through 10","percent of total billed charges","","",""
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2719","2719","2719","1 through 10","percent of total billed charges","","",""
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers With Cc","593","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11055.87","11055.87","11055.87","1 through 10","percent of total billed charges","","",""
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","9213.76","9213.76","9213.76","1 through 10","percent of total billed charges","","",""
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Ulcers Without Cc/Mcc","594","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","54384.86","54384.86","54384.86","1 through 10","percent of total billed charges","","",""
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","23416.79","23416.79","23416.79","1 through 10","percent of total billed charges","","",""
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders With Mcc","595","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","9897.83","9897.83","9897.83","1 through 10","percent of total billed charges","","",""
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","19066.45","19066.45","19066.45","1 through 10","percent of total billed charges","","",""
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","12580.74","8941.41","15418.15","1 through 10","percent of total billed charges","","",""
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13314.53","11500.6","14644.38","1 through 10","percent of total billed charges","","",""
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","14851.82","14851.82","14851.82","1 through 10","percent of total billed charges","","",""
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","32403.92","32403.92","32403.92","1 through 10","percent of total billed charges","","",""
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12679.45","12679.45","12679.45","1 through 10","percent of total billed charges","","",""
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","34853.41","34853.41","34853.41","1 through 10","percent of total billed charges","","",""
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","10317.6","10317.6","10317.6","1 through 10","percent of total billed charges","","",""
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3937.37","3937.37","3937.37","1 through 10","percent of total billed charges","","",""
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Skin Disorders Without Mcc","596","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","14527.9","14527.9","14527.9","1 through 10","percent of total billed charges","","",""
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Mcc","597","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","90461.76","90461.76","90461.76","1 through 10","percent of total billed charges","","",""
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13870.89","13870.89","13870.89","1 through 10","percent of total billed charges","","",""
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders With Cc","598","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignant Breast Disorders Without Cc/Mcc","599","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders With Cc/Mcc","600","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1098.83","1098.83","1098.83","1 through 10","percent of total billed charges","","",""
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Malignant Breast Disorders Without Cc/Mcc","601","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","53466.32","53466.32","54045.53","1 through 10","percent of total billed charges","","",""
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","7293.36","7293.36","7293.36","1 through 10","percent of total billed charges","","",""
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","16437.4","16437.4","16437.4","1 through 10","percent of total billed charges","","",""
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","22588.51","22588.51","22588.51","1 through 10","percent of total billed charges","","",""
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","14587.33","14587.33","14587.33","1 through 10","percent of total billed charges","","",""
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","5222.39","5222.39","5222.39","1 through 10","percent of total billed charges","","",""
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","17926.85","17926.85","26382.97","1 through 10","percent of total billed charges","","",""
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11138.36","6869.62","30685.14","1 through 10","percent of total billed charges","","",""
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","19911.84","19911.84","19911.84","1 through 10","percent of total billed charges","","",""
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","38397.21","38397.21","38397.21","1 through 10","percent of total billed charges","","",""
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis With Mcc","602","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","14887.72","14887.72","14887.72","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","9969.71","9969.71","9969.71","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","8652.05","8652.05","8652.05","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","9039.9","9039.9","9039.9","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","10120.54","5824.36","17229.6","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","2170.23","2170.23","2170.23","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11575.95","9674.02","21638.4","12","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","8279.4","8279.4","8279.4","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","11603.6","7607.32","21471.62","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","18608.01","18608.01","18608.01","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","9193.39","9193.39","9193.39","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","9282.93","9282.93","9282.93","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","7724.04","7724.04","12959.68","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13575.26","1098.83","21518.09","16","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11988.48","6480.08","25882.27","52","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","11222.8","711.71","34791.73","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","3403.15","528.39","38234.53","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","18118.21","14176.75","31798.57","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","15938.75","15938.75","15938.75","1 through 10","percent of total billed charges","","",""
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cellulitis Without Mcc","603","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12445.49","5075.2","19369.85","18","percent of total billed charges","","",""
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","54701.08","54701.08","54701.08","1 through 10","percent of total billed charges","","",""
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","19394.79","19394.79","19394.79","1 through 10","percent of total billed charges","","",""
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","21524.64","21524.64","21524.64","1 through 10","percent of total billed charges","","",""
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","604","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","2455.72","2455.72","3690.84","1 through 10","percent of total billed charges","","",""
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","16869.33","16869.33","16990.28","1 through 10","percent of total billed charges","","",""
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","4841.39","4841.39","4841.39","1 through 10","percent of total billed charges","","",""
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2592.24","2592.24","2592.24","1 through 10","percent of total billed charges","","",""
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","19846.28","15980.7","22893.4","1 through 10","percent of total billed charges","","",""
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","25417.47","25417.47","25417.47","1 through 10","percent of total billed charges","","",""
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1918.8","1918.8","1918.8","1 through 10","percent of total billed charges","","",""
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","605","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9660.18","9660.18","9660.18","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","7135.68","7135.68","7135.68","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","83821.62","83821.62","83821.62","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","7066.4","7066.4","7066.4","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","7648.88","7648.88","7648.88","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","12956.84","12956.84","12956.84","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","35452.51","9741.18","68160.51","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","708.65","708.65","708.65","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders With Mcc","606","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1151.6","1151.6","1151.6","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","10952.28","10952.28","10952.28","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","128036.96","128036.96","128036.96","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","16808.78","16085.15","18341.98","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","12129.47","7748.46","38784.72","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","8203.62","8203.62","8203.62","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","6833.93","6833.93","6833.93","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","16457.62","16457.62","33126.84","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4391.81","4391.81","16942.13","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","17414.82","17414.82","17414.82","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17535.49","11369.54","29873.9","12","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","11435.05","11435.05","11435.05","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","28220.2","28220.2","28220.2","1 through 10","percent of total billed charges","","",""
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Skin Disorders Without Mcc","607","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","11158.09","11158.09","32655.19","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","33924.07","22012.68","71225.26","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","61353.19","34902.66","71270.57","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","47381.67","34924.13","69381.68","16","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","64186.37","47109.03","71965.27","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","29065.93","29065.93","29065.93","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","32723.03","28605.06","199329.31","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","38226.79","38226.79","60819.56","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","18604.27","18604.27","18604.27","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures With Cc/Mcc","614","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","24192.2","24192.2","24192.2","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","19450.86","19450.86","19450.86","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","65358.38","65358.38","65358.38","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","31094.04","31094.04","31094.04","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","61967.63","61967.63","61967.63","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","33906.25","33906.25","33906.25","1 through 10","percent of total billed charges","","",""
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Adrenal And Pituitary Procedures Without Cc/Mcc","615","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","75552.12","75552.12","75552.12","1 through 10","percent of total billed charges","","",""
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","79803.58","79803.58","79803.58","1 through 10","percent of total billed charges","","",""
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","42695.8","42695.8","42695.8","1 through 10","percent of total billed charges","","",""
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","616","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","62457.97","62457.97","62457.97","1 through 10","percent of total billed charges","","",""
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","43700.68","43700.68","43700.68","1 through 10","percent of total billed charges","","",""
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","51017.19","51017.19","51017.19","1 through 10","percent of total billed charges","","",""
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","22273.81","22273.81","22273.81","1 through 10","percent of total billed charges","","",""
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","19614.29","19614.29","19614.29","1 through 10","percent of total billed charges","","",""
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","25095.71","22551.04","40855.82","1 through 10","percent of total billed charges","","",""
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","37226.99","37226.99","37226.99","1 through 10","percent of total billed charges","","",""
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","7581.81","7581.81","7581.81","1 through 10","percent of total billed charges","","",""
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","617","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","43860.35","43860.35","43860.35","1 through 10","percent of total billed charges","","",""
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","618","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","153636.56","153636.56","153636.56","1 through 10","percent of total billed charges","","",""
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Mcc","619","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","39861.35","39861.35","39861.35","1 through 10","percent of total billed charges","","",""
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity With Cc","620","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures For Obesity Without Cc/Mcc","621","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","48304.85","48304.85","48304.85","1 through 10","percent of total billed charges","","",""
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","262248.86","262248.86","262248.86","1 through 10","percent of total billed charges","","",""
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","104009.91","104009.91","104009.91","1 through 10","percent of total billed charges","","",""
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","622","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","188841.77","188841.77","188841.77","1 through 10","percent of total billed charges","","",""
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","73648.47","73648.47","73648.47","1 through 10","percent of total billed charges","","",""
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","66597.1","66597.1","66597.1","1 through 10","percent of total billed charges","","",""
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","22464.4","22464.4","22464.4","1 through 10","percent of total billed charges","","",""
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","41607.23","41607.23","41607.23","1 through 10","percent of total billed charges","","",""
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","623","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","49806.17","49806.17","49806.17","1 through 10","percent of total billed charges","","",""
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","624","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","90269.21","90269.21","90269.21","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","625","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","19095.66","19095.66","19095.66","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","31080.52","31080.52","47703.65","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","53627.41","53627.41","53627.41","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","21980.13","21980.13","21980.13","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","44806.84","44806.84","44806.84","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","34605.42","34605.42","34605.42","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","41115.47","41115.47","41115.47","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","52132.17","52132.17","52132.17","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","626","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","23552.66","23552.66","23552.66","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","29971.57","29971.57","29971.57","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","20016.85","20016.85","20016.85","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","20385.99","20385.99","20385.99","1 through 10","percent of total billed charges","","",""
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","627","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","114643.44","114643.44","114643.44","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","199645.24","199645.24","199645.24","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","159003.47","57208.67","244118.18","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","208964.8","208964.8","208964.8","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","628","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","34941.45","34941.45","34941.45","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","52885.08","52885.08","52885.08","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","110808.15","110808.15","110808.15","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","127367.35","127367.35","127367.35","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","61066.54","61066.54","61066.54","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","44495.69","44495.69","44495.69","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","25345.51","25345.51","25345.51","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","629","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","29897.69","29897.69","29897.69","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","46761.65","46761.65","46761.65","1 through 10","percent of total billed charges","","",""
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","630","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","70312.23","70312.23","70312.23","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","7214.54","7214.54","7214.54","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","26238.14","10941.42","28286.32","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","15606.84","8549.7","38107.5","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","24249.73","24249.73","34181.5","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","12527.03","12527.03","12527.03","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","5804.33","5804.33","5804.33","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","20519.12","20519.12","20519.12","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","11139.67","11139.67","11139.67","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","20040.44","16135.4","22954.27","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","18002.46","9171.5","22623.17","12","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","18325.42","7281.63","61010.97","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","528.39","528.39","528.39","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","18543","18543","18543","1 through 10","percent of total billed charges","","",""
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Mcc","637","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","34144.21","34144.21","34144.21","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","15040.17","6480.9","54256.68","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","5915.9","5915.9","5915.9","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","36053.7","36053.7","36053.7","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17714.02","9280.15","38290.75","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11531.9","7512.72","16619.79","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","12644.56","6038.62","33758.92","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","18059.43","18059.43","18059.43","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","14534.78","13164.03","20338.17","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","10967.43","10967.43","10967.43","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","8699.28","8699.28","8831.48","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","8965.39","8965.39","8965.39","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11632.31","8035.34","18696.21","12","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12035.6","3452.89","25324.95","34","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","19249.9","1573.81","20233.78","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","18073.89","18073.89","31425.05","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","5345.91","3373.42","25568.9","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5210.44","5210.44","28254.7","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","5302.69","5302.69","5302.69","1 through 10","percent of total billed charges","","",""
"Diabetes With Cc","638","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","11393.86","4934.94","17515.31","12","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","8784.63","8784.63","9872.14","1 through 10","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","7095.18","6514.23","12952.4","1 through 10","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8243.79","4815.83","10788.83","11","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","6459.16","6222.77","9373.28","1 through 10","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","11525.53","11525.53","11525.53","1 through 10","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","8871.8","8871.8","8871.8","1 through 10","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","13246.41","13246.41","13246.41","1 through 10","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","5680.02","5680.02","5680.02","1 through 10","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14624","11763.14","15159.26","1 through 10","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8212.43","6502.71","12995.29","21","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","11646.41","5932.67","22837.01","1 through 10","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","7393.63","7393.63","9772.9","1 through 10","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5707.03","5707.03","5707.03","1 through 10","percent of total billed charges","","",""
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Diabetes Without Cc/Mcc","639","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6564.37","4908.31","7445.46","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","13380.46","5928.51","19769.18","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","17320.41","12936.46","46753.88","13","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","745.23","745.23","745.23","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","33383.59","27519.42","50831.2","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","27902.29","8096.19","39098.97","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","33020.2","33020.2","33020.2","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","32864.65","14947.53","56926.34","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","11690.42","9538.8","41642.7","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","53901.52","53901.52","53901.52","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15568.9","15568.9","53632.97","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","13573.85","11595","38006.41","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","97739.19","97739.19","97739.19","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","18848.69","14677.96","96177.36","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16342.53","8095.53","42755.32","35","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","8380.2","4797.87","36351.89","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","20020.27","16596.88","45330.35","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","8034.92","2006.44","49425.35","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","23408.19","23408.19","23408.19","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","640","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","19320.94","7027.55","113847.09","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","11694.69","4680.12","14417.88","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","11729.73","5631.27","41497.48","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","7552.64","7552.64","7552.64","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11960.82","5669.02","27980.52","13","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14056.75","6079.1","57853.43","19","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","13340.61","13340.61","13340.61","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","7692.67","7692.67","15959.83","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","25255.98","12884.82","36075.33","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","4675.4","4675.4","33075.19","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","12947.56","12947.56","12947.56","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","10533.83","10533.83","10533.83","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","11548.88","11548.88","11548.88","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","121721.53","121721.53","121721.53","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14601.92","8270.58","45180.62","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8496.72","6600.61","24336.23","23","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","4418.43","3715.35","30751.78","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","49066.89","27266.09","79842.52","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","31807.55","31807.55","40025.16","1 through 10","percent of total billed charges","","",""
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","641","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","15847.26","10138.66","22331.7","1 through 10","percent of total billed charges","","",""
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13158.59","7931.76","19089.57","1 through 10","percent of total billed charges","","",""
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","4464.46","4464.46","4464.46","1 through 10","percent of total billed charges","","",""
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","13408.57","12733.44","13439.77","1 through 10","percent of total billed charges","","",""
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","23142.15","23142.15","23142.15","1 through 10","percent of total billed charges","","",""
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","136718.49","136718.49","136718.49","1 through 10","percent of total billed charges","","",""
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14637.56","10369.05","26894.53","18","percent of total billed charges","","",""
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","16519.35","16519.35","16519.35","1 through 10","percent of total billed charges","","",""
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","102437.61","102437.61","102437.61","1 through 10","percent of total billed charges","","",""
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","99126.61","99126.61","99126.61","1 through 10","percent of total billed charges","","",""
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inborn And Other Disorders Of Metabolism","642","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","22854.53","22543.01","48082.85","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","22275.67","15164.91","54867.59","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","29053.32","29053.32","45674.44","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","63001.5","63001.5","63001.5","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","28933.47","28933.47","128834.06","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","23572.97","23572.97","23572.97","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","70738.43","16318.89","76024.27","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","33219.87","33219.87","33219.87","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1126.91","1126.91","1126.91","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Mcc","643","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12061.03","12061.03","12061.03","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","27083.22","27083.22","27083.22","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","7419.53","7419.53","7419.53","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14729.5","6280.36","17860.79","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","10733.17","10733.17","10733.17","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","7359.84","6419.55","10006.57","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","31360.17","31360.17","31360.17","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","15649.62","15649.62","15649.62","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","20556.17","19273.25","42845.58","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","10806.14","10806.14","10806.14","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","6053.09","6053.09","6053.09","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders With Cc","644","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","11337.02","11337.02","41364.64","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","11438.12","11438.12","16761.83","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9986.61","9986.61","11939.89","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","2116.21","2116.21","2116.21","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","9798.57","9798.57","9798.57","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","35678.28","35678.28","35678.28","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13464.1","12061.85","22022.25","1 through 10","percent of total billed charges","","",""
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Endocrine Disorders Without Cc/Mcc","645","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","198938.99","198938.99","198938.99","1 through 10","percent of total billed charges","","",""
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","135979.37","117550.87","161248.96","1 through 10","percent of total billed charges","","",""
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","150919.39","150919.39","150919.39","1 through 10","percent of total billed charges","","",""
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","259658.29","259658.29","259658.29","1 through 10","percent of total billed charges","","",""
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis With Mcc","650","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","109075.37","109075.37","109075.37","1 through 10","percent of total billed charges","","",""
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant With Hemodialysis Without Mcc","651","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","147358.17","142135.75","153182.62","1 through 10","percent of total billed charges","","",""
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","147963.52","147963.52","147963.52","1 through 10","percent of total billed charges","","",""
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","231243.2","231243.2","231243.2","1 through 10","percent of total billed charges","","",""
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","116307.47","116307.47","116307.47","1 through 10","percent of total billed charges","","",""
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","129845.28","129845.28","129845.28","1 through 10","percent of total billed charges","","",""
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","168502.79","168502.79","168502.79","1 through 10","percent of total billed charges","","",""
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","149918.33","149918.33","171465.81","1 through 10","percent of total billed charges","","",""
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","118251.78","118251.78","118251.78","1 through 10","percent of total billed charges","","",""
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","130831.89","130831.89","130831.89","1 through 10","percent of total billed charges","","",""
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney Transplant","652","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","24554.17","24554.17","24554.17","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","37271.11","37271.11","37271.11","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","62933.94","54374.38","102075.14","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Mcc","653","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","41267.37","36771.34","45341.18","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","64915.4","55312.17","220342.92","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","48655.16","48655.16","48655.16","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","106668.58","80751.49","240976.61","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","74893.41","42059.1","108626.09","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","58483.67","58483.67","58483.67","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","40227.76","40227.76","42351.06","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","45631.58","45631.58","45631.58","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","62167","39427.31","82250.99","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","44122.76","44122.76","44122.76","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures With Cc","654","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","53535.36","53535.36","53535.36","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","41272.64","41272.64","41272.64","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","38058.11","38058.11","38058.11","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","46960.49","46960.49","46960.49","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","42533.95","42533.95","42533.95","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","51874.12","51874.12","51874.12","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","106145.3","106145.3","106145.3","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","38895.54","38895.54","38895.54","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","93873.05","93873.05","93873.05","1 through 10","percent of total billed charges","","",""
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Bladder Procedures Without Cc/Mcc","655","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","41154.52","41154.52","41154.52","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","104668.14","104668.14","104668.14","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","46765.14","46765.14","46765.14","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","72797.75","72797.75","72797.75","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","58625.08","58625.08","58625.08","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","625.59","625.59","625.59","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14233.33","14233.33","14233.33","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Mcc","656","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","26613.91","26613.91","26613.91","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23471.47","23471.47","23471.47","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","63526.32","52314.35","71636.65","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","35780.02","35780.02","35780.02","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","31953.75","31953.75","31953.75","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","31917.39","31917.39","31917.39","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","18618.16","18618.16","18618.16","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm With Cc","657","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","25286.83","25286.83","25286.83","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","26016.55","26016.55","26016.55","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","20880.92","20880.92","23896.17","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","26360.36","26173.57","45482.3","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","17644.63","17644.63","17644.63","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","39651.99","39651.99","39651.99","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","22422.52","18009.39","26722.54","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","20358.5","20358.5","20358.5","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","658","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","1196038.08","1196038.08","1196038.08","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","55325.21","25044.42","467020.65","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","150505.02","150505.02","150505.02","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","168319.88","168319.88","168319.88","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","56504.04","56504.04","56504.04","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","55304.35","55304.35","55304.35","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","279713.02","279713.02","279713.02","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","241498.92","241498.92","241498.92","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","659","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","88491.82","88491.82","88491.82","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","12805.48","12805.48","12805.48","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","84682.86","84682.86","84682.86","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","34159.05","32819.01","43709.63","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","18116.39","18116.39","18116.39","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","18867.26","18867.26","18867.26","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","163008.79","163008.79","163008.79","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17307.32","17307.32","17307.32","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12281.44","12281.44","12281.44","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","21202.24","21202.24","21202.24","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm With Cc","660","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","12097.14","12097.14","12097.14","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14790.91","14790.91","18497.45","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","26245.42","26245.42","26245.42","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","20628.61","20628.61","20628.61","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","19447.96","19447.96","19447.96","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","16172.25","16172.25","16172.25","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","20961.89","19678.3","36412.66","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","25753.43","25753.43","25753.43","1 through 10","percent of total billed charges","","",""
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","661","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","23484.02","23484.02","23484.02","1 through 10","percent of total billed charges","","",""
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Mcc","662","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","17060.1","17060.1","17060.1","1 through 10","percent of total billed charges","","",""
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","82350.26","82350.26","82350.26","1 through 10","percent of total billed charges","","",""
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures With Cc","663","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","4446.24","4446.24","4446.24","1 through 10","percent of total billed charges","","",""
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Minor Bladder Procedures Without Cc/Mcc","664","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Mcc","665","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy With Cc","666","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatectomy Without Cc/Mcc","667","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","39704.37","39704.37","39704.37","1 through 10","percent of total billed charges","","",""
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","50324.9","50324.9","50324.9","1 through 10","percent of total billed charges","","",""
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","200606.12","200606.12","200606.12","1 through 10","percent of total billed charges","","",""
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","611778.94","611778.94","611778.94","1 through 10","percent of total billed charges","","",""
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Mcc","668","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","28797.74","28797.74","28797.74","1 through 10","percent of total billed charges","","",""
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","38559.09","38559.09","38559.09","1 through 10","percent of total billed charges","","",""
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","45281.37","45281.37","45281.37","1 through 10","percent of total billed charges","","",""
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures With Cc","669","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","27427.26","27427.26","27427.26","1 through 10","percent of total billed charges","","",""
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","10855.28","10855.28","10855.28","1 through 10","percent of total billed charges","","",""
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Procedures Without Cc/Mcc","670","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","11850.2","11850.2","11850.2","1 through 10","percent of total billed charges","","",""
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures With Cc/Mcc","671","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Procedures Without Cc/Mcc","672","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","59874.97","59874.97","59874.97","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","43411.08","43411.08","43411.08","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","29901.96","29901.96","29901.96","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","169987.25","169987.25","169987.25","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","51387.95","51387.95","51387.95","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","149170.28","149170.28","149170.28","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","38575.54","38575.54","38575.54","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","74484.1","74484.1","74484.1","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","59948.35","47450.12","112950.62","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Mcc","673","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","153841.22","153841.22","153841.22","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","50831.25","50831.25","50831.25","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","47832.59","47832.59","47832.59","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","82632.51","82632.51","82632.51","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","48930.51","28947.82","72062","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","66716.7","66716.7","66716.7","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","33496.47","33496.47","33496.47","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","159290.77","159290.77","159290.77","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","62229.08","62229.08","62229.08","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","28301.72","28301.72","37568.06","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","85606.48","85606.48","85606.48","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","34253.93","34253.93","34253.93","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures With Cc","674","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","50338.91","50338.91","50338.91","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","675","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","25637.94","14453.4","29936.06","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","29259.48","29259.48","38968.79","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","32620.51","26647.4","72611.69","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","31859.87","7057.68","175422.46","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","60839.31","60839.31","60839.31","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","10510.79","10510.79","10510.79","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","17007.33","9189.13","19655.81","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","21318.19","15661","62729.08","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","6866.72","6866.72","6866.72","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","7132.1","7132.1","18022.31","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","19182.51","19182.51","19182.51","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","21609.08","21609.08","32900.7","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","21702","10361.2","288601","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","24241.36","5200.53","74128.51","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","6120","6120","6120","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","57157.56","57157.56","57157.56","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","24858.79","24858.79","93701.8","1 through 10","percent of total billed charges","","",""
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Mcc","682","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","33071.94","23987.54","123782.88","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","17845.27","6203.92","36890.95","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","19505.66","7410.03","47090.32","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","7679.93","7679.93","7679.93","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","14634.83","9624.35","21255.54","13","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17900.03","9312.69","23210.51","11","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","12957.4","12957.4","12957.4","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","19103.67","15531.06","60505.88","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","19894.26","19894.26","19894.26","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15433.9","15433.9","64222.56","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","5605.98","5605.98","5605.98","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13121.55","7282.85","53656.32","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12123.5","4969.29","22068.98","18","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7622.46","7001.59","10517.06","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","7475.29","4733.84","71455.44","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1946.25","1946.25","6558.82","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","12786.38","12786.38","32888.22","1 through 10","percent of total billed charges","","",""
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure With Cc","683","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12886.21","1163.12","15282.15","1 through 10","percent of total billed charges","","",""
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","12666.49","12666.49","12666.49","1 through 10","percent of total billed charges","","",""
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","508317.02","508317.02","508317.02","1 through 10","percent of total billed charges","","",""
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","4340.45","4340.45","4340.45","1 through 10","percent of total billed charges","","",""
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","6559.53","6559.53","6559.53","1 through 10","percent of total billed charges","","",""
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","8078.72","8078.72","8078.72","1 through 10","percent of total billed charges","","",""
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Renal Failure Without Cc/Mcc","684","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","19386.9","19386.9","19386.9","1 through 10","percent of total billed charges","","",""
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Admit For Renal Dialysis","685","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","30917.04","30917.04","30917.04","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","69956.08","69956.08","69956.08","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","47696.35","47696.35","47696.35","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","28062.78","28062.78","28062.78","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","27811.82","27811.82","77924.88","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","58368.35","58368.35","58368.35","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","34999.72","34999.72","34999.72","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Mcc","686","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","6410.91","6410.91","6410.91","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","40776.57","40776.57","40776.57","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","35446.05","35446.05","35446.05","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5255.32","5255.32","5255.32","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","19184.61","19184.61","19184.61","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms With Cc","687","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","688","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","1031.28","1031.28","1031.28","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","48476.33","48476.33","48476.33","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","14362.84","14362.84","101218.52","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13252.54","13252.54","27828.72","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","20621.98","20621.98","20621.98","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","17927.28","17927.28","17927.28","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","14756.11","14756.11","14756.11","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","46394.72","46394.72","46394.72","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12864.55","12864.55","17018.59","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7590.7","7374.66","60169.57","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","36991.07","36991.07","36991.07","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections With Mcc","689","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","27145.5","27145.5","27145.5","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","14406.78","12511.63","27235.63","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","36400.96","36400.96","36400.96","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","40381.9","40381.9","40381.9","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","14739.61","9797.75","45866.85","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14237.8","7382.88","20851.24","11","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","36110.6","24926.52","84641.63","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","18341.34","12460.51","18828.2","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","16050.08","16050.08","16050.08","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","6555.26","6555.26","9119.46","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","13691.53","13691.53","19156.33","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","7604.03","7604.03","7604.03","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1046.5","1046.5","1046.5","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11629.45","5627.32","15877.4","21","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","34447.26","34447.26","34447.26","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","47117.58","47117.58","47117.58","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","5966.91","5966.91","9332.7","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","9688.42","8599.03","20032.62","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","12394.66","12394.66","12394.66","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Infections Without Mcc","690","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8646.24","2302.34","17318.53","1 through 10","percent of total billed charges","","",""
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W Cc/Mcc","691","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","692","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","21504.27","21504.27","21504.27","1 through 10","percent of total billed charges","","",""
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","43734.44","43734.44","43734.44","1 through 10","percent of total billed charges","","",""
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones With Mcc","693","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","12653.26","12653.26","12653.26","1 through 10","percent of total billed charges","","",""
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","27553.76","27553.76","27553.76","1 through 10","percent of total billed charges","","",""
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","17266.58","17266.58","17266.58","1 through 10","percent of total billed charges","","",""
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","6057.69","6057.69","6057.69","1 through 10","percent of total billed charges","","",""
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14720.05","14720.05","14720.05","1 through 10","percent of total billed charges","","",""
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6847.67","2640.77","13730.38","1 through 10","percent of total billed charges","","",""
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","22644.99","22644.99","22644.99","1 through 10","percent of total billed charges","","",""
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urinary Stones Without Mcc","694","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","20822.8","20822.8","20822.8","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","53311.49","53311.49","53311.49","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms With Mcc","695","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","11370.62","11370.62","11370.62","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12127.51","12127.51","12127.51","1 through 10","percent of total billed charges","","",""
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Kidney And Urinary Tract Signs And Symptoms Without Mcc","696","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1860.99","1860.99","1860.99","1 through 10","percent of total billed charges","","",""
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Urethral Stricture","697","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","27558.48","25226.55","44875.94","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","26495.84","26495.84","26495.84","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","22203.52","14454.95","80990.55","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","19671.09","10784.79","47936.51","17","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","16768.34","16016.67","99219.23","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","16060.58","16060.58","16060.58","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","64732.15","64732.15","64732.15","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","27045.92","27045.92","27045.92","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","26129.3","21444.53","137757.33","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","30234.7","30234.7","71432.07","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","20113.16","8449.27","33600.44","16","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","22615.32","21164.15","30331.42","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","91375.69","91375.69","91375.69","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","18493.05","18493.05","18493.05","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Mcc","698","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12139.37","12139.37","243430.33","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","13325.43","9033.2","37513.64","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","23979.97","13678.11","38196.26","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","15992.19","15992.19","15992.19","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","16841.79","11500.51","74890.88","14","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","19739.24","10832.66","85042.81","17","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","74251.33","74251.33","74251.33","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","11051.53","11051.53","11051.53","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","10113.03","8299.35","31220.23","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","8139.89","8139.89","8139.89","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","61851.52","61851.52","61851.52","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","12913.21","12005.11","66640.85","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","11373.62","11373.62","13637.75","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","8246.92","7568.88","12029.54","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13323.64","5940.76","28501.99","16","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","7970.99","7970.99","12279.95","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","42198.99","42198.99","42198.99","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","6801.97","6801.97","6801.97","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","51714.47","51714.47","51714.47","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses With Cc","699","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","14656.11","11316.79","22597.83","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12880.28","12880.28","12880.28","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13297.77","13297.77","13297.77","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8224.02","7836.64","26919.8","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","13682.52","13682.52","13682.52","1 through 10","percent of total billed charges","","",""
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","700","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","35577.82","35577.82","35577.82","1 through 10","percent of total billed charges","","",""
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","50656.43","50656.43","50656.43","1 through 10","percent of total billed charges","","",""
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23397.14","23397.14","23397.14","1 through 10","percent of total billed charges","","",""
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","58360.36","58360.36","58360.36","1 through 10","percent of total billed charges","","",""
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","48741.35","48741.35","48741.35","1 through 10","percent of total billed charges","","",""
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures With Cc/Mcc","707","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","22039.2","22039.2","22039.2","1 through 10","percent of total billed charges","","",""
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","21108.09","21108.09","21108.09","1 through 10","percent of total billed charges","","",""
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","16869.07","16869.07","16869.07","1 through 10","percent of total billed charges","","",""
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","20065.57","20065.57","20065.57","1 through 10","percent of total billed charges","","",""
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Male Pelvic Procedures Without Cc/Mcc","708","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","30216.29","30216.29","30216.29","1 through 10","percent of total billed charges","","",""
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","65854.2","65854.2","65854.2","1 through 10","percent of total billed charges","","",""
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","64800.65","64800.65","64800.65","1 through 10","percent of total billed charges","","",""
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","13870.15","13870.15","13870.15","1 through 10","percent of total billed charges","","",""
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures With Cc/Mcc","709","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","41652.54","41652.54","41652.54","1 through 10","percent of total billed charges","","",""
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","24978.74","24978.74","24978.74","1 through 10","percent of total billed charges","","",""
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","45159.72","45159.72","45159.72","1 through 10","percent of total billed charges","","",""
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25803.25","18325.78","42593.33","1 through 10","percent of total billed charges","","",""
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","33104.95","33104.95","33104.95","1 through 10","percent of total billed charges","","",""
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Penis Procedures Without Cc/Mcc","710","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","13123.4","13123.4","15671.87","1 through 10","percent of total billed charges","","",""
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","25708.61","25708.61","25708.61","1 through 10","percent of total billed charges","","",""
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15591.75","15591.75","15591.75","1 through 10","percent of total billed charges","","",""
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","9490.03","9490.03","9490.03","1 through 10","percent of total billed charges","","",""
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17695.28","17695.28","17695.28","1 through 10","percent of total billed charges","","",""
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","31167.44","31167.44","31167.44","1 through 10","percent of total billed charges","","",""
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures With Cc/Mcc","711","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","34793.38","34793.38","34793.38","1 through 10","percent of total billed charges","","",""
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9279.34","9279.34","9279.34","1 through 10","percent of total billed charges","","",""
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Testes Procedures Without Cc/Mcc","712","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","21601.38","21601.38","21601.38","1 through 10","percent of total billed charges","","",""
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy With Cc/Mcc","713","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Transurethral Prostatectomy Without Cc/Mcc","714","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","715","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","23164.98","23164.98","23164.98","1 through 10","percent of total billed charges","","",""
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","716","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","62439.26","62439.26","62439.26","1 through 10","percent of total billed charges","","",""
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","717","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","718","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","3100.04","3100.04","3100.04","1 through 10","percent of total billed charges","","",""
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Mcc","722","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","16938.96","16938.96","16938.96","1 through 10","percent of total billed charges","","",""
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5522.33","5522.33","5522.33","1 through 10","percent of total billed charges","","",""
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","13948.23","13948.23","13948.23","1 through 10","percent of total billed charges","","",""
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","22026.42","22026.42","22026.42","1 through 10","percent of total billed charges","","",""
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System With Cc","723","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Male Reproductive System Without Cc/Mcc","724","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy With Mcc","725","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Benign Prostatic Hypertrophy Without Mcc","726","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","23346.63","23346.63","23346.63","1 through 10","percent of total billed charges","","",""
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
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"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
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"Inflammation Of The Male Reproductive System With Mcc","727","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
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"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","28917.81","28917.81","28917.81","1 through 10","percent of total billed charges","","",""
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13532.45","13532.45","13532.45","1 through 10","percent of total billed charges","","",""
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"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
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"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","9256.74","9256.74","23812.76","1 through 10","percent of total billed charges","","",""
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"Inflammation Of The Male Reproductive System Without Mcc","728","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
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"Other Male Reproductive System Diagnoses Without Cc/Mcc","730","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Male Reproductive System Diagnoses Without Cc/Mcc","730","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","55853.16","55853.16","55853.16","1 through 10","percent of total billed charges","","",""
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","734","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","735","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","54903.94","54903.94","54903.94","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","64647.62","64647.62","64647.62","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","24817.89","24817.89","24817.89","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","69285.63","69285.63","69285.63","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","736","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","31985.83","31985.83","40682.61","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","33244.26","26492.99","129187.11","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","50375.68","36617.95","99957.98","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","36395.86","36395.86","36395.86","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","30319.01","30319.01","30319.01","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14816.15","14816.15","14816.15","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","41861.22","41861.22","72773.64","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","57632.65","57632.65","57632.65","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","737","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","24937.68","24937.68","24937.68","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17674.09","17674.09","17674.09","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","738","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","93642.41","93642.41","93642.41","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","739","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","54262.82","54262.82","54262.82","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","52054.57","52054.57","52054.57","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","37323.14","37323.14","37323.14","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","25710.38","25710.38","25710.38","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","54375.11","54375.11","54375.11","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","740","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","29324.58","29324.58","31180.47","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","34193.79","34193.79","34193.79","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","37138.52","37138.52","37138.52","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","741","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","17136.45","17136.45","17136.45","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","36882.02","36882.02","40546.85","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","35707.95","30269.34","41788.16","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24334.42","23146","40488.17","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","30199.2","30199.2","30199.2","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","46034.04","46034.04","46034.04","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","24451.3","24451.3","24451.3","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","51344.89","51344.89","53116.96","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","742","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","35156.25","35156.25","45844.06","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","22849.55","22849.55","22849.55","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","43665.13","43665.13","43665.13","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","24100.98","24100.98","38482","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24010.27","18932.16","34197.91","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","33383.05","33383.05","37954.04","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","29519.62","29519.62","29519.62","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","18343.36","18343.36","18343.36","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","18720.84","18720.84","18720.84","1 through 10","percent of total billed charges","","",""
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","743","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","26448.36","26448.36","26448.36","1 through 10","percent of total billed charges","","",""
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","46001.9","46001.9","46001.9","1 through 10","percent of total billed charges","","",""
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","12687.14","12687.14","12687.14","1 through 10","percent of total billed charges","","",""
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","34777.17","34777.17","34777.17","1 through 10","percent of total billed charges","","",""
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14899.14","14899.14","14899.14","1 through 10","percent of total billed charges","","",""
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","15517.21","15517.21","15517.21","1 through 10","percent of total billed charges","","",""
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","77541.51","77541.51","77541.51","1 through 10","percent of total billed charges","","",""
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","45963.98","45963.98","45963.98","1 through 10","percent of total billed charges","","",""
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","744","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","15789.54","15789.54","15789.54","1 through 10","percent of total billed charges","","",""
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","16727.09","16727.09","16727.09","1 through 10","percent of total billed charges","","",""
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","8700.79","8700.79","8700.79","1 through 10","percent of total billed charges","","",""
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","8415.75","8415.75","8415.75","1 through 10","percent of total billed charges","","",""
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","745","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","346.5","346.5","346.5","1 through 10","percent of total billed charges","","",""
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17887.49","17887.49","21302.38","1 through 10","percent of total billed charges","","",""
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","16094.58","16094.58","16094.58","1 through 10","percent of total billed charges","","",""
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","33134.67","33134.67","33134.67","1 through 10","percent of total billed charges","","",""
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","32842.9","32842.9","32842.9","1 through 10","percent of total billed charges","","",""
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","21974.24","21974.24","21974.24","1 through 10","percent of total billed charges","","",""
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures With Cc/Mcc","746","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","39538.65","39538.65","39538.65","1 through 10","percent of total billed charges","","",""
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","19591.11","19591.11","19591.11","1 through 10","percent of total billed charges","","",""
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","747","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Female Reproductive System Reconstructive Procedures","748","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","59450.17","59450.17","59450.17","1 through 10","percent of total billed charges","","",""
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10139.66","10139.66","10139.66","1 through 10","percent of total billed charges","","",""
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","78328.46","78328.46","78328.46","1 through 10","percent of total billed charges","","",""
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","23766.98","23766.98","23766.98","1 through 10","percent of total billed charges","","",""
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","51118.75","51118.75","51118.75","1 through 10","percent of total billed charges","","",""
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","23987.22","23987.22","23987.22","1 through 10","percent of total billed charges","","",""
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures With Cc/Mcc","749","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","14098.12","14098.12","14098.12","1 through 10","percent of total billed charges","","",""
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","750","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","26486.53","26486.53","26486.53","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","31431.53","31431.53","31431.53","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","22835.79","22835.79","22835.79","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","74825.82","74825.82","74825.82","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Mcc","754","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","27577.01","27577.01","27577.01","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","14638.16","14638.16","14638.16","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","94840.17","94840.17","94840.17","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","22641.28","22641.28","22641.28","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","13854.12","13854.12","13854.12","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","34468.73","34468.73","34468.73","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","961.11","961.11","961.11","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System With Cc","755","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","33001.68","33001.68","33001.68","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","35660.51","35660.51","35660.51","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","36898.69","36898.69","36898.69","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","14564.51","14564.51","14564.51","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","42713.46","42713.46","42713.46","1 through 10","percent of total billed charges","","",""
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Malignancy, Female Reproductive System Without Cc/Mcc","756","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10428.52","10428.52","10428.52","1 through 10","percent of total billed charges","","",""
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14967.43","14967.43","14967.43","1 through 10","percent of total billed charges","","",""
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Mcc","757","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","22747.16","22747.16","22747.16","1 through 10","percent of total billed charges","","",""
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15268.25","15268.25","15268.25","1 through 10","percent of total billed charges","","",""
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11988.21","11988.21","11988.21","1 through 10","percent of total billed charges","","",""
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10269.02","6931.45","34457.35","1 through 10","percent of total billed charges","","",""
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","32008.58","32008.58","32008.58","1 through 10","percent of total billed charges","","",""
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","10069.92","10069.92","10069.92","1 through 10","percent of total billed charges","","",""
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System With Cc","758","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","5932.4","5932.4","7527.81","1 through 10","percent of total billed charges","","",""
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10811.2","4115.03","14210.19","1 through 10","percent of total billed charges","","",""
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","4771.94","4771.94","4771.94","1 through 10","percent of total billed charges","","",""
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infections, Female Reproductive System Without Cc/Mcc","759","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","3772.65","3772.65","3772.65","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","7967.33","7967.33","7967.33","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","10319.44","10319.44","12835.7","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","15696.2","15696.2","15696.2","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","42737.84","42737.84","42737.84","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","6099.28","6099.28","6099.28","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5455.22","3135.16","31367.25","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","25499.52","25499.52","25499.52","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","760","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10815.52","10815.52","10815.52","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","1913.74","1913.74","1913.74","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8623.41","8623.41","8623.41","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","10020.22","10020.22","10020.22","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10833.29","10833.29","10833.29","1 through 10","percent of total billed charges","","",""
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","761","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W Cc/Mcc","765","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section W/O Cc/Mcc","766","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Sterilization &/Or D&C","767","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","18183.37","14616.34","48294.97","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17700.81","15235.92","42640.98","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","19908.38","14045.82","53056.7","13","percent of total billed charges","","",""
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","15575.92","9626.08","26322.47","15","percent of total billed charges","","",""
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","17684.7","13349.73","38384.64","15","percent of total billed charges","","",""
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","20858.96","20858.96","20858.96","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14864.84","12931.84","34944.73","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","17484.66","17484.66","17484.66","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","14565.12","14565.12","14565.12","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","17741.68","17741.68","17741.68","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","768","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","15329.95","14491.05","18425.4","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","21897.93","21897.93","21897.93","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","44257.19","30984.31","111272.16","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","30844.15","30844.15","30844.15","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","32380.91","32380.91","32380.91","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","49775.3","49775.3","49775.3","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","29545.76","12718.68","32459.67","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses With O.R. Procedures","769","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","14513.02","14513.02","14513.02","1 through 10","percent of total billed charges","","",""
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15694.53","15694.53","15694.53","1 through 10","percent of total billed charges","","",""
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","4544.8","4544.8","4544.8","1 through 10","percent of total billed charges","","",""
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","18405.58","18405.58","18405.58","1 through 10","percent of total billed charges","","",""
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion With D&C, Aspiration Curettage Or Hysterotomy","770","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W Complicating Diagnoses","774","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery W/O Complicating Diagnoses","775","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","6190.4","3805.36","22490.95","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","5824.62","4669.22","10358.35","13","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6876.54","4245.35","14935.19","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","6056.85","3575.41","29896.78","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","3780.68","3485.35","6301.55","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","7273.53","5153.73","14565.23","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","5906.34","4365.54","21463.61","15","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","5815.44","4021.64","13459.19","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","10348.34","10348.34","10348.34","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","5398.34","5398.34","5398.34","1 through 10","percent of total billed charges","","",""
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","776","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","5374.39","3731.15","11389.01","1 through 10","percent of total billed charges","","",""
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ectopic Pregnancy","777","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Threatened Abortion","778","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14675.06","14675.06","14675.06","1 through 10","percent of total billed charges","","",""
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","14016.65","14016.65","14016.65","1 through 10","percent of total billed charges","","",""
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11423.65","8978.91","15186.52","1 through 10","percent of total billed charges","","",""
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","16309.91","16309.91","16309.91","1 through 10","percent of total billed charges","","",""
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","6641.59","6641.59","6641.59","1 through 10","percent of total billed charges","","",""
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Abortion Without D&C","779","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","7354.26","7354.26","7354.26","1 through 10","percent of total billed charges","","",""
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"False Labor","780","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W Medical Complications","781","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses W/O Medical Complications","782","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","88116.7","88116.7","240392.43","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24485.1","24485.1","147827.99","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","96479.93","96479.93","96479.93","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15156.24","15156.24","15156.24","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","105002.98","105002.98","105002.98","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","85807.58","85807.58","85807.58","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","21584.69","10909.79","99295.29","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","143283.13","143283.13","143283.13","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","26677.36","26677.36","26677.36","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Mcc","783","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","52732.06","52732.06","52732.06","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","55549.62","55549.62","67419.64","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13251.11","13251.11","31917.28","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16455.2","13222.84","23170.43","12","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","27641.53","18126.36","50368.35","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","9945.9","9945.9","9945.9","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13034.23","11843.19","18910.04","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17841.89","11487.49","54400.34","16","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","23304.47","18928.23","35353.92","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","13942.95","13942.95","13942.95","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","16758.03","16758.03","16758.03","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization With Cc","784","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","16039.99","12356.24","71296.17","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","19825.7","19825.7","40149.64","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17532.17","17532.17","20946.58","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","15868.5","15868.5","15868.5","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","12360.05","11251.35","23492.09","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11236","10703.4","16745.75","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12714.95","10428.95","19444.18","15","percent of total billed charges","","",""
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","338977.13","338977.13","338977.13","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","30772.3","30772.3","30772.3","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","16051.13","16051.13","16051.13","1 through 10","percent of total billed charges","","",""
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section With Sterilization Without Cc/Mcc","785","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12257.48","11987.4","14227.83","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","20019.52","13613.56","90008.8","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","29445.96","15858.05","127913.27","14","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24680.94","15112.49","94470.7","30","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","24250.61","13546.97","74786.17","15","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","24519.51","17954.7","30674.52","14","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","32566.12","32566.12","32566.12","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","25170.41","16025.81","42922.91","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","20675.26","14467.47","67960.93","28","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","26447.23","26447.23","26447.23","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","32687.5","32687.5","32687.5","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","32829.37","32829.37","32829.37","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","23867.25","23867.25","23867.25","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Mcc","786","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","19577.34","14440.95","26685.86","18","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","21702","9999.82","42166.83","22","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17354.91","14538.07","34830.94","33","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","17820.95","11875.4","34940.64","39","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","18287.14","11500.6","50654.91","29","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","21359.96","13764.31","46374.91","19","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","27349.14","27349.14","27349.14","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","16303.69","12239.39","60916.64","23","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16656.43","10478.79","33116.05","54","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","16710.56","11735.47","28944.71","17","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","8600.33","8600.33","8600.33","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","21360.74","17021.51","21806.64","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization With Cc","787","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","19345.35","13355.5","32611.38","24","percent of total billed charges","","",""
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12379.06","9357.88","28725.78","18","percent of total billed charges","","",""
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","16760.29","12524.73","44778.29","28","percent of total billed charges","","",""
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16000.61","11408.34","31034.3","45","percent of total billed charges","","",""
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","15990.52","11073.16","28000.99","23","percent of total billed charges","","",""
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","14263.64","9648.03","22375.17","25","percent of total billed charges","","",""
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14499.6","12373.7","23177.94","13","percent of total billed charges","","",""
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13197.42","9546.21","23151.8","56","percent of total billed charges","","",""
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","14468.51","11958.67","22100.62","12","percent of total billed charges","","",""
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","13080.05","13080.05","13080.05","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","10251.77","10251.77","10251.77","1 through 10","percent of total billed charges","","",""
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Cesarean Section Without Sterilization Without Cc/Mcc","788","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","15381.69","11198.68","29084.14","18","percent of total billed charges","","",""
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonates, Died Or Transferred To Another Acute Care Facility","789","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","291191.03","25349.13","1089184.27","1 through 10","percent of total billed charges","","",""
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","129685.91","56140.71","549626.14","16","percent of total billed charges","","",""
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","132984.37","27468.29","460090.36","16","percent of total billed charges","","",""
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","63502.53","9611.16","233422.87","11","percent of total billed charges","","",""
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","202168.08","43673.91","527611.56","1 through 10","percent of total billed charges","","",""
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","77340.45","77340.45","77340.45","1 through 10","percent of total billed charges","","",""
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","138227.2","54657.73","410764.34","22","percent of total billed charges","","",""
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","78583.41","24914.89","523228.64","41","percent of total billed charges","","",""
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","265832.56","265832.56","265832.56","1 through 10","percent of total billed charges","","",""
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","100077.26","64745.46","200362.51","1 through 10","percent of total billed charges","","",""
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","32316.73","32316.73","32316.73","1 through 10","percent of total billed charges","","",""
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","790","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","107424.99","60743.28","568744.98","13","percent of total billed charges","","",""
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","8170.41","2767.47","84368","1 through 10","percent of total billed charges","","",""
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","27960.78","23051.24","485304.56","1 through 10","percent of total billed charges","","",""
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","60067.14","7180.38","178098.05","14","percent of total billed charges","","",""
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","52193.14","5659.74","72450.34","1 through 10","percent of total billed charges","","",""
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","28804.22","28804.22","252906.9","1 through 10","percent of total billed charges","","",""
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","19050.84","4488.65","74460.17","13","percent of total billed charges","","",""
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","33836.27","3114.59","182150.79","30","percent of total billed charges","","",""
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","96341.07","96341.07","192360.65","1 through 10","percent of total billed charges","","",""
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","40176.18","3205.74","65073.34","1 through 10","percent of total billed charges","","",""
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","42403.83","42403.83","42403.83","1 through 10","percent of total billed charges","","",""
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity With Major Problems","791","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","22673.45","2673.57","221062.05","18","percent of total billed charges","","",""
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","7455.65","2167.34","9053.77","1 through 10","percent of total billed charges","","",""
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","4669.07","4669.07","4669.07","1 through 10","percent of total billed charges","","",""
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","3706.72","2989.19","12288.78","1 through 10","percent of total billed charges","","",""
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","2724.25","1743.58","35354.49","1 through 10","percent of total billed charges","","",""
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","7841.26","5407.29","25955.66","1 through 10","percent of total billed charges","","",""
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","2570.69","2570.69","2570.69","1 through 10","percent of total billed charges","","",""
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","2233.35","1248.28","46187.33","1 through 10","percent of total billed charges","","",""
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2079.34","1221.91","10468.97","34","percent of total billed charges","","",""
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","5837.47","3993.67","6168.24","1 through 10","percent of total billed charges","","",""
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","10434.89","10434.89","10434.89","1 through 10","percent of total billed charges","","",""
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prematurity Without Major Problems","792","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","4201.85","3041.15","52900.11","1 through 10","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","40105.1","2442.69","171398.96","17","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","46842.64","6920.84","129999.77","20","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","28564.34","2553.39","259504.98","26","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","8510.28","2080.41","77668.12","27","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","7383.53","1423.5","23185.35","14","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","3687.66","3687.66","3687.66","1 through 10","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","65988.16","65988.16","65988.16","1 through 10","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","30151.78","2659.06","158404.49","22","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7721.69","1738.09","68523.19","68","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12114.77","2246.31","189771.72","14","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","22277.18","2769.19","827221.03","1 through 10","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1845.69","1845.69","30333.44","1 through 10","percent of total billed charges","","",""
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Term Neonate With Major Problems","793","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6830.76","2089.81","60231.44","24","percent of total billed charges","","",""
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","1932.86","1111.98","4515.21","40","percent of total billed charges","","",""
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13211.82","2256.36","39115.6","1 through 10","percent of total billed charges","","",""
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1882.06","852.64","5314.51","54","percent of total billed charges","","",""
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","2060.6","1180.75","3910.36","73","percent of total billed charges","","",""
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","1846.23","1237.05","6931.19","52","percent of total billed charges","","",""
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","73848.24","73848.24","73848.24","1 through 10","percent of total billed charges","","",""
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1804.98","1234.92","3922.55","52","percent of total billed charges","","",""
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1861.05","1166.68","4250.57","201","percent of total billed charges","","",""
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2184.79","1308.96","10064.18","28","percent of total billed charges","","",""
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","2070.69","616.68","12240.82","1 through 10","percent of total billed charges","","",""
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1270.14","1270.14","1601.78","1 through 10","percent of total billed charges","","",""
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neonate With Other Significant Problems","794","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1912.67","1173.17","3806.71","59","percent of total billed charges","","",""
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","1460.22","1148","2481.14","31","percent of total billed charges","","",""
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","5631.23","5631.23","5631.23","1 through 10","percent of total billed charges","","",""
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1283.17","786.54","2302.28","31","percent of total billed charges","","",""
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","1430.12","818.79","2351.53","59","percent of total billed charges","","",""
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","1447.62","1108.93","2284.41","55","percent of total billed charges","","",""
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","2401.14","2401.14","2401.14","1 through 10","percent of total billed charges","","",""
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1502.49","1050.33","2334.75","46","percent of total billed charges","","",""
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1316.47","1060.31","2468.61","151","percent of total billed charges","","",""
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1616.33","782.01","3828.88","21","percent of total billed charges","","",""
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1250.93","1107.59","1968.92","11","percent of total billed charges","","",""
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","1380.73","1295.22","2118.25","1 through 10","percent of total billed charges","","",""
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Normal Newborn","795","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","1535.25","1100.71","2422.15","33","percent of total billed charges","","",""
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","19389.42","19389.42","19389.42","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Mcc","796","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8452.67","8452.67","8452.67","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16682.89","16682.89","16682.89","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","12520.51","12520.51","12520.51","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13051.88","13051.88","20169.11","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C With Cc","797","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","15768.21","15768.21","15768.21","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","19243.46","15204.93","23900.54","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","798","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","15009.37","15009.37","15009.37","1 through 10","percent of total billed charges","","",""
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25872.99","25872.99","25872.99","1 through 10","percent of total billed charges","","",""
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","30332.38","30332.38","30332.38","1 through 10","percent of total billed charges","","",""
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Mcc","799","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","64578.72","64578.72","64578.72","1 through 10","percent of total billed charges","","",""
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures With Cc","800","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Splenic Procedures Without Cc/Mcc","801","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","29676.75","29676.75","29676.75","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","802","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23160.19","23160.19","23160.19","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","15602.27","15602.27","15602.27","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","18557.44","18557.44","18557.44","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","28651.68","28651.68","28651.68","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","803","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","50304.35","50304.35","50304.35","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","804","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","18383.4","8210.62","31151.12","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","20813.66","13579.84","24793.56","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","19774.66","15752.64","26628.31","16","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","15423.07","13708.56","30415.6","14","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","16199.06","16160.83","21484.46","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","16329.7","11382.42","26017.99","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15262.31","7779.03","22511.89","31","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","14832.92","14832.92","14832.92","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","19552.74","19552.74","20718.85","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","16076.51","16076.51","16076.51","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","25762.91","25762.91","25762.91","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Mcc","805","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12275.41","10983.25","15345.39","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","16536.73","13555.38","20421.52","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15207.76","10091.49","24746.25","28","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16025.38","10012.89","25773.58","60","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","16710.78","11928.65","29360.38","32","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15639.51","10285.25","22441.27","32","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","15438.58","15438.58","15438.58","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","15471.17","9176.81","21026.64","26","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13835.34","10174.77","19558.33","99","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","15719.39","13882.09","36371.59","19","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","15669.59","15423.11","21340.84","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","14466.75","13541.4","22879.57","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C With Cc","806","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","15495.63","9792.06","19188.31","22","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","14805.83","9843.07","21524","37","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","16316.07","9559.49","22477.12","40","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","15738.01","10249.3","22480.59","93","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","13912.77","8248.49","21166.07","72","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15525.75","9309.94","21414.07","55","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","8643.91","8643.91","12548.28","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","15599.56","15599.56","15599.56","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13588.42","9267.94","19446.9","38","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12510.07","8711.73","19560.21","150","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12045.11","4999.34","18761.64","21","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","11872.11","7488.36","14318.92","11","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","14648.22","10949.64","27647.18","1 through 10","percent of total billed charges","","",""
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","807","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12128.59","9486.12","17253.65","32","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","18273.87","18273.87","18273.87","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","9826.49","9826.49","89521.87","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","31507.06","21664.32","64958.91","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","51741.84","17794.32","126613.45","11","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","121733.49","121733.49","121733.49","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","29535.8","15925.93","431761.97","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15858.88","15858.88","15858.88","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","54816.11","54816.11","54816.11","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","47238.89","47238.89","55927.93","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","24591.65","24591.65","24591.65","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13109.08","13109.08","13109.08","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","25841.32","7890.57","58852.73","11","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","13711.59","13711.59","13711.59","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","89760.57","89760.57","89760.57","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","808","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","26873.22","15885","168316.69","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12946.13","7576.2","26653.26","13","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","41782.75","25044.05","52802.39","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","22613.19","11919.3","39166.28","24","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","22085.8","22085.8","22085.8","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","10323.87","6505.78","21415.68","21","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","19112.32","7943.53","30845.82","24","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","12155.04","12155.04","25722.98","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","16881.67","16881.67","16881.67","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","28881.6","28881.6","28881.6","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","4460.57","4460.57","4460.57","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","25113.79","14157.6","64152.04","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","5062.35","5062.35","5062.35","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","17706.24","17706.24","19130","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13307.78","7417.59","33103.32","25","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","23287.06","12669.58","37224.91","14","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","11279.79","11279.79","11279.79","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","109446.9","109446.9","109446.9","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","24392.01","14189.54","38394.75","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","809","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6910.53","3345.63","10293.76","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","48982.76","48982.76","48982.76","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","37541.28","37541.28","37541.28","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","36561.41","36561.41","36561.41","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","8073.6","8073.6","8073.6","1 through 10","percent of total billed charges","","",""
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","810","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","348053.98","348053.98","348053.98","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","13707.08","12697.59","24297.98","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","7111.38","6092.73","144631.48","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","33313.93","33313.93","33313.93","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","25091.8","18726.03","28675.65","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16811.6","11772.76","36087.14","11","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","15607.89","15607.89","16287.92","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","298525.87","298525.87","298525.87","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","20947.78","20947.78","20947.78","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","22276.83","22276.83","22276.83","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","59168.17","59168.17","59168.17","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","26571.48","6898.32","71764.35","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","19690.06","8426.88","33029.83","24","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","66278.55","66278.55","66278.55","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","39188.82","39188.82","44578.8","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders With Mcc","811","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","20193.84","7493.99","82342.37","19","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","12892.51","6531.24","40215.33","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","23225.09","8274.54","36566.49","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","12642.41","5739.53","26017.04","24","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11756.95","6572.71","28144.43","33","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","14350.25","12578.65","31360.45","13","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","14377.7","8843.22","29895.28","11","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","12930.02","11509.26","21009.43","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","19850.81","8393.62","620179.79","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","4081.18","4081.18","4081.18","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11147.31","4043.5","23820.48","28","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13366.93","6783.77","34943.43","99","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","15386.26","7477.59","26592.85","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","15211.21","7932.84","45847.5","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","13223.66","13223.66","13627.2","1 through 10","percent of total billed charges","","",""
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Red Blood Cell Disorders Without Mcc","812","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","16397.22","7943","44049.51","53","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","41626.03","17534.69","93363.86","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","21171.36","21171.36","21171.36","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","35106.77","29884.98","85339.56","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","19230.07","13286.89","54414.33","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","6542.96","6542.96","6542.96","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","12945.76","7106.15","101295.09","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","25419.24","25419.24","25419.24","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","28147.64","28147.64","28147.64","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","44243.18","44243.18","44243.18","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","41526.98","41526.98","41526.98","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","36217.44","25284.13","122946.19","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","192695.17","192695.17","192695.17","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5306.84","5306.84","5306.84","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","40171.67","40171.67","40171.67","1 through 10","percent of total billed charges","","",""
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Coagulation Disorders","813","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","24977.01","24977.01","24977.01","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","66183.3","33812.25","185613.15","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","35110.4","35110.4","35110.4","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13296.54","11509.21","82658.85","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","63412.86","63412.86","63412.86","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","63387.67","63387.67","63387.67","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","512464.81","512464.81","512464.81","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","18943.7","18943.7","18943.7","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","506983.67","506983.67","506983.67","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","19497.96","19497.96","19497.96","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Mcc","814","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","34118.04","34118.04","795548.94","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","19301.67","15473.77","19564.4","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","15698.93","6620.78","29915.24","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","23193.87","12543.68","36003.72","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","28114.05","28114.05","28114.05","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","7636.21","7636.21","7636.21","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","60710.6","60710.6","60710.6","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","14154.19","14154.19","14154.19","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","6243.2","6243.2","6243.2","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","38453.34","38453.34","38453.34","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders With Cc","815","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","2580.49","2580.49","2580.49","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","8754.02","8754.02","8754.02","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","8046.43","8046.43","15404.06","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","12399.76","12399.76","12399.76","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","9926.7","9926.7","9926.7","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","13355.18","13355.18","13355.18","1 through 10","percent of total billed charges","","",""
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","816","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","5198.33","5198.33","5198.33","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","51436.9","51436.9","51436.9","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","22569.89","22569.89","22569.89","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","156508.05","156508.05","156508.05","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13674.07","13674.07","14929.8","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","11125.87","11125.87","11125.87","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","39061.4","39061.4","39061.4","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Mcc","817","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","41943.17","41943.17","41943.17","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16528.53","10744.81","55655.79","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","49187.68","49187.68","49187.68","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","30763.73","30763.73","30763.73","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","47794.56","47794.56","47794.56","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13290.22","10562.79","40491.79","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","21384.9","21384.9","21384.9","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","33764.19","33764.19","33764.19","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures With Cc","818","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","81354.25","81354.25","81354.25","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","23798.25","23557.29","38479.87","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","18319.39","18319.39","18319.39","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","14802.78","14802.78","14802.78","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","19406.32","19406.32","19406.32","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","819","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","70382.28","70382.28","70382.28","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","111824.06","111824.06","111824.06","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","36207.07","36207.07","36207.07","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","167734.66","167734.66","167734.66","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","820","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","88942.58","88942.58","88942.58","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","60746.11","60746.11","90625.34","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","50643.93","50643.93","50643.93","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","15552.81","15552.81","15552.81","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1975.15","1975.15","1975.15","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","46117.66","46117.66","46117.66","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures With Cc","821","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","20828.25","20828.25","20828.25","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","33603.69","33603.69","33603.69","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","33417.64","33417.64","33417.64","1 through 10","percent of total billed charges","","",""
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","822","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","216955.06","216955.06","216955.06","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","194449.13","194449.13","194449.13","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","75952.63","75952.63","75952.63","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","823","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","28870.82","28870.82","128763","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","90731.26","90731.26","107580.54","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","23385.93","23385.93","23385.93","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","119620.94","119620.94","119620.94","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","139431.06","139431.06","139431.06","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","824","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","32700.4","32700.4","32700.4","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","26773.89","26773.89","26773.89","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","825","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","78823.41","78823.41","78823.41","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","103295.54","44181.32","429789.75","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","95191.64","95191.64","95191.64","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","30138.29","30138.29","30138.29","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","826","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","41982.97","41982.97","41982.97","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","38555.73","38555.73","38555.73","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","46306.41","40701.61","55987.67","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","48970.2","48970.2","48970.2","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","64054.92","64054.92","64054.92","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","43228.81","43228.81","43228.81","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","34473.55","34473.55","34473.55","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","32710.9","32710.9","32710.9","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","50449.61","50449.61","50449.61","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","827","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","25627.35","25627.35","25627.35","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","36315.18","20248.67","81450.43","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","24437.11","24437.11","24437.11","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","35284.61","35284.61","35284.61","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","32619.28","30013.87","45114.84","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","828","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","15299.12","15299.12","15299.12","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","75982.05","75982.05","75982.05","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","37453.9","37453.9","170233.46","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25425.42","11617.32","59583.64","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","48097.76","48097.76","48097.76","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","28309.81","28309.81","671483.54","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","106265.78","106265.78","106265.78","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","829","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","17132.51","17132.51","17132.51","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","48798.03","48798.03","69040.41","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","26175.05","26175.05","26175.05","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","37249.36","37249.36","37249.36","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","18893.43","18893.43","18893.43","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","23581.61","23581.61","23581.61","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","14921.04","14921.04","14921.04","1 through 10","percent of total billed charges","","",""
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","830","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14373.17","9272.01","44336.14","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","33280.94","33280.94","33280.94","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12227.93","6542.62","28215.01","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","7752.64","7752.64","7752.64","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","831","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","17541.17","17541.17","17541.17","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","13863.39","8782.33","18936.19","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","8001.54","6571.9","28935.03","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","12479.93","6872.34","26808.33","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","10294.69","10294.69","17493.97","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","13035.65","13035.65","13035.65","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","8708.63","8708.63","14227.8","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10364.82","5885.12","24489.01","23","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","4219.24","4219.24","4219.24","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","11592.01","11592.01","11592.01","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","7987.09","7987.09","22495.62","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures With Cc","832","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6443.3","984.74","12918.35","15","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","6868.7","1789.77","60352.4","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","7758.84","7758.84","9581.07","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","15133.07","15133.07","15133.07","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","5085.07","5085.07","5085.07","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","13525.51","13525.51","13525.51","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","733.7","733.7","733.7","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6857.63","3975.22","10334.11","14","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","6558.28","4246.67","10617.87","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","1938.17","1938.17","1938.17","1 through 10","percent of total billed charges","","",""
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","833","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","6656.84","6656.84","6656.84","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","21084.85","13501.17","374341.68","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","72067.3","45421.24","245506.13","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","124673.46","124673.46","124673.46","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","283006.43","280390.44","314412.75","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","71658.23","71658.23","71658.23","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","72110.06","59292.69","119769.52","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","159545.34","159545.34","159545.34","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","145192.77","145192.77","159307.44","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","245952.42","185904.21","259835.37","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","172412.29","172412.29","200719.15","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","306646.12","306646.12","306646.12","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","115949.98","115949.98","171186.53","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","95639.08","95639.08","95639.08","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","130496.78","130496.78","130496.78","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Mcc","834","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","175050.54","175050.54","175050.54","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","64279.5","64279.5","64279.5","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","194032.25","194032.25","408256.94","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","19429.05","19429.05","19429.05","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","37341.09","37341.09","37341.09","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","92278.45","92278.45","140488.1","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","101484.4","101484.4","104471.37","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","176668.67","176668.67","176668.67","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","41624.51","41624.51","41624.51","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","127271.83","127271.83","127271.83","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Cc","835","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","148676.09","148676.09","148676.09","1 through 10","percent of total billed charges","","",""
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","18520.66","18520.66","18520.66","1 through 10","percent of total billed charges","","",""
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","5486.07","5486.07","5486.07","1 through 10","percent of total billed charges","","",""
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16128.12","16128.12","16128.12","1 through 10","percent of total billed charges","","",""
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia Without Cc/Mcc","836","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","36490.69","36490.69","36490.69","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","120814.43","120814.43","120814.43","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","29258.67","19587.63","82593.05","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","112837.51","25673.48","409141.42","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","113220.31","17283.12","289465.94","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","16080.67","13042.4","200293.71","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","31679.97","31679.97","31679.97","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","20715.07","20715.07","20715.07","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","115231.18","115231.18","115231.18","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","29203.74","7903.21","187418.28","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","22737.41","22737.41","22737.41","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","198951.98","198951.98","198951.98","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","837","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","63697.45","63697.45","63697.45","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","121156.86","121156.86","121156.86","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","80206.87","80206.87","80206.87","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","77371.45","77371.45","77371.45","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","18653.35","17714.95","36976.29","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","17695.75","15944.06","40806.03","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","26231.46","26231.46","26231.46","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","15601.27","10254.46","358816.35","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","29826.39","29826.39","181254.71","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","18179.51","18179.51","59407.98","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","47291.68","47291.68","47291.68","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","20818.17","13653.85","84701.89","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","11420.78","11420.78","11420.78","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","838","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","31602.63","31602.63","31602.63","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","17501.17","17501.17","17501.17","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","21506.42","19835.05","21652.72","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","33470.18","33470.18","42312.57","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","37185.97","18231.58","77548.29","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","12547.87","10227.53","70647.72","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","15367.7","9274.57","30984.94","13","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","26472.89","10011.15","68749.39","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","12503.23","10464.59","33033.65","1 through 10","percent of total billed charges","","",""
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","839","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","16180.5","14019.93","24131.92","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","124149.34","124149.34","124149.34","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","55415.19","55415.19","137016.14","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","45015.07","45015.07","45015.07","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","83800.3","80086.4","170053.52","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","30496.86","28990.32","254329.29","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","11295.59","11295.59","11295.59","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","24872.24","24872.24","153500.72","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","59233.59","59233.59","59233.59","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","14398.22","14398.22","14398.22","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","516246.88","516246.88","516246.88","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","53312.59","53312.59","53312.59","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","28219.28","26250.96","226434.29","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","123539.79","123539.79","123539.79","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","33181.1","33181.1","33181.1","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Mcc","840","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","16472.03","11729.83","47502.72","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","60538.95","60538.95","60538.95","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","28231.15","14344.56","49401.74","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","36949.21","36949.21","36949.21","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","12799.27","12799.27","12799.27","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","14755.33","14755.33","14755.33","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","16447.62","16447.62","16447.62","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","15688.74","15688.74","15688.74","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia With Cc","841","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","24538.97","24538.97","24538.97","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","18436.85","18436.85","18436.85","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","22863.56","22863.56","22863.56","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","7413.91","7413.91","7413.91","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","6453.55","6453.55","6453.55","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","16997.32","16997.32","16997.32","1 through 10","percent of total billed charges","","",""
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","842","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","56146.99","56146.99","56146.99","1 through 10","percent of total billed charges","","",""
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","25552.78","25552.78","25552.78","1 through 10","percent of total billed charges","","",""
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","10733.78","10733.78","10733.78","1 through 10","percent of total billed charges","","",""
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","11121.75","11121.75","11121.75","1 through 10","percent of total billed charges","","",""
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","17537.47","17537.47","17537.47","1 through 10","percent of total billed charges","","",""
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","1207.89","1207.89","1207.89","1 through 10","percent of total billed charges","","",""
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","843","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","7960.73","7960.73","7960.73","1 through 10","percent of total billed charges","","",""
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","44165.17","44165.17","44165.17","1 through 10","percent of total billed charges","","",""
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","22806.75","22806.75","22806.75","1 through 10","percent of total billed charges","","",""
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","844","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","845","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","16183.41","12624.27","145229.54","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15616.23","11913.46","26510.1","11","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","21260.02","13235.26","22990.12","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","38257.25","20810.21","159484.2","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","19383.36","19383.36","27237.87","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","16398.86","16398.86","16398.86","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","22736.5","22736.5","22736.5","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16601.46","7957.12","71756.21","11","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","13097.7","13097.7","13097.7","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","24682.21","15071.1","56678.57","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","846","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9717.78","9717.78","9717.78","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","12565.74","12565.74","13429.21","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12919.04","5378.66","21876.59","33","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13800.52","8877.09","22256.09","39","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13461.93","6770.75","23311.42","73","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","12781.46","9054.5","25796.66","35","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","179543.72","179543.72","179543.72","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","8117.34","7585.22","33161.46","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","11795.43","11795.43","11795.43","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","10153.78","8937.65","21864.64","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","192768.57","192768.57","192768.57","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","10424.3","4298.05","49100.19","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14032","8093.29","19591.37","30","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","11922.36","11003.67","19690.99","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12151.38","6964.2","22500.74","21","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","10269.15","4089.56","18261.3","15","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","847","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9200.07","4198.69","13071.24","43","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12570.06","12570.06","12570.06","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","6385.14","6385.14","6385.14","1 through 10","percent of total billed charges","","",""
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","848","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","53890.1","53890.1","53890.1","1 through 10","percent of total billed charges","","",""
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Radiotherapy","849","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","166361.94","166361.94","189974.13","1 through 10","percent of total billed charges","","",""
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Leukemia With Other Procedures","850","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","69903.42","67708.32","145502.18","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","68187.7","68187.7","786025.98","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","172096.66","172096.66","172096.66","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","108189.98","51139.11","189189.9","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","117833.33","35966.05","348372.23","19","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","80617.86","80617.86","80617.86","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","78485.99","57447.35","84094.41","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","47189","47189","47189","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","40936.46","40936.46","40936.46","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","70245.73","70245.73","208815.97","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","138141.99","138141.99","138141.99","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","43463.99","40315.11","152844.99","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","85485.85","39519.83","407231.5","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","77476.15","37127.23","122098.44","21","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","55259.85","55259.85","63089.94","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","58644.56","24257.75","472675.4","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","230445.76","230445.76","230445.76","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","38319.45","38319.45","38319.45","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","853","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","72819.08","19091.96","162465.84","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","42373.88","42373.88","42373.88","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","57239.12","57239.12","57239.12","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11404.97","11404.97","11404.97","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","40780.31","40780.31","79924.22","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","10264.61","10264.61","10264.61","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","1795.54","1795.54","1795.54","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","2909.7","2909.7","2909.7","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","57110.55","57110.55","57110.55","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","24696.71","24696.71","24696.71","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","29395.99","29395.99","29395.99","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures With Cc","854","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","16790.69","16790.69","16790.69","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","22395.11","22395.11","22395.11","1 through 10","percent of total billed charges","","",""
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","855","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","16890.5","16890.5","28319.93","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","35134.7","35134.7","35134.7","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","155821.05","155821.05","155821.05","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","31560.32","31560.32","37040.72","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","33076.95","33076.95","68024.61","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","74217.98","74217.98","74217.98","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","72630.71","72630.71","72630.71","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","70963.64","70963.64","72705.28","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","8330.99","8330.99","8330.99","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","58875.93","58875.93","58875.93","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","45224.46","45224.46","45224.46","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","856","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","142500.22","142500.22","142500.22","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","107870.06","107870.06","107870.06","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","30704","30704","30704","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","33125.77","33125.77","33125.77","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","141475.79","141475.79","141475.79","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","34115.31","34115.31","34115.31","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","35779.44","35779.44","35779.44","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","172437.7","172437.7","172437.7","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","56960.94","56960.94","56960.94","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","39666.9","39666.9","57517.32","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","24303.89","24303.89","24303.89","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","27296.37","27296.37","27296.37","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","67313.59","67313.59","67313.59","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","46214.02","46214.02","46214.02","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","857","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11329.93","11329.93","11329.93","1 through 10","percent of total billed charges","","",""
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","858","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","29339.55","29339.55","49770.52","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","46001.88","46001.88","63297.79","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11601.04","11601.04","14375.52","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","23261.31","13223.92","146164.39","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","39806.38","20492.83","74415.8","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","22554.75","22554.75","62622.14","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","8551.92","8551.92","8551.92","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","14044.76","14044.76","14044.76","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","25627.33","25627.33","63565.14","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","73307.92","24612.04","75643.28","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","16996.05","16996.05","33478.05","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","9048.41","9048.41","9048.41","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","815747.84","815747.84","815747.84","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections With Mcc","862","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","48027.69","48027.69","48027.69","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","10838.12","10838.12","10838.12","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","6396.95","6396.95","6396.95","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11490.16","8572.22","39247.46","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","12657.94","9456.73","24216.09","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","9974.37","9974.37","16224.32","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","8750.93","8750.93","8750.93","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","14208.98","14208.98","14208.98","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","7669.2","7669.2","20232.1","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","8380.45","8380.45","8380.45","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","17779.71","5563.48","32931.42","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","6522.68","6522.68","12718.87","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7358.67","7358.67","7358.67","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","12453.49","12453.49","48081.49","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","7984.64","7984.64","7984.64","1 through 10","percent of total billed charges","","",""
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Postoperative And Post-Traumatic Infections Without Mcc","863","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","7561.28","7561.28","8702.24","1 through 10","percent of total billed charges","","",""
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12369.12","12369.12","13540.31","1 through 10","percent of total billed charges","","",""
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","13459.24","13459.24","13459.24","1 through 10","percent of total billed charges","","",""
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","9839.09","6095.83","20723","1 through 10","percent of total billed charges","","",""
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","17731.68","17731.68","21658.31","1 through 10","percent of total billed charges","","",""
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","10867.12","10867.12","10867.12","1 through 10","percent of total billed charges","","",""
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12615.81","12615.81","12615.81","1 through 10","percent of total billed charges","","",""
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8864.43","2629.88","15157.72","1 through 10","percent of total billed charges","","",""
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","33195.21","33195.21","33195.21","1 through 10","percent of total billed charges","","",""
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","25494.62","25494.62","25494.62","1 through 10","percent of total billed charges","","",""
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Fever And Inflammatory Conditions","864","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10065.71","10065.71","10065.71","1 through 10","percent of total billed charges","","",""
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","18418.58","18418.58","18418.58","1 through 10","percent of total billed charges","","",""
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11705.79","11705.79","25606","1 through 10","percent of total billed charges","","",""
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","15986.77","15986.77","16740.52","1 through 10","percent of total billed charges","","",""
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","21933.99","21933.99","21933.99","1 through 10","percent of total billed charges","","",""
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7792.77","7792.77","7792.77","1 through 10","percent of total billed charges","","",""
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","15554.06","15554.06","15554.06","1 through 10","percent of total billed charges","","",""
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness With Mcc","865","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8844.77","8844.77","8844.77","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","13895.03","13895.03","13895.03","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","12024.93","12024.93","12024.93","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","8625.42","8625.42","14659.61","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","19139.75","5886.96","28312.4","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","10557.12","10557.12","10557.12","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","20208.82","13220.61","20877.54","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","8528.7","8528.7","26024.11","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","24856.36","24856.36","24856.36","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","11313.95","11313.95","11313.95","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","3292.73","3292.73","3292.73","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","10210.31","10210.31","10210.31","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11265.94","6283.75","39396.28","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","8446.8","8446.8","13200.02","1 through 10","percent of total billed charges","","",""
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Viral Illness Without Mcc","866","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","7740.04","7740.04","32737.8","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","203500.4","203500.4","203500.4","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","24870.7","21837.72","217592.81","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","56121.8","56121.8","56121.8","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","60509.45","60509.45","60509.45","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","79049.06","79049.06","79049.06","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","257521.58","257521.58","257521.58","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","128201.59","128201.59","128201.59","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Mcc","867","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","256.34","256.34","256.34","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25938.38","25938.38","38485.81","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","49599.04","49599.04","49599.04","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","9822.64","9822.64","9822.64","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","38234.71","38234.71","38234.71","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","241414.48","241414.48","241414.48","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","40192.65","40192.65","40192.65","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses With Cc","868","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","246555.52","246555.52","246555.52","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","8019.36","8019.36","8019.36","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","697.9","697.9","697.9","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11671.1","11671.1","11671.1","1 through 10","percent of total billed charges","","",""
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","869","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","155138.91","155138.91","155138.91","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","104514.71","103610.92","114729.26","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","132608.24","105117.07","163598.79","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","230215.14","230215.14","230215.14","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","121032.63","121032.63","250772.28","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","103239.23","103239.23","112924.46","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","141687.68","141687.68","141687.68","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","631083.67","631083.67","631083.67","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","126822","126822","126822","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis With Mv >96 Hours","870","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","209590.9","209590.9","209590.9","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","35208.37","17844.79","89906.53","24","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","41653.34","20412.31","96021.2","22","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","137686.28","137686.28","137686.28","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","26007.58","15219.35","63858.79","33","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","32319.65","10580.2","77722.27","37","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1859.86","1859.86","22814.05","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","47932.62","14049.07","61453.95","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","36299","12443.64","64771.75","26","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","30174.33","22239.57","45321.31","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","22094.73","12225.4","52788.49","12","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","51744.79","12355.79","66941.28","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","44886.57","21510.09","50475.06","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","33455.09","24954.26","44324.47","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","26028.32","10985.75","51628.36","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","11933.94","11933.94","45369.17","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","29656.49","10528.22","72270.33","27","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","29233.39","13338.29","78677.7","46","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","28131.22","13416.08","68443.3","21","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","26488.65","10811.3","71342.25","20","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","53955.29","8861.82","107609.86","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","74296.2","74296.2","76450.68","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","871","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","32419.79","11062.52","67606.73","26","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","8989","8989","83568.37","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","25917.5","10309.68","66830.94","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","17551.33","13768.8","40901.45","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14442.08","7496.49","26095.59","15","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","58387.73","58387.73","58387.73","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","11093.26","11093.26","11093.26","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","13253.32","8451.52","34022.97","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","15877.88","15877.88","15877.88","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","11783.42","8540.82","30879.11","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","14007.42","14007.42","14007.42","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","12087.19","12087.19","24279.1","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","11327","11327","11327","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","18870.1","12160.43","23388.69","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14985.05","9195.33","37978.93","18","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","10804","7037.38","25042.56","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","20917.3","20917.3","20917.3","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","10403.73","1540.02","28385.56","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","29996.29","29996.29","29996.29","1 through 10","percent of total billed charges","","",""
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","872","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9942.63","3950.04","20781.61","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","42103.8","34533.79","92788.81","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","38414.97","38414.97","38414.97","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","41367.32","36302.34","61637.22","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","73000.79","32176.81","149000.34","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","33680.51","33680.51","33680.51","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","32048.12","32048.12","32048.12","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","50068.12","50068.12","50068.12","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","31046.76","31046.76","31046.76","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","37285.95","33118.43","67564.32","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Principal Diagnosis Of Mental Illness","876","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","23384.72","23384.72","23384.72","1 through 10","percent of total billed charges","","",""
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15443.26","13132.78","23114.61","1 through 10","percent of total billed charges","","",""
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","30002.78","30002.78","30002.78","1 through 10","percent of total billed charges","","",""
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","17767.81","17767.81","17767.81","1 through 10","percent of total billed charges","","",""
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","19941.79","19941.79","19941.79","1 through 10","percent of total billed charges","","",""
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","12573.01","12573.01","12573.01","1 through 10","percent of total billed charges","","",""
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","10916.58","7817.34","22194.92","1 through 10","percent of total billed charges","","",""
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10139.38","5490.68","18627.93","1 through 10","percent of total billed charges","","",""
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","1366.93","1366.93","1366.93","1 through 10","percent of total billed charges","","",""
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","6117.63","6117.63","6117.63","1 through 10","percent of total billed charges","","",""
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Acute Adjustment Reaction And Psychosocial Dysfunction","880","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","44475.42","28244.24","49638.18","1 through 10","percent of total billed charges","","",""
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","116392.83","116392.83","116392.83","1 through 10","percent of total billed charges","","",""
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","18358.67","18358.67","18358.67","1 through 10","percent of total billed charges","","",""
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","25976.71","15732.69","41331.85","1 through 10","percent of total billed charges","","",""
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","15144.69","15144.69","15144.69","1 through 10","percent of total billed charges","","",""
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","75722.19","75722.19","75722.19","1 through 10","percent of total billed charges","","",""
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Depressive Neuroses","881","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","20838.84","20838.84","38275.32","1 through 10","percent of total billed charges","","",""
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","25048.59","25048.59","37939.22","1 through 10","percent of total billed charges","","",""
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Neuroses Except Depressive","882","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","56165.22","56165.22","56165.22","1 through 10","percent of total billed charges","","",""
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","144914.21","144914.21","164228.08","1 through 10","percent of total billed charges","","",""
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","19949.96","17271.64","147144.06","1 through 10","percent of total billed charges","","",""
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","42677.9","23435.28","213195.07","1 through 10","percent of total billed charges","","",""
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","20701.44","20701.44","20701.44","1 through 10","percent of total billed charges","","",""
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","24642.95","24642.95","24642.95","1 through 10","percent of total billed charges","","",""
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","6397.38","6397.38","6397.38","1 through 10","percent of total billed charges","","",""
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","70717.29","47951.45","85333.76","1 through 10","percent of total billed charges","","",""
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Disorders Of Personality And Impulse Control","883","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","18983.01","18983.01","18983.01","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","34275.87","34275.87","34275.87","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15914.54","5534.3","21909.13","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","29469.05","20378.58","50366.58","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","15302.47","15302.47","99070.16","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","31128.65","31128.65","31128.65","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","8899.9","8899.9","8899.9","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","47490.45","47490.45","47490.45","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","11586.48","11586.48","36896.58","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","5044.76","5044.76","5044.76","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","1765.61","1765.61","1956.45","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","4976.47","4976.47","4976.47","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","3339.58","3339.58","3339.58","1 through 10","percent of total billed charges","","",""
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Organic Disturbances And Intellectual Disability","884","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","15299.56","15299.56","32426.46","1 through 10","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","40022.49","17625.26","175574.93","29","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","43841.91","14603.4","107986.93","32","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","1878.45","1878.45","1878.45","1 through 10","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","109969.5","109969.5","109969.5","1 through 10","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","25530.31","9760.09","112433.61","89","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","41939.99","13664.54","101824.9","49","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","32301.36","7035.69","131066.7","19","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","18005.72","18005.72","59974.14","1 through 10","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","38549.6","17482.58","51155.32","1 through 10","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","31315.33","31315.33","31315.33","1 through 10","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","27969.57","27969.57","27969.57","1 through 10","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","42587.12","5982.65","266714.86","1 through 10","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","26076.81","5954.65","139249.87","1 through 10","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","44916.1","38010.58","112388.7","1 through 10","percent of total billed charges","","",""
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Psychoses","885","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","32203.27","32203.27","32203.27","1 through 10","percent of total billed charges","","",""
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","35552.88","35552.88","35552.88","1 through 10","percent of total billed charges","","",""
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","24074.95","17639.8","25376","1 through 10","percent of total billed charges","","",""
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","2318.51","2318.51","45922.48","1 through 10","percent of total billed charges","","",""
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Behavioral And Developmental Disorders","886","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","109050.58","109050.58","109050.58","1 through 10","percent of total billed charges","","",""
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","156448.15","156448.15","156448.15","1 through 10","percent of total billed charges","","",""
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","38095.3","38095.3","38095.3","1 through 10","percent of total billed charges","","",""
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","112321.13","43483.28","174003.02","1 through 10","percent of total billed charges","","",""
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","4244.57","4244.57","4244.57","1 through 10","percent of total billed charges","","",""
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","16143.97","16143.97","16143.97","1 through 10","percent of total billed charges","","",""
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","47323.09","47323.09","47323.09","1 through 10","percent of total billed charges","","",""
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","44787.05","44787.05","44787.05","1 through 10","percent of total billed charges","","",""
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Mental Disorder Diagnoses","887","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence, Left Ama","894","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","895","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","22194.18","16749.69","28428.24","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","1883.26","1883.26","1883.26","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","53593.85","53593.85","53593.85","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","29686.77","29686.77","29686.77","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","6742.44","6742.44","6742.44","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","17430.78","17430.78","17430.78","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13333.34","9939.97","21804.52","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12436.54","9638.87","18713.28","12","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","18736.87","18736.87","18736.87","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","21045.65","5186.13","23125.67","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","896","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","20400.39","17257.86","29393.25","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","24660.81","24660.81","24660.81","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","8605.18","8605.18","13235.47","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","2737.99","2737.99","2737.99","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","7971.61","7971.61","11176.47","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","16491.52","16491.52","16491.52","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","10727.43","7857.68","14092.45","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","750","750","750","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","12873.54","12873.54","12873.54","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","28668.66","28668.66","28668.66","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11962.91","8097.09","18151.86","18","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","12555.75","9207.36","25085.83","22","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","8835.99","8835.99","8835.99","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","15629.08","15629.08","15629.08","1 through 10","percent of total billed charges","","",""
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","897","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12048.42","1151.6","14788.48","1 through 10","percent of total billed charges","","",""
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","101176.7","101176.7","101176.7","1 through 10","percent of total billed charges","","",""
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","80351.78","80351.78","80351.78","1 through 10","percent of total billed charges","","",""
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Mcc","901","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","48900.26","48900.26","48900.26","1 through 10","percent of total billed charges","","",""
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","75313.92","75313.92","75313.92","1 through 10","percent of total billed charges","","",""
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","30242.02","30242.02","30242.02","1 through 10","percent of total billed charges","","",""
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","19633.04","19633.04","19633.04","1 through 10","percent of total billed charges","","",""
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","109384.91","109384.91","109384.91","1 through 10","percent of total billed charges","","",""
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","301204.55","301204.55","301204.55","1 through 10","percent of total billed charges","","",""
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries With Cc","902","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","32284.87","32284.87","32284.87","1 through 10","percent of total billed charges","","",""
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Wound Debridements For Injuries Without Cc/Mcc","903","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","60336.31","60336.31","60336.31","1 through 10","percent of total billed charges","","",""
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","35061.42","35061.42","35061.42","1 through 10","percent of total billed charges","","",""
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","54027.51","54027.51","54027.51","1 through 10","percent of total billed charges","","",""
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","62143.34","62143.34","62143.34","1 through 10","percent of total billed charges","","",""
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","44218.84","44218.84","44218.84","1 through 10","percent of total billed charges","","",""
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","197251.61","197251.61","197251.61","1 through 10","percent of total billed charges","","",""
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries With Cc/Mcc","904","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","173363.23","173363.23","173363.23","1 through 10","percent of total billed charges","","",""
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","11762.27","11762.27","11762.27","1 through 10","percent of total billed charges","","",""
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Skin Grafts For Injuries Without Cc/Mcc","905","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13516.18","13516.18","13516.18","1 through 10","percent of total billed charges","","",""
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hand Procedures For Injuries","906","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","20130.96","20130.96","20130.96","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","174223.53","174223.53","174223.53","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","86778.95","45368.96","103775.26","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","47449.1","44006.03","225357.57","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","62711.37","62711.37","62711.37","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","19421.55","19421.55","19421.55","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","56163.42","56163.42","56163.42","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","104822.33","86427.54","161221.83","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","83498.86","83498.86","83498.86","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","42447.48","42447.48","42447.48","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","57206.14","57206.14","57206.14","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Mcc","907","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","33993.9","33993.9","33993.9","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","14425.23","14425.23","218817.83","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","15631.09","15631.09","15631.09","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","28673.29","28673.29","28673.29","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","52539.13","42558.46","93565.32","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","51090.25","31295.18","99215.98","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","13153.12","13153.12","33374.83","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","63319.75","63319.75","63319.75","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","16719.96","16719.96","16719.96","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","10906.95","10906.95","10906.95","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries With Cc","908","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","15382.97","15382.97","15382.97","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","30038.41","30038.41","30038.41","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","22249.69","22249.69","22249.69","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","28406.39","28406.39","28406.39","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","50393.51","50393.51","50393.51","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","37213.01","37213.01","37213.01","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Injuries Without Cc/Mcc","909","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","53538.85","53538.85","53538.85","1 through 10","percent of total billed charges","","",""
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury With Mcc","913","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","38521.05","38521.05","38521.05","1 through 10","percent of total billed charges","","",""
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","12893.54","12893.54","12893.54","1 through 10","percent of total billed charges","","",""
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Traumatic Injury Without Mcc","914","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","37282.01","37282.01","37282.01","1 through 10","percent of total billed charges","","",""
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions With Mcc","915","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","9291.56","9291.56","9291.56","1 through 10","percent of total billed charges","","",""
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","5406.65","5406.65","5406.65","1 through 10","percent of total billed charges","","",""
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","5393.86","5393.86","9595.99","1 through 10","percent of total billed charges","","",""
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","9782.1","9782.1","9782.1","1 through 10","percent of total billed charges","","",""
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","35320.74","35320.74","35320.74","1 through 10","percent of total billed charges","","",""
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","7249.23","7249.23","7249.23","1 through 10","percent of total billed charges","","",""
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Allergic Reactions Without Mcc","916","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","4420.51","3784.15","5177.07","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","13817.65","13817.65","13817.65","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","40305.7","40305.7","40305.7","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","21102.7","21102.7","21102.7","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","70737.77","70737.77","70737.77","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","38720.59","38720.59","38720.59","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","24186.34","16050.28","52336.54","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","11653.22","11653.22","11653.22","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","32253.22","8027.08","116078.58","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","14089.42","6757.05","41082.93","24","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","3862.8","3862.8","6833.27","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","33008.84","33008.84","33008.84","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","15559.4","15559.4","15559.4","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","19133.85","19133.85","19133.85","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs With Mcc","917","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","29021.34","13535.03","213614.85","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","36947.09","36947.09","36947.09","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","34898.54","34898.54","34898.54","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","7064.32","7064.32","7064.32","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14726.26","14726.26","14726.26","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","25096.63","25096.63","25096.63","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","20933.34","20933.34","20933.34","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","12268.91","4898.04","42989.89","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","2930.32","2930.32","2930.32","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","5412.28","5412.28","5412.28","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","767.11","767.11","767.11","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","9427.56","7710.41","34648.17","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10267.19","5933.52","39272.62","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","20663.92","20663.92","20663.92","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","9047.01","9047.01","9047.01","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","2872.41","2872.41","3409.14","1 through 10","percent of total billed charges","","",""
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Poisoning And Toxic Effects Of Drugs Without Mcc","918","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10082.9","3356.67","17820.86","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","42693.14","42693.14","42693.14","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","71905.2","68193.74","142160.05","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","22281.19","10839.54","126050.47","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","14069.77","5050.71","30200.81","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","17475.85","17475.85","17475.85","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","18897.57","18897.57","18897.57","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","25244.47","24513.78","86438.09","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","15571.07","15571.07","15571.07","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","59281.56","59281.56","59281.56","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","88000.46","88000.46","120032.62","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","160781.72","160781.72","160781.72","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13943.19","13943.19","13943.19","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7099.67","4923.91","55635.97","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","13952.53","13952.53","13952.53","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","22426.7","7101.94","32083.12","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","17931.75","17931.75","17931.75","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","22476.05","22476.05","22476.05","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Mcc","919","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","33646.17","8825.43","38912.75","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","5702.8","5702.8","9181.97","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","11389.92","11389.92","19658.8","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15013.89","10510.78","23437.97","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","16211.02","9929.77","37009.68","12","percent of total billed charges","","",""
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","13597.04","10352.08","48997.76","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","12113.45","12113.45","12113.45","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11493.35","5303.36","12894.92","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","33227.28","13822.26","48801.42","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","20142.01","14995.39","48585.97","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment With Cc","920","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","8772.29","8772.29","8772.29","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","10847.73","10847.73","10847.73","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","21165.53","21165.53","21165.53","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","6602.97","6602.97","6602.97","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","7293.83","7293.83","7293.83","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","16267.55","16267.55","16267.55","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","3345.63","3345.63","3345.63","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","6890.08","6890.08","6890.08","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","8512.95","8512.95","8512.95","1 through 10","percent of total billed charges","","",""
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Complications Of Treatment Without Cc/Mcc","921","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","49098.04","49098.04","49098.04","1 through 10","percent of total billed charges","","",""
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","8408.99","8408.99","23423.17","1 through 10","percent of total billed charges","","",""
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","40924.8","40924.8","40924.8","1 through 10","percent of total billed charges","","",""
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","27398.81","21464.8","75866.95","1 through 10","percent of total billed charges","","",""
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","15249.86","15249.86","15249.86","1 through 10","percent of total billed charges","","",""
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","43138.63","43138.63","43138.63","1 through 10","percent of total billed charges","","",""
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","922","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","21587.92","19877.44","24948.26","1 through 10","percent of total billed charges","","",""
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","1687.6","1687.6","1687.6","1 through 10","percent of total billed charges","","",""
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1222.77","1222.77","1222.77","1 through 10","percent of total billed charges","","",""
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","19978.15","19978.15","19978.15","1 through 10","percent of total billed charges","","",""
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","923","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","7599.56","7599.56","15108.96","1 through 10","percent of total billed charges","","",""
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","927","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","180326.11","180326.11","180326.11","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","19474.24","19474.24","19474.24","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","178271.2","178271.2","178271.2","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","46232.54","46232.54","114326.9","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","43865.11","43865.11","43865.11","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","928","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","94987.93","94987.93","94987.93","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","52936.03","52936.03","52936.03","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","26907.26","26907.26","31905.56","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","42544.07","42544.07","42544.07","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","41253.54","41253.54","41253.54","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","102622.44","102622.44","102622.44","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","929","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","933","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","7865.12","7865.12","7865.12","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","4793.27","4793.27","4793.27","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","4424.77","4424.77","4424.77","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7353.62","4066.8","48331.74","1 through 10","percent of total billed charges","","",""
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Full Thickness Burn Without Skin Graft Or Inhalation Injury","934","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","19086.55","19086.55","19086.55","1 through 10","percent of total billed charges","","",""
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","11642.61","6107.84","14924.11","1 through 10","percent of total billed charges","","",""
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","8975.8","3186.99","23150.18","1 through 10","percent of total billed charges","","",""
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","119838.78","119838.78","119838.78","1 through 10","percent of total billed charges","","",""
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive Burns","935","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","10509.17","2352.38","24828.14","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","27264.37","27264.37","27264.37","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","939","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","19094.67","19094.67","19094.67","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","33930.67","33930.67","33930.67","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","133921.13","133921.13","133921.13","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","940","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","11884.93","11884.93","11884.93","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","20139.37","20139.37","20139.37","1 through 10","percent of total billed charges","","",""
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","941","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","62510.43","62510.43","62510.43","1 through 10","percent of total billed charges","","",""
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","42825.8","42825.8","42825.8","1 through 10","percent of total billed charges","","",""
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","31544.69","31544.69","31544.69","1 through 10","percent of total billed charges","","",""
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","48292.93","48292.93","48292.93","1 through 10","percent of total billed charges","","",""
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","5739.87","5739.87","5739.87","1 through 10","percent of total billed charges","","",""
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","37463.35","37463.35","37463.35","1 through 10","percent of total billed charges","","",""
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","42459.82","42459.82","42459.82","1 through 10","percent of total billed charges","","",""
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","16902.74","16902.74","16902.74","1 through 10","percent of total billed charges","","",""
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","47873.06","47873.06","47873.06","1 through 10","percent of total billed charges","","",""
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","28275.88","28275.88","28275.88","1 through 10","percent of total billed charges","","",""
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation With Cc/Mcc","945","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","26748.99","26748.99","26748.99","1 through 10","percent of total billed charges","","",""
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Rehabilitation Without Cc/Mcc","946","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","23358.31","23358.31","23358.31","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","31442.66","29406.83","36516.3","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","28174.45","23612.49","29507.43","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","23562.41","23562.41","23562.41","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","84666.64","84666.64","84666.64","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","34908.61","34908.61","34908.61","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","1163.12","1163.12","1163.12","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","19149.28","18520.29","39865.24","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","5194.84","5194.84","28762.56","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","18375.31","18375.31","18375.31","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms With Mcc","947","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","13291.56","13291.56","13291.56","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","16695.56","5327.52","19300.87","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","11130.13","11130.13","33053.27","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","17204.61","17204.61","17204.61","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","18768.15","11174.58","67796.93","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","10384.36","10384.36","43921.18","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","18149.81","18149.81","18149.81","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","10814.98","10814.98","28369.88","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","27251.54","27251.54","27251.54","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","11792.42","7513.02","19722.05","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","12714.25","11079.32","30633.82","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","11823.71","11823.71","11823.71","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","16916.92","16916.92","16916.92","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","19065.41","19065.41","19065.41","1 through 10","percent of total billed charges","","",""
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Signs And Symptoms Without Mcc","948","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","35957.61","35957.61","81299.63","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","46352.55","29775.8","69774.2","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","31514.88","17478.24","60779.73","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","38401.66","16303.24","56404.79","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","15086.32","15086.32","31799.26","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","20968.66","20968.66","68998.84","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","30528.98","30528.98","30528.98","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","14910.8","14910.8","14910.8","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","62747.48","62747.48","62747.48","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","52956.2","49453.48","70415.96","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","25804.63","25804.63","25804.63","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","18444.04","18444.04","23844.05","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","21543.02","21543.02","26446.76","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","30343.2","30343.2","30343.2","1 through 10","percent of total billed charges","","",""
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare With Cc/Mcc","949","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","43141.41","43141.41","43141.41","1 through 10","percent of total billed charges","","",""
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","18506.24","18506.24","18506.24","1 through 10","percent of total billed charges","","",""
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","4279.67","4279.67","4279.67","1 through 10","percent of total billed charges","","",""
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","11952.37","11952.37","11952.37","1 through 10","percent of total billed charges","","",""
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","37650.13","37650.13","37650.13","1 through 10","percent of total billed charges","","",""
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","9982.48","9982.48","9982.48","1 through 10","percent of total billed charges","","",""
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Aftercare Without Cc/Mcc","950","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","9532.16","9532.16","9532.16","1 through 10","percent of total billed charges","","",""
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","3706.98","3706.98","3706.98","1 through 10","percent of total billed charges","","",""
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","7319.39","7319.39","7319.39","1 through 10","percent of total billed charges","","",""
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Factors Influencing Health Status","951","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","12871.77","12871.77","12871.77","1 through 10","percent of total billed charges","","",""
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","55467.93","55467.93","55467.93","1 through 10","percent of total billed charges","","",""
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Craniotomy For Multiple Significant Trauma","955","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","125729.94","125729.94","125729.94","1 through 10","percent of total billed charges","","",""
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","34316.64","34316.64","34316.64","1 through 10","percent of total billed charges","","",""
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","270783.26","270783.26","270783.26","1 through 10","percent of total billed charges","","",""
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","36978.8","36978.8","36978.8","1 through 10","percent of total billed charges","","",""
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","216087.75","216087.75","216087.75","1 through 10","percent of total billed charges","","",""
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","134521.68","134521.68","134521.68","1 through 10","percent of total billed charges","","",""
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","57307.6","57307.6","57307.6","1 through 10","percent of total billed charges","","",""
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","956","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","105869.5","105869.5","105869.5","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","463820.02","463820.02","463820.02","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","44032.85","44032.85","44032.85","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","206734.17","206734.17","206734.17","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","80328.07","80328.07","80328.07","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","55316.79","55316.79","55316.79","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Mcc","957","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","31685.78","31685.78","31685.78","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","20115.05","20115.05","20115.05","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","29428.5","28611.68","144954.12","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","57139.78","57139.78","133031.92","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma With Cc","958","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","55245.95","55245.95","125770.79","1 through 10","percent of total billed charges","","",""
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","959","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","8574.45","8574.45","8574.45","1 through 10","percent of total billed charges","","",""
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","16034.7","16034.7","16034.7","1 through 10","percent of total billed charges","","",""
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","110450.05","110450.05","110450.05","1 through 10","percent of total billed charges","","",""
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","19193.62","19193.62","19193.62","1 through 10","percent of total billed charges","","",""
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Mcc","963","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","28544.06","28544.06","28544.06","1 through 10","percent of total billed charges","","",""
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","12661.36","12661.36","12661.36","1 through 10","percent of total billed charges","","",""
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","4430.55","4430.55","4430.55","1 through 10","percent of total billed charges","","",""
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","2109.07","2109.07","2109.07","1 through 10","percent of total billed charges","","",""
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma With Cc","964","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","26994.61","26994.61","26994.61","1 through 10","percent of total billed charges","","",""
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Other Multiple Significant Trauma Without Cc/Mcc","965","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","124832.57","124832.57","124832.57","1 through 10","percent of total billed charges","","",""
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures With Mcc","969","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","30200.33","30200.33","30200.33","1 through 10","percent of total billed charges","","",""
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Extensive O.R. Procedures Without Mcc","970","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","61996.32","61996.32","61996.32","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","35204.75","9585.45","194071.7","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","37035.86","27602.78","151205.13","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","45968.4","45968.4","45968.4","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","46996.83","16855.32","101918.4","11","percent of total billed charges","","",""
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","47523.76","47523.76","47523.76","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Mcc","974","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","36041.83","36041.83","46524.27","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","21165.99","20728.39","25859.69","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","15318.76","15318.76","15318.76","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","13397.94","13397.94","137244.47","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","23521.5","23521.5","23521.5","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","13417.83","13417.83","13417.83","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","18013.1","8894.69","38344.32","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","8269.18","8269.18","8269.18","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","38196.07","38196.07","38196.07","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition With Cc","975","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","26648.56","19320.4","29403.2","1 through 10","percent of total billed charges","","",""
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Major Related Condition Without Cc/Mcc","976","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","68774.98","68774.98","68774.98","1 through 10","percent of total billed charges","","",""
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","12096.61","12096.61","12096.61","1 through 10","percent of total billed charges","","",""
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10822.01","10822.01","10822.01","1 through 10","percent of total billed charges","","",""
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","7034.87","7034.87","7034.87","1 through 10","percent of total billed charges","","",""
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Hiv With Or Without Other Related Condition","977","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","52042.88","52042.88","52042.88","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","87794.32","87794.32","87794.32","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","114440.96","114440.96","114440.96","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","236071.06","236071.06","236071.06","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","133323.48","33337.58","228092.14","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","113868.84","113868.84","113868.84","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","174930.15","174930.15","174930.15","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","185733.82","111061.03","293508.21","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","70192.72","70192.72","70192.72","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","210163.08","210163.08","210163.08","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","585212.58","585212.58","585212.58","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","154428.68","154428.68","154428.68","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","143518","143518","143518","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","107006.03","99607.23","178955.35","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","126920.3","126920.3","126920.3","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","250025.58","250025.58","250025.58","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","83015.49","83015.49","176059.35","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","981","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","14914.64","14914.64","14914.64","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","71264.55","71264.55","71264.55","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","39744.14","39744.14","39744.14","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","36948.54","33358.32","38896.7","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","29210.18","26157.64","49082.56","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","42078.3","42078.3","42078.3","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","37536.04","16460.68","128171.52","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","39542.48","39542.48","39542.48","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","23005.29","23005.29","23005.29","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","3083.67","3083.67","3083.67","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","62387.89","62387.89","62387.89","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","982","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","52825.68","52825.68","52825.68","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","17293.82","17293.82","17293.82","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","12614.39","12614.39","14396.87","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","36555.78","36555.78","36555.78","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","49830.66","49830.66","49830.66","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","10714.57","10714.57","10714.57","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","54191.22","54191.22","54191.22","1 through 10","percent of total billed charges","","",""
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","983","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","31339.64","31339.64","31339.64","1 through 10","percent of total billed charges","","",""
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","984","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","985","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","986","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","36825.19","36825.19","36825.19","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","186428.4","186428.4","186428.4","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","80506.93","80506.93","80506.93","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","203354.87","203354.87","203354.87","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","89936.64","89936.64","89936.64","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","383057.16","383057.16","383057.16","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","68772.26","68772.26","163359.9","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","62123.58","62123.58","62123.58","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","987","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","74215.37","74215.37","74215.37","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","34530.97","34530.97","34530.97","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","41730.52","41730.52","41730.52","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","26193.63","26193.63","26193.63","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","15297.01","15297.01","15297.01","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","52859.02","52859.02","52859.02","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","78267.28","78267.28","78267.28","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","988","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","36764.01","36764.01","36764.01","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","27178.96","27178.96","27178.96","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","3814.95","3814.95","3814.95","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","17275.7","17275.7","17275.7","1 through 10","percent of total billed charges","","",""
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","989","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","27260.14","27260.14","27260.14","1 through 10","percent of total billed charges","","",""
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Principal Diagnosis Invalid As Discharge Diagnosis","998","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","All Commercial Plans","","100","","2169.21","2169.21","2169.21","1 through 10","percent of total billed charges","","",""
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Aetna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Alterwood","Advantage  Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Amerigroup","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Carefirst Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Bcbs","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Cigna","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Employee","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Ehp","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Geisinger","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Health Net","Federal Services Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Hopkins","Elderplus Other Commercial Plan","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Humana","Military Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Kaiser","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Keycare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Maryland Physicians Care","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Medicare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Multiplan","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Phcs","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Priority Partners","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","All Commercial Plans","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Unitedhealthcare","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Usfhp","Prime Tricare Government","","100","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Wellcare","Advantage Medicare Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Ungroupable","999","MS-DRG","","","","","facility","inpatient","","","","","","Wellpoint","Medicaid Managed Care Plan","","92.3","","","","","0","percent of total billed charges","","","No services performed during 15-month lookback period."
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","250","RC","13533-800-24","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","13533-800-21","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","13533-800-21","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","250","RC","13533-800-20","NDC","","","facility","both","1","EA","","63.06","63.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","250","RC","13533-800-20","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","250","RC","13533-800-24","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","250","RC","13533-800-71","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","13533-800-25","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","13533-800-25","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","250","RC","13533-800-24","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","250","RC","13533-800-24","NDC","","","facility","both","1","EA","","62.54","62.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","250","RC","13533-800-20","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","250","RC","13533-800-12","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","250","RC","13533-800-12","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thrombate Iii: 1 Kit In 1 Carton (13533-606-12)  *  10 Ml In 1 Vial, Glass (13533-605-21)  *  10 Ml In 1 Vial, Glass (76297-002-12)","250","RC","13533-606-12","NDC","","","facility","both","1","EA","","6.43","6.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","13533-605-21","NDC","","","facility","both","1","EA","","6.43","6.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyperrab: 1 Vial In 1 Carton (13533-318-05)  / 5 Ml In 1 Vial (13533-318-50)","250","RC","13533-318-05","NDC","","","facility","both","1","EA","","365.69","365.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-15)  / 25 Ml In 1 Vial, Glass (13533-800-16)","250","RC","13533-800-15","NDC","","","facility","both","1","EA","","63.38","63.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-15)  / 25 Ml In 1 Vial, Glass (13533-800-16)","250","RC","13533-800-15","NDC","","","facility","both","1","EA","","63.38","63.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","13533-800-13","NDC","","","facility","both","1","EA","","62.44","62.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","13533-800-13","NDC","","","facility","both","1","EA","","62.44","62.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","250","RC","13533-800-12","NDC","","","facility","both","1","EA","","60.83","60.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","250","RC","13533-800-12","NDC","","","facility","both","1","EA","","62.44","62.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyperrab: 1 Vial In 1 Carton (13533-318-05)  / 5 Ml In 1 Vial (13533-318-50)","250","RC","13533-318-05","NDC","","","facility","both","1","EA","","511.34","511.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","14789-330-08","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","14789-250-07","NDC","","","facility","both","1","EA","","5.35","5.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","14789-137-07","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital Sodium: 10 Vial, Glass In 1 Carton (14789-128-05)  / 1 Ml In 1 Vial, Glass (14789-128-07)","250","RC","14789-128-05","NDC","","","facility","both","1","EA","","20.06","20.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam In Sodium Chloride: 10 Bag In 1 Carton (14789-330-15)  / 100 Ml In 1 Bag (14789-330-08)","250","RC","14789-330-15","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","14789-122-07","NDC","","","facility","both","1","EA","","341.32","341.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","14789-121-07","NDC","","","facility","both","1","EA","","24.06","24.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Papaverine Hydrochloride: 10 Vial, Single-Use In 1 Carton (14789-121-05)  / 2 Ml In 1 Vial, Single-Use (14789-121-07)","250","RC","14789-121-05","NDC","","","facility","both","1","EA","","27.48","27.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","14789-116-07","NDC","","","facility","both","1","EA","","97.94","97.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 100 Ml In 1 Bag (14789-115-08)","250","RC","14789-115-08","NDC","","","facility","both","1","EA","","12.17","12.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","14789-108-16","NDC","","","facility","both","1","EA","","5.64","5.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","14789-015-07","NDC","","","facility","both","1","EA","","655.61","655.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isoproterenol Hydrochloride: 10 Vial, Single-Dose In 1 Carton (14789-011-01)  / 1 Ml In 1 Vial, Single-Dose","250","RC","14789-011-01","NDC","","","facility","both","1","EA","","213.01","213.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","13925-515-01","NDC","","","facility","both","1","EA","","116.13","116.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dapsone: 2 BLISTER PACK in 1 CARTON (13925-505-30)  / 15 TABLET in 1 BLISTER PACK","250","RC","13925-505-30","NDC","","","facility","both","1","EA","","3.69","3.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dapsone: 2 Blister Pack In 1 Carton (13925-504-30)  / 15 Tablet In 1 Blister Pack","250","RC","13925-504-30","NDC","","","facility","both","1","EA","","3.28","3.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (13668-091-90)","250","RC","13668-091-90","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 30 Tablet, Orally Disintegrating In 1 Bottle (13668-089-30)","250","RC","13668-089-30","NDC","","","facility","both","1","EA","","4.41","4.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 30 Tablet, Orally Disintegrating In 1 Bottle (13668-088-30)","250","RC","13668-088-30","NDC","","","facility","both","1","EA","","6.01","6.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Citalopram: 100 Tablet, Film Coated In 1 Bottle (13668-011-01)","250","RC","13668-011-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","13533-800-72","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","13533-800-72","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","250","RC","13533-800-71","NDC","","","facility","both","1","EA","","62.47","62.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","13668-107-05","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losartan Potassium: 90 TABLET in 1 BOTTLE (13668-113-90) ","250","RC","13668-113-90","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (13668-216-30)","250","RC","13668-216-30","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-709-10)","250","RC","13811-709-10","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-708-10)","250","RC","13811-708-10","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-707-10)","250","RC","13811-707-10","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-706-10)","250","RC","13811-706-10","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet In 1 Bottle (13668-720-90)","250","RC","13668-720-90","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sacubitril And Valsartan: 60 Tablet In 1 Bottle (13668-636-60)","250","RC","13668-636-60","NDC","","","facility","both","1","EA","","2.36","2.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sacubitril And Valsartan: 60 Tablet In 1 Bottle (13668-634-60)","250","RC","13668-634-60","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","13668-593-80","NDC","","","facility","both","1","EA","","11.79","11.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tadalafil: 30 Tablet In 1 Bottle (13668-581-30)","250","RC","13668-581-30","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Minocycline Hydrochloride: 50 Capsule In 1 Bottle (13668-484-50)","250","RC","13668-484-50","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Anagrelide: 100 Capsule In 1 Bottle (13668-453-01)","250","RC","13668-453-01","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 100 Tablet In 1 Bottle (13668-268-01)","250","RC","13668-268-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (13668-221-30)","250","RC","13668-221-30","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","250","RC","13533-800-71","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyperrab: 1 Vial In 1 Carton (13533-318-01)  / 1 Ml In 1 Vial (13533-318-10)","250","RC","13533-318-01","NDC","","","facility","both","1","EA","","365.62","365.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 12 Pouch In 1 Case (0990-7953-09)  / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag","250","RC","0990-7953-09","NDC","","","facility","both","1","EA","","8.72","8.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 24 Pouch In 1 Case (0990-7953-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag","250","RC","0990-7953-03","NDC","","","facility","both","1","EA","","9.11","9.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 24 Pouch In 1 Case (0990-7953-02)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag","250","RC","0990-7953-02","NDC","","","facility","both","1","EA","","13.37","13.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 32 Pouch In 1 Case (0990-7983-61)  / 1 Bag In 1 Pouch / 150 Ml In 1 Bag","250","RC","0990-7983-61","NDC","","","facility","both","1","EA","","7.2","7.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 Pouch In 1 Case (0990-7935-19)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag","250","RC","0990-7935-19","NDC","","","facility","both","1","EA","","20.68","20.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Pouch In 1 Case (0990-7930-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag","250","RC","0990-7930-03","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 Pouch In 1 Case (0990-7918-19)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag","250","RC","0990-7918-19","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 20 Pouch In 1 Case (0990-7730-37)  / 4 Bag In 1 Pouch / 100 Ml In 1 Bag","250","RC","0990-7730-37","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 Pouch In 1 Case (0990-7936-19)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag","250","RC","0990-7936-19","NDC","","","facility","both","1","EA","","16.2","16.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ifosfamide: 1 Vial, Single-Dose In 1 Carton (10019-926-02)  / 60 Ml In 1 Vial, Single-Dose (10019-926-16)","250","RC","10019-926-02","NDC","","","facility","both","1","EA","","45.33","45.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","10019-925-82","NDC","","","facility","both","1","EA","","19.94","19.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ifosfamide: 1 Vial, Single-Dose In 1 Carton (10019-925-01)  / 20 Ml In 1 Vial, Single-Dose (10019-925-82)","250","RC","10019-925-01","NDC","","","facility","both","1","EA","","39.97","39.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 60 BAG in 1 CASE (0990-7984-11)  / 100 mL in 1 BAG","250","RC","0990-7984-11","NDC","","","facility","both","1","EA","","15.16","15.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Transderm Scop: 1 Patch In 1 Pouch (10019-553-90)  / 3 D In 1 Patch","250","RC","10019-553-90","NDC","","","facility","both","1","EA","","17.44","17.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Maxitrol: 5 mL in 1 BOTTLE, PLASTIC (0998-0630-06) ","250","RC","0998-0630-06","NDC","","","facility","both","1","EA","","188.07","188.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alcaine: 1 Bottle In 1 Carton (0998-0016-15)  / 15 Ml In 1 Bottle","250","RC","0998-0016-15","NDC","","","facility","both","1","EA","","48.71","48.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 12 Pouch In 1 Case (0990-7990-09)  / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag","250","RC","0990-7990-09","NDC","","","facility","both","1","EA","","10.8","10.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 48 Pouch In 1 Case (0990-7984-23)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","250","RC","0990-7984-23","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Pouch In 1 Case (0990-7984-20)  / 4 Bag In 1 Pouch / 25 Ml In 1 Bag","250","RC","0990-7984-20","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Pouch In 1 Case (0990-7984-20)  / 4 Bag In 1 Pouch / 25 Ml In 1 Bag","250","RC","0990-7984-20","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0990-7715-13","NDC","","","facility","both","1","EA","","3.11","3.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0990-7715-13","NDC","","","facility","both","1","EA","","20.25","20.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mannitol: 12 Pouch In 1 Case (0990-7715-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag (0990-7715-13)","250","RC","0990-7715-03","NDC","","","facility","both","1","EA","","3.07","3.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0944-2700-12","NDC","","","facility","both","1","EA","","67.31","67.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0944-2700-11","NDC","","","facility","both","1","EA","","67.67","67.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mannitol: 12 Pouch In 1 Case (0990-7715-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag (0990-7715-13)","250","RC","0990-7715-03","NDC","","","facility","both","1","EA","","20.17","20.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 24 Pouch In 1 Case (0990-7075-26)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","250","RC","0990-7075-26","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leflunomide: 1 Bottle In 1 Carton (0955-1737-30)  / 30 Tablet, Film Coated In 1 Bottle","250","RC","0955-1737-30","NDC","","","facility","both","1","EA","","8.31","8.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0955-1052-01","NDC","","","facility","both","1","EA","","15.7","15.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Cello Pack In 1 Carton (0955-1006-10)  / 1 Syringe In 1 Cello Pack (0955-1006-01)  / .6 Ml In 1 Syringe","250","RC","0955-1006-10","NDC","","","facility","both","1","EA","","10.36","10.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Cello Pack In 1 Carton (0955-1004-10)  / 1 Syringe In 1 Cello Pack (0955-1004-01)  / .4 Ml In 1 Syringe","250","RC","0955-1004-10","NDC","","","facility","both","1","EA","","10.35","10.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","10019-926-16","NDC","","","facility","both","1","EA","","44.54","44.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesna: 1 Vial, Multi-Dose In 1 Box (10019-953-01)  / 10 Ml In 1 Vial, Multi-Dose (10019-953-62)","250","RC","10019-953-01","NDC","","","facility","both","1","EA","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Grafco Applicator 15 Cm: 100 Stick In 1 Tube (12165-100-01)","250","RC","12165-100-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fml: 1 Bottle, Dropper In 1 Carton (11980-211-05)  / 5 Ml In 1 Bottle, Dropper","250","RC","11980-211-05","NDC","","","facility","both","1","EA","","279.52","279.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Critic Aid Clear Af: 57 G In 1 Tube (11701-067-23)","250","RC","11701-067-23","NDC","","","facility","both","1","EA","","11.39","11.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miralax: 24 Packet In 1 Carton (11523-7268-8)  / 17 G In 1 Packet","250","RC","11523-7268-8","NDC","","","facility","both","1","EA","","2.04","2.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miralax: 10 Packet In 1 Carton (11523-7268-3)  / 17 G In 1 Packet","250","RC","11523-7268-3","NDC","","","facility","both","1","EA","","2.24","2.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"1 TUBE in 1 CARTON (11523-1314-2)  / 113 g in 1 TUBE","250","RC","11523-1314-2","NDC","","","facility","both","1","EA","","7.53","7.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"PROGESTERONE: 100 CAPSULE in 1 BOTTLE (10888-7136-2) ","250","RC","10888-7136-2","NDC","","","facility","both","1","EA","","5.44","5.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"PROGESTERONE: 100 CAPSULE in 1 BOTTLE (10888-7135-2) ","250","RC","10888-7135-2","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pvp Iodine Prep Swabstick Ones And Threes: 25 Packet In 1 Box (10819-3885-2)  / 7 Ml In 1 Packet","250","RC","10819-3885-2","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 100 Capsule In 1 Bottle (10702-237-01)","250","RC","10702-237-01","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Critic Aid Clear: 71 G In 1 Tube (11701-066-33)","250","RC","11701-066-33","NDC","","","facility","both","1","EA","","5.88","5.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyperrab: 1 Vial In 1 Carton (13533-318-01)  / 1 Ml In 1 Vial (13533-318-10)","250","RC","13533-318-01","NDC","","","facility","both","1","EA","","670.12","670.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Tablet In 1 Bottle, Plastic (13517-625-01)","250","RC","13517-625-01","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Tablet In 1 Bottle (13517-113-01)","250","RC","13517-113-01","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Tablet In 1 Bottle (13517-112-01)","250","RC","13517-112-01","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 473 Ml In 1 Bottle, Plastic (13517-107-16)","250","RC","13517-107-16","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 500 Tablet In 1 Bottle (13107-084-05)","250","RC","13107-084-05","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 500 Tablet In 1 Bottle (13107-083-05)","250","RC","13107-083-05","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Tablet In 1 Bottle (13107-079-01)","250","RC","13107-079-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (13107-001-30)","250","RC","13107-001-30","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 500 Tablet, Film Coated In 1 Bottle (13107-001-05)","250","RC","13107-001-05","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","12496-1212-1","NDC","","","facility","both","1","EA","","29.81","29.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","12496-1208-1","NDC","","","facility","both","1","EA","","14.91","14.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","12496-1202-1","NDC","","","facility","both","1","EA","","8.32","8.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenex: 5 AMPULE in 1 CARTON (12496-0757-5)  / 1 mL in 1 AMPULE (12496-0757-1) ","250","RC","12496-0757-5","NDC","","","facility","both","1","EA","","8.39","8.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 100 Tablet In 1 Bottle, Plastic (10702-201-01)","250","RC","10702-201-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 100 Tablet In 1 Bottle (10702-170-01)","250","RC","10702-170-01","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Peg-3350, Sodium Chloride, Sodium Bicarbonate And Potassium Chloride: 4 L In 1 Bottle (10572-302-01)","250","RC","10572-302-01","NDC","","","facility","both","1","EA","","33.54","33.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenazopyridine Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE (10135-620-01) ","250","RC","10135-620-01","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 100 Tablet In 1 Bottle, Plastic (10135-533-01)","250","RC","10135-533-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bethkis: 14 Pouch In 1 Carton (10122-820-56)  / 4 Ampule In 1 Pouch / 4 Ml In 1 Ampule","250","RC","10122-820-56","NDC","","","facility","both","1","EA","","222.04","222.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","10122-620-01","NDC","","","facility","both","1","EA","","32.41","32.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyproheptadine Hydrochloride: 100 TABLET in 1 BOTTLE (10135-638-01) ","250","RC","10135-638-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Curosurf: 3 Ml In 1 Vial, Glass (10122-510-03)","250","RC","10122-510-03","NDC","","","facility","both","1","EA","","1481.53","1481.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","10122-325-01","NDC","","","facility","both","1","EA","","119.7","119.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ferriprox: 500 Ml In 1 Bottle, Plastic (10122-101-50)","250","RC","10122-101-50","NDC","","","facility","both","1","EA","","555.4","555.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","10019-953-62","NDC","","","facility","both","1","EA","","2.66","2.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Curosurf: 1.5 Ml In 1 Vial, Glass (10122-510-01)","250","RC","10122-510-01","NDC","","","facility","both","1","EA","","765.76","765.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle (10135-676-01)","250","RC","10135-676-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle (10135-679-01)","250","RC","10135-679-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Sulfate, Potassium Sulfate And Magnesium Sulfate: 2 Bottle, Plastic In 1 Carton (10572-012-01)  / 177.4 Ml In 1 Bottle, Plastic","250","RC","10572-012-01","NDC","","","facility","both","1","EA","","123.89","123.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","10572-011-01","NDC","","","facility","both","1","EA","","61.01","61.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"MONSELS SOLUTION: 8 g in 1 BOTTLE, GLASS (10481-0112-8) ","250","RC","10481-0112-8","NDC","","","facility","both","1","EA","","22.98","22.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (10135-779-01)","250","RC","10135-779-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Digoxin: 100 Tablet In 1 Bottle (10135-747-01)","250","RC","10135-747-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranylcypromine: 100 Tablet In 1 Bottle (10135-739-01)","250","RC","10135-739-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rifabutin: 100 Capsule In 1 Bottle (10135-738-01)","250","RC","10135-738-01","NDC","","","facility","both","1","EA","","7.71","7.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyrazinamide: 60 Tablet In 1 Bottle (10135-735-60)","250","RC","10135-735-60","NDC","","","facility","both","1","EA","","6.04","6.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyrazinamide: 100 Tablet In 1 Bottle (10135-735-01)","250","RC","10135-735-01","NDC","","","facility","both","1","EA","","5.94","5.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isradipine: 100 Capsule In 1 Bottle (16252-539-01)","250","RC","16252-539-01","NDC","","","facility","both","1","EA","","2.4","2.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isradipine: 100 Capsule In 1 Bottle (16252-540-01)","250","RC","16252-540-01","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrochlorothiazide: 100 Tablet In 1 Bottle (16729-184-01)","250","RC","16729-184-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16729-171-01)","250","RC","16729-171-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 100 Tablet In 1 Bottle, Plastic (16729-138-00)","250","RC","16729-138-00","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 500 Tablet In 1 Bottle, Plastic (16729-137-16)","250","RC","16729-137-16","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 500 Tablet In 1 Bottle, Plastic (16729-136-16)","250","RC","16729-136-16","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Carton (16729-115-05)  / 10 Ml In 1 Vial","250","RC","16729-115-05","NDC","","","facility","both","1","EA","","145.37","145.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolic Acid: 120 Tablet, Delayed Release In 1 Bottle (16729-189-29)","250","RC","16729-189-29","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial, Multi-Dose In 1 Box (16729-114-11)  / 50 Ml In 1 Vial, Multi-Dose","250","RC","16729-114-11","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial, Multi-Dose In 1 Box (16729-114-08)  / 25 Ml In 1 Vial, Multi-Dose","250","RC","16729-114-08","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 100 Capsule In 1 Bottle (16729-094-01)","250","RC","16729-094-01","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Bottle (16729-043-01)","250","RC","16729-043-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Anastrozole: 90 Tablet In 1 Bottle, Plastic (16729-035-15)","250","RC","16729-035-15","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle, Plastic (16729-440-10)","250","RC","16729-440-10","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (16729-422-10)  / 30 G In 1 Tube","250","RC","16729-422-10","NDC","","","facility","both","1","EA","","65.18","65.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (16729-421-10)  / 30 G In 1 Tube","250","RC","16729-421-10","NDC","","","facility","both","1","EA","","103.9","103.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 100 Capsule, Extended Release In 1 Bottle (16729-331-01)","250","RC","16729-331-01","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 20 Ml In 1 Vial (16729-298-05)","250","RC","16729-298-05","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dalfampridine: 60 Tablet, Film Coated, Extended Release In 1 Bottle (16729-292-12)","250","RC","16729-292-12","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle, Plastic (16729-280-10)","250","RC","16729-280-10","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle, Plastic (16729-279-10)","250","RC","16729-279-10","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle, Plastic (16729-278-10)","250","RC","16729-278-10","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial In 1 Carton (16729-277-30)  / 2 Ml In 1 Vial","250","RC","16729-277-30","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial In 1 Carton (16729-277-03)  / 10 Ml In 1 Vial","250","RC","16729-277-03","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisplatin: 100 Ml In 1 Vial (16729-288-38)","250","RC","16729-288-38","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Anastrozole: 30 Tablet In 1 Bottle, Plastic (16729-035-10)","250","RC","16729-035-10","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bicalutamide: 30 Tablet In 1 Bottle (16729-023-10)","250","RC","16729-023-10","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"bumetanide: 100 TABLET in 1 BOTTLE (16714-833-01) ","250","RC","16714-833-01","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 120 Tablet, Delayed Release In 1 Bottle (16714-830-01)","250","RC","16714-830-01","NDC","","","facility","both","1","EA","","4.14","4.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 10 CAPSULE in 1 CARTON (16714-819-01) ","250","RC","16714-819-01","NDC","","","facility","both","1","EA","","15.92","15.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bicalutamide: 100 Tablet, Film Coated In 1 Bottle (16714-816-02)","250","RC","16714-816-02","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevelamer Carbonate: 270 Tablet, Film Coated In 1 Bottle (16714-814-01)","250","RC","16714-814-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ezetimibe: 30 Tablet In 1 Bottle (16714-813-01)","250","RC","16714-813-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"New Day: 1 Blister Pack In 1 Carton (16714-809-01)  / 1 Tablet In 1 Blister Pack","250","RC","16714-809-01","NDC","","","facility","both","1","EA","","20.31","20.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorthalidone: 100 TABLET in 1 BOTTLE (16714-801-01) ","250","RC","16714-801-01","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone: 60 Capsule In 1 Bottle (16714-835-01)","250","RC","16714-835-01","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sumatriptan: 1 Blister Pack In 1 Carton (16714-797-01)  / 9 Tablet In 1 Blister Pack","250","RC","16714-797-01","NDC","","","facility","both","1","EA","","2.33","2.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sumatriptan: 1 Blister Pack In 1 Carton (16714-796-01)  / 9 Tablet In 1 Blister Pack","250","RC","16714-796-01","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Terbinafine: 30 Tablet In 1 Bottle (16714-795-01)","250","RC","16714-795-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valganciclovir: 60 TABLET, FILM COATED in 1 BOTTLE (16714-765-01) ","250","RC","16714-765-01","NDC","","","facility","both","1","EA","","5.99","5.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (16714-759-01)","250","RC","16714-759-01","NDC","","","facility","both","1","EA","","3.56","3.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (16714-758-01)","250","RC","16714-758-01","NDC","","","facility","both","1","EA","","3.16","3.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sumatriptan: 1 Blister Pack In 1 Carton (16714-798-01)  / 9 Tablet In 1 Blister Pack","250","RC","16714-798-01","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clomipramine Hydrochloride: 100 Capsule In 1 Bottle (16714-851-03)","250","RC","16714-851-03","NDC","","","facility","both","1","EA","","4.06","4.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (16714-857-01)  / 50 Ml In 1 Vial, Single-Dose","250","RC","16714-857-01","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 500 Tablet In 1 Bottle (16729-019-16)","250","RC","16729-019-16","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 30 Tablet, Film Coated In 1 Bottle (16714-991-01)","250","RC","16714-991-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-990-01)","250","RC","16714-990-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-989-01)","250","RC","16714-989-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-988-01)","250","RC","16714-988-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (16714-985-02)  / 80 G In 1 Tube","250","RC","16714-985-02","NDC","","","facility","both","1","EA","","8.07","8.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"1 BOTTLE in 1 CARTON (16714-973-01)  / 100 TABLET in 1 BOTTLE","250","RC","16714-973-01","NDC","","","facility","both","1","EA","","42.76","42.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (16714-950-01)","250","RC","16714-950-01","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Permethrin: 1 Tube In 1 Container (16714-897-01)  / 60 G In 1 Tube","250","RC","16714-897-01","NDC","","","facility","both","1","EA","","26.9","26.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 100 Tablet In 1 Bottle (16714-887-01)","250","RC","16714-887-01","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 1 Tube In 1 Carton (16714-878-01)  / 35.44 G In 1 Tube","250","RC","16714-878-01","NDC","","","facility","both","1","EA","","13.53","13.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (16714-867-01)","250","RC","16714-867-01","NDC","","","facility","both","1","EA","","5.17","5.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 90 Tablet, Film Coated In 1 Bottle, Plastic (16729-442-15)","250","RC","16729-442-15","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride: 30 Tablet, Extended Release In 1 Bottle (16729-443-10)","250","RC","16729-443-10","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride: 30 Tablet, Extended Release In 1 Bottle (16729-444-10)","250","RC","16729-444-10","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","19515-904-41","NDC","","","facility","both","1","EA","","24.3","24.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flulaval 2024/2025: 10 Syringe In 1 Carton (19515-810-52)  / .5 Ml In 1 Syringe (19515-810-41)","250","RC","19515-810-52","NDC","","","facility","both","1","EA","","26.19","26.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","19515-810-41","NDC","","","facility","both","1","EA","","26.19","26.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hylenex Recombinant: 4 Box In 1 Carton (18657-117-04)  / 1 Vial In 1 Box (18657-117-02)  / 1 Ml In 1 Vial (18657-117-01)","250","RC","18657-117-04","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","18657-117-02","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","18657-117-01","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 72 Cup, Unit-Dose In 1 Box, Unit-Dose (17856-1045-1)  / 5 Ml In 1 Cup, Unit-Dose (17856-1045-2)","250","RC","17856-1045-1","NDC","","","facility","both","1","EA","","7.57","7.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gavilax: 72 Pouch In 1 Case (17856-0312-6)  / 4.5 G In 1 Pouch","250","RC","17856-0312-6","NDC","","","facility","both","1","EA","","2.85","2.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gavilax: 50 Cup In 1 Case (17856-0312-5)  / 8.5 G In 1 Cup","250","RC","17856-0312-5","NDC","","","facility","both","1","EA","","25.25","25.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (21922-011-05)  / 30 G In 1 Tube","250","RC","21922-011-05","NDC","","","facility","both","1","EA","","79.65","79.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (21922-017-04)  / 15 G In 1 Tube","250","RC","21922-017-04","NDC","","","facility","both","1","EA","","6.65","6.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 25 Vial In 1 Carton (23155-240-41)  / 2 Ml In 1 Vial (23155-240-31)","250","RC","23155-240-41","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-240-31","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine: 100 Capsule In 1 Bottle (23155-194-01)","250","RC","23155-194-01","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-166-31","NDC","","","facility","both","1","EA","","2.29","2.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate Delayed Release: 100 Tablet, Delayed Release In 1 Bottle (23155-142-01)","250","RC","23155-142-01","NDC","","","facility","both","1","EA","","3.92","3.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naratriptan: 9 Tablet In 1 Blister Pack (23155-055-19)","250","RC","23155-055-19","NDC","","","facility","both","1","EA","","4.74","4.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet In 1 Bottle (23155-026-01)","250","RC","23155-026-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (23155-018-01)","250","RC","23155-018-01","NDC","","","facility","both","1","EA","","7.79","7.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (23155-017-01)","250","RC","23155-017-01","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (21922-063-04)  / 15 G In 1 Tube","250","RC","21922-063-04","NDC","","","facility","both","1","EA","","3.65","3.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Tube In 1 Carton (21922-049-17)  / 40 G In 1 Tube","250","RC","21922-049-17","NDC","","","facility","both","1","EA","","66.39","66.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mupirocin: 1 Tube In 1 Carton (21922-029-04)  / 15 G In 1 Tube","250","RC","21922-029-04","NDC","","","facility","both","1","EA","","41.5","41.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Permethrin: 1 Tube In 1 Carton (21922-021-07)  / 60 G In 1 Tube","250","RC","21922-021-07","NDC","","","facility","both","1","EA","","49.79","49.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (21922-017-05)  / 30 G In 1 Tube","250","RC","21922-017-05","NDC","","","facility","both","1","EA","","13.22","13.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gavilax: 8.5 G In 1 Bag (17856-0312-2)","250","RC","17856-0312-2","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 1 VIAL in 1 CARTON (17478-937-25)  / 25 mL in 1 VIAL","250","RC","17478-937-25","NDC","","","facility","both","1","EA","","18.18","18.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 10 TUBE in 1 CARTON (17478-711-31)  / 5 mL in 1 TUBE","250","RC","17478-711-31","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","17238-900-99","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bioglo: 100 Packet In 1 Box (17238-900-11)  / 1 Mg In 1 Packet (17238-900-99)","250","RC","17238-900-11","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dermoplast Pain Relieving: 85 G In 1 Can (16864-680-03)","250","RC","16864-680-03","NDC","","","facility","both","1","EA","","9.95","9.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dermoplast Pain Relieving: 78 G In 1 Can (16864-680-01)","250","RC","16864-680-01","NDC","","","facility","both","1","EA","","10.22","10.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Domeboro: 12 Powder, For Solution In 1 Box (16864-240-01)","250","RC","16864-240-01","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16729-502-03","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 90 Tablet In 1 Bottle (16729-449-15)","250","RC","16729-449-15","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 90 Tablet In 1 Bottle (16729-447-15)","250","RC","16729-447-15","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dehydrated Alcohol: 10 Vial In 1 Carton (16729-710-45)  / 5 Ml In 1 Vial (16729-710-31)","250","RC","16729-710-45","NDC","","","facility","both","1","EA","","625","625","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 250 Ml In 1 Bag (17271-701-05)","250","RC","17271-701-05","NDC","","","facility","both","1","EA","","2.86","2.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 500 Ml In 1 Bag (17271-701-06)","250","RC","17271-701-06","NDC","","","facility","both","1","EA","","3.58","3.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adenosine: 10 Vial In 1 Carton (17478-542-02)  / 2 Ml In 1 Vial","250","RC","17478-542-02","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 AMPULE in 1 CARTON (17478-540-01)  / 1 mL in 1 AMPULE","250","RC","17478-540-01","NDC","","","facility","both","1","EA","","4.68","4.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dehydrated Alcohol: 10 VIAL in 1 CARTON (17478-503-05)  / 5 mL in 1 VIAL","250","RC","17478-503-05","NDC","","","facility","both","1","EA","","12.61","12.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"FUL-GLO: 100 APPLICATOR in 1 CARTON (17478-404-01)  / 1 STRIP in 1 APPLICATOR","250","RC","17478-404-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"FUL-GLO: 300 APPLICATOR in 1 CARTON (17478-403-03)  / 1 STRIP in 1 APPLICATOR","250","RC","17478-403-03","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Proparacaine Hydrochloride: 1 BOTTLE, DROPPER in 1 CARTON (17478-263-12)  / 15 mL in 1 BOTTLE, DROPPER","250","RC","17478-263-12","NDC","","","facility","both","1","EA","","58.43","58.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pilocarpine Hydrochloride: 1 BOTTLE, DROPPER in 1 CARTON (17478-224-12)  / 15 mL in 1 BOTTLE, DROPPER","250","RC","17478-224-12","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine: 1 BOTTLE, DROPPER in 1 CARTON (17478-215-05)  / 5 mL in 1 BOTTLE, DROPPER","250","RC","17478-215-05","NDC","","","facility","both","1","EA","","62.25","62.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine: 1 BOTTLE, DROPPER in 1 CARTON (17478-215-02)  / 2 mL in 1 BOTTLE, DROPPER","250","RC","17478-215-02","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenylephrine Hydrochloride: 1 BOTTLE, DROPPER in 1 CARTON (17478-206-05)  / 5 mL in 1 BOTTLE, DROPPER","250","RC","17478-206-05","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenylephrine Hydrochloride: 1 Bottle, Dropper In 1 Carton (17478-201-02)  / 2 Ml In 1 Bottle, Dropper","250","RC","17478-201-02","NDC","","","facility","both","1","EA","","5.81","5.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tropicamide: 1 BOTTLE, DROPPER in 1 CARTON (17478-102-12)  / 15 mL in 1 BOTTLE, DROPPER","250","RC","17478-102-12","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclopentolate Hydrochloride: 1 BOTTLE, DROPPER in 1 CARTON (17478-097-02)  / 2 mL in 1 BOTTLE, DROPPER","250","RC","17478-097-02","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin: 50 TUBE in 1 CARTON (17478-070-31)  / 1 g in 1 TUBE","250","RC","17478-070-31","NDC","","","facility","both","1","EA","","13.41","13.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Artificial Tears: 1 TUBE in 1 CARTON (17478-062-35)  / 3.5 g in 1 TUBE","250","RC","17478-062-35","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"FENTANYL CITRATE: 10 AMPULE in 1 CARTON (17478-030-05)  / 5 mL in 1 AMPULE","250","RC","17478-030-05","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 30 Bag In 1 Case (17271-720-05)  / 250 Ml In 1 Bag","250","RC","17271-720-05","NDC","","","facility","both","1","EA","","5.35","5.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1000 Ml In 1 Bag (17271-701-07)","250","RC","17271-701-07","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 10 VIAL in 1 CARTON (17478-937-10)  / 10 mL in 1 VIAL","250","RC","17478-937-10","NDC","","","facility","both","1","EA","","3.07","3.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (16714-755-01)","250","RC","16714-755-01","NDC","","","facility","both","1","EA","","3.1","3.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (16714-160-01)","250","RC","16714-160-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Progesterone: 100 Capsule In 1 Bottle (16714-158-01)","250","RC","16714-158-01","NDC","","","facility","both","1","EA","","1.2","1.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (16714-143-01)","250","RC","16714-143-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (16714-142-01)","250","RC","16714-142-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 30 Tablet, Film Coated In 1 Bottle (16714-112-01)","250","RC","16714-112-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxychloroquine Sulfate: 100 Tablet, Film Coated In 1 Bottle (16714-110-01)","250","RC","16714-110-01","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 1 Bottle, Glass In 1 Carton (16714-087-01)  / 120 Ml In 1 Bottle, Glass","250","RC","16714-087-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tadalafil: 30 Tablet, Film Coated In 1 Bottle (16714-075-01)","250","RC","16714-075-01","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulvestrant: 2 Syringe, Glass In 1 Carton (16714-070-02)  / 5 Ml In 1 Syringe, Glass (16714-070-01)","250","RC","16714-070-02","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (16714-056-10)  / .8 Ml In 1 Syringe (16714-056-01)","250","RC","16714-056-10","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Liothyronine Sodium: 100 Tablet In 1 Bottle (16714-167-01)","250","RC","16714-167-01","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tizanidine: 150 Tablet In 1 Bottle (16714-172-01)","250","RC","16714-172-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Granisetron Hydrochloride: 2 BLISTER PACK in 1 CARTON (16714-221-32)  / 10 TABLET, FILM COATED in 1 BLISTER PACK (16714-221-12) ","250","RC","16714-221-32","NDC","","","facility","both","1","EA","","13.89","13.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 3 Blister Pack In 1 Carton (16714-201-30)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","16714-201-30","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 1 Blister Pack In 1 Carton (16714-201-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","16714-201-10","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 3 Blister Pack In 1 Carton (16714-200-30)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack (16714-200-10)","250","RC","16714-200-30","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-200-10","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 60 Tablet In 1 Bottle (16714-196-01)","250","RC","16714-196-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guanfacine: 100 Tablet, Extended Release In 1 Bottle (16714-192-01)","250","RC","16714-192-01","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lansoprazole: 100 Blister Pack In 1 Carton (16714-186-02)  / 10 Tablet, Orally Disintegrating, Delayed Release In 1 Blister Pack (16714-186-01)","250","RC","16714-186-02","NDC","","","facility","both","1","EA","","14.8","14.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-186-01","NDC","","","facility","both","1","EA","","14.8","14.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lansoprazole: 100 Blister Pack In 1 Carton (16714-185-02)  / 10 Tablet, Orally Disintegrating, Delayed Release In 1 Blister Pack (16714-185-01)","250","RC","16714-185-02","NDC","","","facility","both","1","EA","","5.48","5.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-185-01","NDC","","","facility","both","1","EA","","5.48","5.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 60 Tablet In 1 Bottle (16714-197-01)","250","RC","16714-197-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mupirocin: 1 Tube In 1 Carton (16714-055-01)  / 15 G In 1 Tube","250","RC","16714-055-01","NDC","","","facility","both","1","EA","","187.85","187.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Tablet, Chewable In 1 Bottle (16571-786-01)","250","RC","16571-786-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levocarnitine: 9 Blister Pack In 1 Carton (16571-762-09)  / 10 Tablet In 1 Blister Pack","250","RC","16571-762-09","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamylon: 1 Tube In 1 Carton (16571-723-60)  / 56.7 G In 1 Tube","250","RC","16571-723-60","NDC","","","facility","both","1","EA","","120.23","120.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clomipramine Hydrochloride: 90 Capsule In 1 Bottle (16571-684-09)","250","RC","16571-684-09","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clomipramine Hydrochloride: 30 Capsule In 1 Bottle (16571-684-03)","250","RC","16571-684-03","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clomipramine Hydrochloride: 90 Capsule In 1 Bottle (16571-683-09)","250","RC","16571-683-09","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Acetate: 200 Capsule In 1 Bottle, Plastic (16571-813-20)","250","RC","16571-813-20","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 473 Ml In 1 Bottle (16571-675-16)","250","RC","16571-675-16","NDC","","","facility","both","1","EA","","3.69","3.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Tablet In 1 Bottle (16571-668-01)","250","RC","16571-668-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Tablet In 1 Bottle (16571-667-01)","250","RC","16571-667-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cromolyn Sodium: 12 Pouch In 1 Carton (16571-600-96)  / 8 Ampule In 1 Pouch / 5 Ml In 1 Ampule","250","RC","16571-600-96","NDC","","","facility","both","1","EA","","10.37","10.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cetirizine Hydrochloride: 100 Tablet In 1 Bottle (16571-401-10)","250","RC","16571-401-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorhexidine Gluconate Oral Rinse: 473 Ml In 1 Bottle (16571-128-48)","250","RC","16571-128-48","NDC","","","facility","both","1","EA","","5.06","5.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16571-113-01)","250","RC","16571-113-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet In 1 Bottle (16571-107-01)","250","RC","16571-107-01","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyoscyamine Sulfate: 100 Tablet, Extended Release In 1 Bottle (16477-738-01)","250","RC","16477-738-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Tablet In 1 Bottle (16571-671-01)","250","RC","16571-671-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 100 Tablet In 1 Bottle (16571-822-01)","250","RC","16571-822-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Capsule In 1 Bottle (16571-869-01)","250","RC","16571-869-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clopidogrel: 100 Tablet In 1 Box, Unit-Dose (16714-052-11)","250","RC","16714-052-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clopidogrel: 10 Tablet In 1 Blister Pack (16714-052-10)","250","RC","16714-052-10","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (16714-046-10)  / 1 Ml In 1 Syringe (16714-046-01)","250","RC","16714-046-10","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-046-01","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (16714-036-10)  / .8 Ml In 1 Syringe (16714-036-01)","250","RC","16714-036-10","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-036-01","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (16714-026-10)  / .6 Ml In 1 Syringe (16714-026-01)","250","RC","16714-026-10","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-026-01","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-016-01","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle (16714-010-01)","250","RC","16714-010-01","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle (16714-008-01)","250","RC","16714-008-01","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-006-01","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosaprepitant: 1 Vial, Single-Dose In 1 Carton (16714-248-01)  / 5 Ml In 1 Vial, Single-Dose","250","RC","16714-248-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosaprepitant: 1 Vial, Single-Dose In 1 Carton (16714-248-01)  / 5 Ml In 1 Vial, Single-Dose","250","RC","16714-248-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 1 Bottle, Plastic In 1 Carton (16714-671-02)  / 50 Ml In 1 Bottle, Plastic","250","RC","16714-671-02","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 500 Capsule In 1 Bottle (16714-662-02)","250","RC","16714-662-02","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 500 Capsule In 1 Bottle (16714-661-02)","250","RC","16714-661-02","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Capsule In 1 Bottle (16714-661-01)","250","RC","16714-661-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 50 TABLET, FILM COATED in 1 BOTTLE (16714-653-01) ","250","RC","16714-653-01","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-644-01","NDC","","","facility","both","1","EA","","25.41","25.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Moxifloxacin: 1 Bottle In 1 Carton (16714-643-01)  / 3 Ml In 1 Bottle","250","RC","16714-643-01","NDC","","","facility","both","1","EA","","14.95","14.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alendronate Sodium: 30 Tablet In 1 Bottle (16714-631-01)","250","RC","16714-631-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin And Dexamethasone: 1 Bottle, Dropper In 1 Carton (16714-628-01)  / 7.5 Ml In 1 Bottle, Dropper","250","RC","16714-628-01","NDC","","","facility","both","1","EA","","183.7","183.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zolpidem Tartrate: 100 Tablet, Film Coated In 1 Bottle (16714-622-01)","250","RC","16714-622-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zolpidem Tartrate: 100 Tablet, Film Coated In 1 Bottle (16714-621-01)","250","RC","16714-621-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (16714-611-05)","250","RC","16714-611-05","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alendronate Sodium: 1 Blister Pack In 1 Carton (16714-633-01)  / 4 Tablet In 1 Blister Pack","250","RC","16714-633-01","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-690-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-692-10","NDC","","","facility","both","1","EA","","2.01","2.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Itraconazole: 30 Capsule, Coated Pellets In 1 Bottle (16714-743-02)","250","RC","16714-743-02","NDC","","","facility","both","1","EA","","3.47","3.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Capsule In 1 Bottle (16714-721-02)","250","RC","16714-721-02","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Capsule In 1 Bottle (16714-720-02)","250","RC","16714-720-02","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entecavir: 30 Tablet, Film Coated In 1 Bottle, Plastic (16714-718-01)","250","RC","16714-718-01","NDC","","","facility","both","1","EA","","2.86","2.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entecavir: 30 Tablet, Film Coated In 1 Bottle, Plastic (16714-717-01)","250","RC","16714-717-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 60 Tablet In 1 Bottle (16714-703-01)","250","RC","16714-703-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 60 TABLET in 1 BOTTLE (16714-702-01) ","250","RC","16714-702-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (16714-698-03)","250","RC","16714-698-03","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (16714-697-03)","250","RC","16714-697-03","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 1 Bottle In 1 Carton (16714-696-01)  / 35 Ml In 1 Bottle","250","RC","16714-696-01","NDC","","","facility","both","1","EA","","8.35","8.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 30 Tablet In 1 Bottle (16714-694-01)","250","RC","16714-694-01","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 100 Tablet In 1 Bottle (16714-693-02)","250","RC","16714-693-02","NDC","","","facility","both","1","EA","","1.73","1.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 30 Tablet In 1 Bottle (16714-693-01)","250","RC","16714-693-01","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (16714-757-01)","250","RC","16714-757-01","NDC","","","facility","both","1","EA","","3.28","3.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-611-04)","250","RC","16714-611-04","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 1 Bottle, Plastic In 1 Carton (16714-601-02)  / 60 Ml In 1 Bottle, Plastic","250","RC","16714-601-02","NDC","","","facility","both","1","EA","","3.92","3.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefadroxil: 75 Ml In 1 Bottle (16714-390-01)","250","RC","16714-390-01","NDC","","","facility","both","1","EA","","2.96","2.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefadroxil: 50 Capsule In 1 Bottle (16714-388-01)","250","RC","16714-388-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 473 Ml In 1 Bottle, Plastic (16714-358-01)","250","RC","16714-358-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Tablet, Film Coated In 1 Bottle (16714-332-01)","250","RC","16714-332-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-301-01","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefadroxil: 100 Ml In 1 Bottle (16714-390-02)","250","RC","16714-390-02","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 500 Capsule In 1 Bottle (16714-299-04)","250","RC","16714-299-04","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Capsule In 1 Bottle (16714-298-01)","250","RC","16714-298-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 200 Ml In 1 Bottle (16714-294-03)","250","RC","16714-294-03","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 125 Ml In 1 Bottle (16714-294-02)","250","RC","16714-294-02","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 50 Ml In 1 Bottle (16714-293-01)","250","RC","16714-293-01","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (16714-276-02)  / 80 G In 1 Tube","250","RC","16714-276-02","NDC","","","facility","both","1","EA","","7.06","7.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-258-01)","250","RC","16714-258-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tretinoin: 1 Tube In 1 Carton (16714-249-01)  / 20 G In 1 Tube","250","RC","16714-249-01","NDC","","","facility","both","1","EA","","117.47","117.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefdinir: 60 CAPSULE in 1 BOTTLE (16714-391-02) ","250","RC","16714-391-02","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 100 Tablet In 1 Bottle (16714-577-01)","250","RC","16714-577-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 100 Tablet In 1 Bottle (16714-576-02)","250","RC","16714-576-02","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pravastatin Sodium: 90 Tablet In 1 Bottle (16714-558-01)","250","RC","16714-558-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 1 Tube, With Applicator In 1 Carton (16714-557-01)  / 70 G In 1 Tube, With Applicator","250","RC","16714-557-01","NDC","","","facility","both","1","EA","","102.26","102.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 1 Vial In 1 Carton (16714-536-01)  / 1 Ml In 1 Vial","250","RC","16714-536-01","NDC","","","facility","both","1","EA","","2.33","2.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","16714-531-10","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (16714-517-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Pharmacy Bulk Package","250","RC","16714-517-01","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin Palmitate Hydrochloride (Pediatric): 1 Bottle, Plastic In 1 Carton (16714-483-02)  / 100 Ml In 1 Bottle, Plastic","250","RC","16714-483-02","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-446-01)","250","RC","16714-446-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 100 Tablet In 1 Bottle (16714-443-01)","250","RC","16714-443-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefpodoxime Proxetil: 1 Bottle In 1 Carton (16714-403-02)  / 100 Ml In 1 Bottle","250","RC","16714-403-02","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefpodoxime Proxetil: 1 Bottle In 1 Carton (16714-403-01)  / 50 Ml In 1 Bottle","250","RC","16714-403-01","NDC","","","facility","both","1","EA","","13.16","13.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefuroxime Axetil: 60 Tablet In 1 Bottle (16714-401-02)","250","RC","16714-401-02","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefuroxime Axetil: 60 Tablet In 1 Bottle (16714-400-02)","250","RC","16714-400-02","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine: 100 Tablet In 1 Bottle (23155-250-01)","250","RC","23155-250-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0944-2700-08","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 100 Blister Pack In 1 Carton (0904-6552-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6552-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 100 Blister Pack In 1 Carton (0904-6551-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6551-61","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 100 Blister Pack In 1 Carton (0904-6550-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6550-61","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Senna-Lax: 10 Blister Pack In 1 Box (0904-6522-61)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6522-61","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 100 Blister Pack In 1 Carton (0904-6519-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6519-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Memantine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6506-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6506-61","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Memantine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6505-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6505-61","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Blister Pack In 1 Carton (0904-6503-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6503-61","NDC","","","facility","both","1","EA","","3.31","3.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Blister Pack In 1 Carton (0904-6502-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6502-61","NDC","","","facility","both","1","EA","","1.53","1.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 100 Blister Pack In 1 Carton (0904-6501-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6501-61","NDC","","","facility","both","1","EA","","2.69","2.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 50 Blister Pack In 1 Carton (0904-6501-06)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6501-06","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 100 Blister Pack In 1 Carton (0904-6500-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6500-61","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 100 Blister Pack In 1 Carton (0904-6476-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6476-61","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Memantine Hydrochloride: 50 Blister Pack In 1 Carton (0904-6505-06)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6505-06","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 30 Blister Pack In 1 Carton (0904-6553-04)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6553-04","NDC","","","facility","both","1","EA","","6.44","6.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Perphenazine: 100 Blister Pack In 1 Carton (0904-6599-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6599-61","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 30 Blister Pack In 1 Carton (0904-6596-04)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6596-04","NDC","","","facility","both","1","EA","","10.74","10.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tolterodine Tartrate: 30 Blister Pack In 1 Carton (0904-6593-04)  / 1 Capsule, Extended Release In 1 Blister Pack","250","RC","0904-6593-04","NDC","","","facility","both","1","EA","","9.33","9.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tolterodine Tartrate: 30 Blister Pack In 1 Carton (0904-6592-04)  / 1 Capsule, Extended Release In 1 Blister Pack","250","RC","0904-6592-04","NDC","","","facility","both","1","EA","","8.85","8.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6585-61)  / 1 TABLET, EXTENDED RELEASE in 1 BLISTER PACK","250","RC","0904-6585-61","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Blister Pack In 1 Carton (0904-6575-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6575-61","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6554-61)  / 1 TABLET in 1 BLISTER PACK","250","RC","0904-6554-61","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 100 Blister Pack In 1 Carton (0904-6572-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6572-61","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 100 Blister Pack In 1 Carton (0904-6570-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-6570-61","NDC","","","facility","both","1","EA","","2.19","2.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 50 Blister Pack In 1 Carton (0904-6570-06)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-6570-06","NDC","","","facility","both","1","EA","","3.39","3.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"100 BLISTER PACK in 1 CARTON (0904-6564-61)  / 1 CAPSULE in 1 BLISTER PACK","250","RC","0904-6564-61","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6558-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","250","RC","0904-6558-61","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6557-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","250","RC","0904-6557-61","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride: 30 Blister Pack In 1 Carton (0904-6573-04)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","250","RC","0904-6573-04","NDC","","","facility","both","1","EA","","3.87","3.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 100 Blister Pack In 1 Carton (0904-6475-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6475-61","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisacodyl: 10 Blister Pack In 1 Box (0904-6407-61)  / 10 Tablet, Delayed Release In 1 Blister Pack","250","RC","0904-6407-61","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Blister Pack In 1 Carton (0904-6374-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6374-61","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Blister Pack In 1 Carton (0904-6373-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6373-61","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6371-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6371-61","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6370-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6370-61","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Major Regular Strength Assorted Flavors: 150 Tablet, Chewable In 1 Bottle, Plastic (0904-6412-92)","250","RC","0904-6412-92","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6363-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-6363-61","NDC","","","facility","both","1","EA","","1.24","1.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Tablet In 1 Box, Unit-Dose (0904-6362-61)","250","RC","0904-6362-61","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Tablet In 1 Box, Unit-Dose (0904-6360-61)","250","RC","0904-6360-61","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Tablet In 1 Box, Unit-Dose (0904-6359-61)","250","RC","0904-6359-61","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Tablet In 1 Box, Unit-Dose (0904-6358-61)","250","RC","0904-6358-61","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6369-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6369-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tizanidine: 100 Blister Pack In 1 Carton (0904-6418-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6418-61","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 100 Blister Pack In 1 Carton (0904-6474-61)  / 1 Tablet, Delayed Release In 1 Blister Pack","250","RC","0904-6474-61","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6470-61)  / 1 CAPSULE, EXTENDED RELEASE in 1 BLISTER PACK","250","RC","0904-6470-61","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6469-61)  / 1 CAPSULE, EXTENDED RELEASE in 1 BLISTER PACK","250","RC","0904-6469-61","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6468-61)  / 1 CAPSULE, EXTENDED RELEASE in 1 BLISTER PACK","250","RC","0904-6468-61","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clopidogrel: 20 Blister Pack In 1 Carton (0904-6467-10)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6467-10","NDC","","","facility","both","1","EA","","8.95","8.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clopidogrel: 30 Blister Pack In 1 Carton (0904-6467-07)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6467-07","NDC","","","facility","both","1","EA","","13.24","13.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6454-61)  / 1 CAPSULE, DELAYED RELEASE in 1 BLISTER PACK","250","RC","0904-6454-61","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine Hydrochloride: 30 BLISTER PACK in 1 CARTON (0904-6452-04)  / 1 CAPSULE, DELAYED RELEASE in 1 BLISTER PACK","250","RC","0904-6452-04","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Mononitrate: 100 Blister Pack In 1 Carton (0904-6450-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-6450-61","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Mononitrate: 100 Blister Pack In 1 Carton (0904-6449-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-6449-61","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6442-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6442-61","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6441-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6441-61","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Escitalopram: 100 Blister Pack In 1 Carton (0904-6427-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6427-61","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Escitalopram: 100 Blister Pack In 1 Carton (0904-6426-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6426-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"PEG 3350: 17 g in 1 PACKET (0904-6422-86) ","250","RC","0904-6422-86","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Perphenazine: 100 Blister Pack In 1 Carton (0904-6600-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6600-61","NDC","","","facility","both","1","EA","","1.58","1.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 100 Blister Pack In 1 Carton (0904-6352-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6352-61","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6780-61)  / 1 Tablet, Coated In 1 Blister Pack","250","RC","0904-6780-61","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6779-61)  / 1 Tablet, Coated In 1 Blister Pack","250","RC","0904-6779-61","NDC","","","facility","both","1","EA","","1.78","1.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6778-61)  / 1 Tablet, Coated In 1 Blister Pack","250","RC","0904-6778-61","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6773-61)  / 10 Tablet In 1 Blister Pack","250","RC","0904-6773-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Loratadine Oral: 1 Bottle In 1 Carton (0904-6767-20)  / 120 Ml In 1 Bottle","250","RC","0904-6767-20","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6781-61)  / 1 Tablet, Coated In 1 Blister Pack","250","RC","0904-6781-61","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"mintox: 355 mL in 1 BOTTLE (0904-6764-14) ","250","RC","0904-6764-14","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin Low Dose: 1000 Tablet, Delayed Release In 1 Bottle, Plastic (0904-6751-80)","250","RC","0904-6751-80","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6730-61)  / 10 Tablet In 1 Blister Pack","250","RC","0904-6730-61","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sennosides: 1 Bottle In 1 Carton (0904-6725-59)  / 100 Tablet, Film Coated In 1 Bottle","250","RC","0904-6725-59","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 500 Tablet In 1 Bottle (0904-6720-40)","250","RC","0904-6720-40","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mucus Relief Er: 100 Blister Pack In 1 Carton (0904-6718-39)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-6718-39","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cetirizine: 100 Blister Pack In 1 Carton (0904-6717-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6717-61","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nasal Decongestant: 1 Bottle, Spray In 1 Carton (0904-6761-30)  / 30 Ml In 1 Bottle, Spray","250","RC","0904-6761-30","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 100 Blister Pack In 1 Carton (0904-6782-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6782-61","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6818-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6818-61","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 50 Blister Pack In 1 Carton (0904-6818-06)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6818-06","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6817-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6817-61","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 50 Blister Pack In 1 Carton (0904-6817-06)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6817-06","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Montelukast Sodium: 100 Blister Pack In 1 Carton (0904-6808-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6808-61","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Blister Pack In 1 Carton (0904-6798-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6798-61","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Blister Pack In 1 Carton (0904-6797-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6797-61","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin Low Dose Chewable Orange: 1000 Tablet, Chewable In 1 Package (0904-6794-80)","250","RC","0904-6794-80","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin Low Dose Chewable Orange: 300 Blister Pack In 1 Carton (0904-6794-30)  / 1 Tablet, Chewable In 1 Blister Pack","250","RC","0904-6794-30","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Modafinil: 30 Blister Pack In 1 Carton (0904-6791-04)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6791-04","NDC","","","facility","both","1","EA","","7.3","7.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Blister Pack In 1 Carton (0904-6799-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6799-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cetirizine: 1 Bottle In 1 Carton (0904-6717-60)  / 100 Tablet, Film Coated In 1 Bottle","250","RC","0904-6717-60","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 100 Blister Pack In 1 Carton (0904-6709-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6709-61","NDC","","","facility","both","1","EA","","1.78","1.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6640-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6640-61","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6639-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6639-61","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6638-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6638-61","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glipizide: 100 Blister Pack In 1 Carton (0904-6637-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6637-61","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride: 100 Blister Pack In 1 Carton (0904-6635-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6635-61","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6641-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6641-61","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"amantadine hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-6630-61)  / 1 CAPSULE in 1 BLISTER PACK","250","RC","0904-6630-61","NDC","","","facility","both","1","EA","","2.69","2.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ear Drops Major: 1 Bottle In 1 Carton (0904-6627-35)  / 15 Ml In 1 Bottle","250","RC","0904-6627-35","NDC","","","facility","both","1","EA","","2.52","2.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Blister Pack In 1 Carton (0904-6624-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6624-61","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyridostigmine Bromide: 100 Blister Pack In 1 Carton (0904-6622-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6622-61","NDC","","","facility","both","1","EA","","1.9","1.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Blister Pack In 1 Carton (0904-6620-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6620-61","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Blister Pack In 1 Carton (0904-6619-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6619-61","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6642-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6642-61","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"azithromycin monohydrate: 5 BLISTER PACK in 1 CARTON (0904-6708-06)  / 10 TABLET in 1 BLISTER PACK","250","RC","0904-6708-06","NDC","","","facility","both","1","EA","","2.06","2.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevelamer Carbonate: 100 Blister Pack In 1 Carton (0904-6707-82)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6707-82","NDC","","","facility","both","1","EA","","5.92","5.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 50 Blister Pack In 1 Carton (0904-6705-06)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6705-06","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mintox Plus Tabs: 100 Tablet, Chewable In 1 Bottle (0904-6700-60)","250","RC","0904-6700-60","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 1 Bottle, Plastic In 1 Carton (0904-6678-40)  / 500 Ml In 1 Bottle, Plastic","250","RC","0904-6678-40","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sildenafil: 50 Blister Pack In 1 Carton (0904-6671-06)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6671-06","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sildenafil: 30 Blister Pack In 1 Carton (0904-6671-04)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6671-04","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Blister Pack In 1 Carton (0904-6667-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6667-61","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Blister Pack In 1 Carton (0904-6666-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6666-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Blister Pack In 1 Carton (0904-6665-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6665-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 100 Blister Pack In 1 Carton (0904-6663-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6663-61","NDC","","","facility","both","1","EA","","4.63","4.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Mapap: 4 Blister Pack In 1 Carton (0904-6645-24)  / 6 Tablet, Chewable In 1 Blister Pack","250","RC","0904-6645-24","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6643-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6643-61","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6615-61)  / 1 Capsule, Delayed Release In 1 Blister Pack","250","RC","0904-6615-61","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 100 Blister Pack In 1 Carton (0904-6351-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6351-61","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box (0904-2056-61)  / 10 Capsule In 1 Blister Pack","250","RC","0904-2056-61","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bismatrol: 5 BLISTER PACK in 1 CARTON (0904-1315-46)  / 6 TABLET, CHEWABLE in 1 BLISTER PACK","250","RC","0904-1315-46","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate: 30 Blister Pack In 1 Carton (0904-0428-04)  / 1 Capsule In 1 Blister Pack","250","RC","0904-0428-04","NDC","","","facility","both","1","EA","","2.39","2.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-0202-61)  / 1 TABLET, FILM COATED in 1 BLISTER PACK","250","RC","0904-0202-61","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"ROBAFEN COUGH FORMULA: 473 mL in 1 BOTTLE (0904-0061-16) ","250","RC","0904-0061-16","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oil: 473 Ml In 1 Bottle, Plastic (0869-0831-43)","250","RC","0869-0831-43","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0832-7123-89","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (0832-6056-12)","250","RC","0832-6056-12","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0832-6020-89","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0832-6019-89","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluvoxamine Maleate: 100 Tablet, Film Coated In 1 Bottle (0832-1672-11)","250","RC","0832-1672-11","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluvoxamine Maleate: 100 Tablet, Film Coated In 1 Bottle (0832-1671-11)","250","RC","0832-1671-11","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fiber Tabs: 90 Tablet, Film Coated In 1 Bottle (0904-2500-91)","250","RC","0904-2500-91","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxazosin: 100 Blister Pack In 1 Carton (0904-5523-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-5523-61","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxazosin: 100 Blister Pack In 1 Carton (0904-5522-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-5522-61","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pentoxifylline: 100 Blister Pack In 1 Carton (0904-5448-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-5448-61","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acid Gone Antacid Extra Strength: 100 Tablet, Chewable In 1 Bottle (0904-5365-60)","250","RC","0904-5365-60","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Banophen: 1 Tube In 1 Carton (0904-5354-31)  / 28 G In 1 Tube","250","RC","0904-5354-31","NDC","","","facility","both","1","EA","","2.98","2.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sudogest: 1 Bottle, Plastic In 1 Carton (0904-5053-59)  / 100 Tablet, Film Coated In 1 Bottle, Plastic","250","RC","0904-5053-59","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calamine: 177 Ml In 1 Bottle, Plastic (0904-2533-21)","250","RC","0904-2533-21","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 BLISTER PACK in 1 CARTON (0904-5046-61)  / 1 TABLET in 1 BLISTER PACK","250","RC","0904-5046-61","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 TABLET in 1 BOX, UNIT-DOSE (0904-3990-61) ","250","RC","0904-3990-61","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0904-3865-75","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 100 Blister Pack In 1 Carton (0904-3854-61)  / 1 Tablet, Chewable In 1 Blister Pack","250","RC","0904-3854-61","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Earwax Removal Aid: 1 BOTTLE, DISPENSING in 1 CARTON (0904-3220-35)  / 15 mL in 1 BOTTLE, DISPENSING","250","RC","0904-3220-35","NDC","","","facility","both","1","EA","","2.19","2.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 100 Blister Pack In 1 Carton (0904-2725-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-2725-61","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 BLISTER PACK in 1 CARTON (0904-5045-61)  / 1 TABLET in 1 BLISTER PACK","250","RC","0904-5045-61","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0832-1219-89","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jantoven: 100 Blister Pack In 1 Carton (0832-1219-01)  / 1 Tablet In 1 Blister Pack (0832-1219-89)","250","RC","0832-1219-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jantoven: 100 Tablet In 1 Bottle (0832-1219-00)","250","RC","0832-1219-00","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valproic Acid: 100 Capsule In 1 Bottle (0832-0310-11)","250","RC","0832-0310-11","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0832-0038-89","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calmoseptine: 113 G In 1 Tube (0799-0001-04)","250","RC","0799-0001-04","NDC","","","facility","both","1","EA","","8.75","8.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-9407-78","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 Tablet In 1 Bottle (0781-8075-01)","250","RC","0781-8075-01","NDC","","","facility","both","1","EA","","2.33","2.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 Tablet In 1 Bottle (0781-8052-01)","250","RC","0781-8052-01","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nyamyc: 1 Bottle, Plastic In 1 Carton (0832-0465-15)  / 15 G In 1 Bottle, Plastic","250","RC","0832-0465-15","NDC","","","facility","both","1","EA","","17.57","17.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin G Sodium: 10 Vial In 1 Carton (0781-6153-95)  / 1 Injection, Powder, For Solution In 1 Vial (0781-6153-94)","250","RC","0781-6153-95","NDC","","","facility","both","1","EA","","6.51","6.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-6153-94","NDC","","","facility","both","1","EA","","6.85","6.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin G Potassium: 10 Vial In 1 Carton (0781-6135-95)  / 1 Injection, Powder, For Solution In 1 Vial (0781-6135-94)","250","RC","0781-6135-95","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clarithromycin: 100 Ml In 1 Bottle (0781-6023-46)","250","RC","0781-6023-46","NDC","","","facility","both","1","EA","","2.1","2.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diluent: 1 Vial In 1 Carton (0781-6021-94)  / 50 Ml In 1 Vial","250","RC","0781-6021-94","NDC","","","facility","both","1","EA","","13.19","13.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa, Levodopa, And Entacapone: 100 Tablet, Film Coated In 1 Bottle (0781-5669-01)","250","RC","0781-5669-01","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 30 Tablet, Film Coated In 1 Bottle (0781-5668-31)","250","RC","0781-5668-31","NDC","","","facility","both","1","EA","","2.37","2.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-7515-14","NDC","","","facility","both","1","EA","","4.79","4.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0832-0512-89","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 100 Tablet In 1 Bottle (0832-0540-11)","250","RC","0832-0540-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0832-1218-89","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jantoven: 100 Blister Pack In 1 Carton (0832-1218-01)  / 1 Tablet In 1 Blister Pack (0832-1218-89)","250","RC","0832-1218-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jantoven: 100 Tablet In 1 Bottle (0832-1218-00)","250","RC","0832-1218-00","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0832-1216-89","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jantoven: 100 Blister Pack In 1 Carton (0832-1216-01)  / 1 Tablet In 1 Blister Pack (0832-1216-89)","250","RC","0832-1216-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0832-1214-89","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jantoven: 100 Blister Pack In 1 Carton (0832-1214-01)  / 1 Tablet In 1 Blister Pack (0832-1214-89)","250","RC","0832-1214-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jantoven: 100 Tablet In 1 Bottle (0832-1214-00)","250","RC","0832-1214-00","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0832-1213-89","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jantoven: 100 Blister Pack In 1 Carton (0832-1213-01)  / 1 Tablet In 1 Blister Pack (0832-1213-89)","250","RC","0832-1213-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0832-1212-89","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jantoven: 100 Blister Pack In 1 Carton (0832-1212-01)  / 1 Tablet In 1 Blister Pack (0832-1212-89)","250","RC","0832-1212-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0832-1211-89","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jantoven: 100 Blister Pack In 1 Carton (0832-1211-01)  / 1 Tablet In 1 Blister Pack (0832-1211-89)","250","RC","0832-1211-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenoxylate hydrochloride and atropine sulfate: 100 TABLET in 1 BOTTLE (0832-0590-11) ","250","RC","0832-0590-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxazosin: 100 Blister Pack In 1 Carton (0904-5524-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-5524-61","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heartburn Relief Original Strength: 1 Bottle In 1 Carton (0904-5529-52)  / 60 Tablet, Film Coated In 1 Bottle","250","RC","0904-5529-52","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6290-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6290-61","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 100 Blister Pack In 1 Carton (0904-6286-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6286-61","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 50 Blister Pack In 1 Carton (0904-6286-06)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6286-06","NDC","","","facility","both","1","EA","","1.2","1.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 100 Blister Pack In 1 Carton (0904-6283-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6283-61","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone: 80 Blister Pack In 1 Carton (0904-6272-45)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6272-45","NDC","","","facility","both","1","EA","","3.29","3.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone: 80 Blister Pack In 1 Carton (0904-6271-45)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6271-45","NDC","","","facility","both","1","EA","","2.89","2.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone: 80 Blister Pack In 1 Carton (0904-6269-45)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6269-45","NDC","","","facility","both","1","EA","","2.96","2.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"loperamide hydrochloride: 120 mL in 1 BOTTLE (0904-6256-20) ","250","RC","0904-6256-20","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-6238-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6238-61","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa and Levodopa: 100 BLISTER PACK in 1 CARTON (0904-6237-61)  / 1 TABLET in 1 BLISTER PACK","250","RC","0904-6237-61","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 100 Blister Pack In 1 Carton (0904-6221-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6221-61","NDC","","","facility","both","1","EA","","4.95","4.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 100 Blister Pack In 1 Carton (0904-6172-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6172-61","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6291-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6291-61","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atorvastatin Calcium: 50 Blister Pack In 1 Carton (0904-6292-06)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6292-06","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6324-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","250","RC","0904-6324-61","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6323-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","250","RC","0904-6323-61","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6322-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","250","RC","0904-6322-61","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 50 Blister Pack In 1 Carton (0904-6322-06)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","250","RC","0904-6322-06","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sore Throat Cherry: 177 Ml In 1 Bottle, Spray (0904-6305-21)","250","RC","0904-6305-21","NDC","","","facility","both","1","EA","","3.36","3.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6303-61)","250","RC","0904-6303-61","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6302-61)","250","RC","0904-6302-61","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6301-61)","250","RC","0904-6301-61","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6300-61)","250","RC","0904-6300-61","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clopidogrel: 100 Blister Pack In 1 Carton (0904-6294-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6294-61","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atorvastatin Calcium: 30 Blister Pack In 1 Carton (0904-6293-04)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6293-04","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6292-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6292-61","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Citalopram: 100 Blister Pack In 1 Carton (0904-6085-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6085-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Blister Pack In 1 Carton (0904-6823-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6823-61","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Blister Pack In 1 Carton (0904-5785-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-5785-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Blister Pack In 1 Carton (0904-5784-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-5784-61","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicorelief: 50 BLISTER PACK in 1 CARTON (0904-5736-51)  / 1 GUM, CHEWING in 1 BLISTER PACK","250","RC","0904-5736-51","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Petroleum Skin Protectant: 368 G In 1 Jar (0904-5731-82)","250","RC","0904-5731-82","NDC","","","facility","both","1","EA","","5.3","5.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 100 Blister Pack In 1 Carton (0904-5789-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-5789-61","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nasal: 30 mL in 1 BOTTLE, SPRAY (0904-5711-35) ","250","RC","0904-5711-35","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (0904-5677-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-5677-61","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (0904-5676-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-5676-61","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"ENALAPRIL MALEATE: 100 BLISTER PACK in 1 CARTON (0904-5611-61)  / 1 TABLET in 1 BLISTER PACK","250","RC","0904-5611-61","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"ENALAPRIL MALEATE: 100 BLISTER PACK in 1 CARTON (0904-5609-61)  / 1 TABLET in 1 BLISTER PACK","250","RC","0904-5609-61","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Banophen: 1 Bottle, Plastic In 1 Carton (0904-5551-59)  / 100 Tablet, Film Coated In 1 Bottle, Plastic","250","RC","0904-5551-59","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nasal: 15 mL in 1 BOTTLE, SPRAY (0904-5711-30) ","250","RC","0904-5711-30","NDC","","","facility","both","1","EA","","2.15","2.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Mapap: 1 Bottle, Plastic In 1 Carton (0904-5791-46)  / 30 Tablet, Chewable In 1 Bottle, Plastic","250","RC","0904-5791-46","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 100 Blister Pack In 1 Carton (0904-5853-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-5853-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zolpidem Tartrate: 100 Blister Pack In 1 Carton (0904-6082-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6082-61","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 100 Blister Pack In 1 Carton (0904-6009-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6009-61","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 100 Blister Pack In 1 Carton (0904-6008-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6008-61","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 100 Blister Pack In 1 Carton (0904-6007-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6007-61","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin Hydrochloride: 100 Blister Pack In 1 Carton (0904-5959-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-5959-61","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-5929-61)  / 1 TABLET, FILM COATED in 1 BLISTER PACK","250","RC","0904-5929-61","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Digoxin: 100 Blister Pack In 1 Carton (0904-5922-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-5922-61","NDC","","","facility","both","1","EA","","1.58","1.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Digoxin: 100 Blister Pack In 1 Carton (0904-5921-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-5921-61","NDC","","","facility","both","1","EA","","1.43","1.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5892-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-5892-61","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5891-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-5891-61","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 100 Blister Pack In 1 Carton (0904-5855-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-5855-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 100 Blister Pack In 1 Carton (0904-5854-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-5854-61","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Citalopram: 100 Blister Pack In 1 Carton (0904-6084-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6084-61","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0904-6828-05","NDC","","","facility","both","1","EA","","3.71","3.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meclizine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7375-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7375-61","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 100 Blister Pack In 1 Carton (0904-7367-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7367-61","NDC","","","facility","both","1","EA","","7.29","7.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Carton (0904-7365-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7365-61","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Carton (0904-7364-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7364-61","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Carton (0904-7363-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7363-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Carton (0904-7362-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7362-61","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Carton (0904-7361-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7361-61","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Blister Pack In 1 Carton (0904-7355-04)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7355-04","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 100 Blister Pack In 1 Carton (0904-7350-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7350-61","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 50 Blister Pack In 1 Carton (0904-7350-06)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7350-06","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Blister Pack In 1 Carton (0904-7346-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7346-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Blister Pack In 1 Carton (0904-7345-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7345-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meclizine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7376-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7376-61","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Maleate: 50 Blister Pack In 1 Carton (0904-7382-06)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7382-06","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sucralfate: 10 Ml In 1 Cup, Unit-Dose (0904-7470-66)","250","RC","0904-7470-66","NDC","","","facility","both","1","EA","","9.15","9.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 50 Blister Pack In 1 Carton (0904-7468-06)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7468-06","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride Sr: 100 Blister Pack In 1 Carton (0904-7465-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","250","RC","0904-7465-61","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atovaquone: 5 Ml In 1 Cup, Unit-Dose (0904-7459-41)","250","RC","0904-7459-41","NDC","","","facility","both","1","EA","","37.08","37.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 100 Blister Pack In 1 Carton (0904-7458-61)  / 1 Tablet, Delayed Release In 1 Blister Pack","250","RC","0904-7458-61","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7442-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7442-61","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Major Nasal Decongestant: 1 Bottle, Pump In 1 Carton (0904-7427-30)  / 30 Ml In 1 Bottle, Pump","250","RC","0904-7427-30","NDC","","","facility","both","1","EA","","3.12","3.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (0904-7418-44)","250","RC","0904-7418-44","NDC","","","facility","both","1","EA","","3.73","3.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Blister Pack In 1 Carton (0904-7411-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7411-61","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 100 Blister Pack In 1 Carton (0904-7389-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7389-61","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tamsulosin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7383-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7383-61","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7449-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7449-61","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0904-7337-35","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0904-7327-62","NDC","","","facility","both","1","EA","","1.49","1.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0904-7265-41","NDC","","","facility","both","1","EA","","5.74","5.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 100 Blister Pack In 1 Carton (0904-7263-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7263-61","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 100 Blister Pack In 1 Carton (0904-7262-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7262-61","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-7257-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7257-61","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sennosides: 10 Blister Pack In 1 Box, Unit-Dose (0904-7252-61)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7252-61","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sennosides: 100 Tablet, Film Coated In 1 Bottle (0904-7252-60)","250","RC","0904-7252-60","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0904-7266-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7266-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7247-68)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7247-68","NDC","","","facility","both","1","EA","","3.24","3.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7244-68)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7244-68","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7243-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7243-61","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Megestrol Acetate: 100 Blister Pack In 1 Carton (0904-7236-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7236-61","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 100 Blister Pack In 1 Carton (0904-7227-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7227-61","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folic Acid: 100 Blister Pack In 1 Carton (0904-7224-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7224-61","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (0904-7220-61)  / 1 Capsule, Extended Release In 1 Blister Pack","250","RC","0904-7220-61","NDC","","","facility","both","1","EA","","2.1","2.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0904-7276-41","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0904-7325-62","NDC","","","facility","both","1","EA","","3.5","3.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7308-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7308-61","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7307-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7307-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7306-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7306-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7305-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7305-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7304-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7304-61","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 100 Blister Pack In 1 Carton (0904-7293-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-7293-61","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 100 Blister Pack In 1 Carton (0904-7292-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-7292-61","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 100 Blister Pack In 1 Carton (0904-7289-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7289-61","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 100 Blister Pack In 1 Carton (0904-7288-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7288-61","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0904-7279-66","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0904-7278-41","NDC","","","facility","both","1","EA","","1.24","1.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 5 Tray In 1 Case (0904-7276-92)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0904-7276-41)","250","RC","0904-7276-92","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 100 Blister Pack In 1 Carton (0904-7496-61)  / 1 Tablet, Coated In 1 Blister Pack","250","RC","0904-7496-61","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-7501-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7501-61","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0944-0495-06","NDC","","","facility","both","1","EA","","12.93","12.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0944-0495-06","NDC","","","facility","both","1","EA","","20.64","20.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0944-0495-06","NDC","","","facility","both","1","EA","","24.49","24.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 2 Bag In 1 Carton (0944-0495-05)  / 250 Ml In 1 Bag (0944-0495-06)","250","RC","0944-0495-05","NDC","","","facility","both","1","EA","","12.67","12.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 2 Bag In 1 Carton (0944-0495-05)  / 250 Ml In 1 Bag (0944-0495-06)","250","RC","0944-0495-05","NDC","","","facility","both","1","EA","","24.84","24.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 2 Bag In 1 Carton (0944-0495-05)  / 250 Ml In 1 Bag (0944-0495-06)","250","RC","0944-0495-05","NDC","","","facility","both","1","EA","","57.15","57.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0944-0493-04","NDC","","","facility","both","1","EA","","55.23","55.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-02)  / 10 Ml In 1 Bottle, Glass (0944-2700-08)","250","RC","0944-2700-02","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06)  / 200 Ml In 1 Bottle, Glass (0944-2700-12)","250","RC","0944-2700-06","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06)  / 200 Ml In 1 Bottle, Glass (0944-2700-12)","250","RC","0944-2700-06","NDC","","","facility","both","1","EA","","70.38","70.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-05)  / 100 Ml In 1 Bottle, Glass (0944-2700-11)","250","RC","0944-2700-05","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04)  / 50 Ml In 1 Bottle, Glass (0944-2700-10)","250","RC","0944-2700-04","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04)  / 50 Ml In 1 Bottle, Glass (0944-2700-10)","250","RC","0944-2700-04","NDC","","","facility","both","1","EA","","70.38","70.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0944-0493-04","NDC","","","facility","both","1","EA","","64.58","64.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (0904-7219-61)  / 1 Capsule, Extended Release In 1 Blister Pack","250","RC","0904-7219-61","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 3000 Ml In 1 Bag (0941-0413-04)","250","RC","0941-0413-04","NDC","","","facility","both","1","EA","","25.36","25.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 6000 Ml In 1 Bag (0941-0413-01)","250","RC","0941-0413-01","NDC","","","facility","both","1","EA","","52.71","52.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 6000 Ml In 1 Bag (0941-0411-11)","250","RC","0941-0411-11","NDC","","","facility","both","1","EA","","42.6","42.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 2000 Ml In 1 Bag (0941-0411-06)","250","RC","0941-0411-06","NDC","","","facility","both","1","EA","","25.73","25.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 1000 Ml In 1 Bag (0941-0411-05)","250","RC","0941-0411-05","NDC","","","facility","both","1","EA","","15.67","15.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 3000 Ml In 1 Bag (0941-0411-04)","250","RC","0941-0411-04","NDC","","","facility","both","1","EA","","18.6","18.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Low Calcium With Dextrose: 2000 Ml In 1 Bag (0941-0409-06)","250","RC","0941-0409-06","NDC","","","facility","both","1","EA","","5","5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Low Calcium With Dextrose: 3000 Ml In 1 Bag (0941-0409-05)","250","RC","0941-0409-05","NDC","","","facility","both","1","EA","","15.76","15.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Low Calcium With Dextrose: 6000 Ml In 1 Bag (0941-0409-01)","250","RC","0941-0409-01","NDC","","","facility","both","1","EA","","32.4","32.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 1000 Ml In 1 Bag (0941-0413-05)","250","RC","0941-0413-05","NDC","","","facility","both","1","EA","","17.82","17.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 10 Blister Pack In 1 Carton (0904-7914-61)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7914-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 100 Blister Pack In 1 Carton (0904-7728-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7728-61","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acid Gone Antacid: 355 Ml In 1 Bottle (0904-7727-14)","250","RC","0904-7727-14","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 100 Blister Pack In 1 Carton (0904-7511-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7511-61","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cetirizine: 100 Blister Pack In 1 Carton (0904-7510-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7510-61","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin Low Dose Chewable Orange: 300 Blister Pack In 1 Carton (0904-7509-30)  / 1 Tablet, Chewable In 1 Blister Pack","250","RC","0904-7509-30","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride Xl: 100 Blister Pack In 1 Carton (0904-7505-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-7505-61","NDC","","","facility","both","1","EA","","2.13","2.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 2000 Ml In 1 Bag (0941-0413-06)","250","RC","0941-0413-06","NDC","","","facility","both","1","EA","","15.07","15.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 6000 Ml In 1 Bag (0941-0415-01)","250","RC","0941-0415-01","NDC","","","facility","both","1","EA","","7.63","7.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 3000 Ml In 1 Bag (0941-0415-04)","250","RC","0941-0415-04","NDC","","","facility","both","1","EA","","3.24","3.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0944-0493-03","NDC","","","facility","both","1","EA","","57.15","57.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 6 Bag In 1 Carton (0944-0493-02)  / 100 Ml In 1 Bag (0944-0493-04)","250","RC","0944-0493-02","NDC","","","facility","both","1","EA","","57.15","57.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 12 Bag In 1 Carton (0944-0493-01)  / 50 Ml In 1 Bag (0944-0493-03)","250","RC","0944-0493-01","NDC","","","facility","both","1","EA","","56.38","56.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 12 Bag In 1 Carton (0944-0493-01)  / 50 Ml In 1 Bag (0944-0493-03)","250","RC","0944-0493-01","NDC","","","facility","both","1","EA","","57.15","57.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Low Calcium With Dextrose: 2000 Ml In 1 Bag (0941-0459-08)","250","RC","0941-0459-08","NDC","","","facility","both","1","EA","","14.46","14.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Low Calcium With Dextrose: 3000 Ml In 1 Bag (0941-0459-02)","250","RC","0941-0459-02","NDC","","","facility","both","1","EA","","5.43","5.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Low Calcium With Dextrose: 2000 Ml In 1 Bag (0941-0457-08)","250","RC","0941-0457-08","NDC","","","facility","both","1","EA","","3.98","3.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Low Calcium With Dextrose: 3000 Ml In 1 Bag (0941-0457-02)","250","RC","0941-0457-02","NDC","","","facility","both","1","EA","","14.2","14.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Low Calcium With Dextrose: 6000 Ml In 1 Bag (0941-0457-01)","250","RC","0941-0457-01","NDC","","","facility","both","1","EA","","16.38","16.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Low Calcium With Dextrose: 2500 Ml In 1 Bag (0941-0433-53)","250","RC","0941-0433-53","NDC","","","facility","both","1","EA","","22.5","22.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Low Calcium With Dextrose: 2500 Ml In 1 Bag (0941-0430-53)","250","RC","0941-0430-53","NDC","","","facility","both","1","EA","","17.95","17.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 2500 Ml In 1 Bag (0941-0429-53)","250","RC","0941-0429-53","NDC","","","facility","both","1","EA","","22.5","22.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 2500 Ml In 1 Bag (0941-0427-53)","250","RC","0941-0427-53","NDC","","","facility","both","1","EA","","18","18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 2500 Ml In 1 Bag (0941-0426-53)","250","RC","0941-0426-53","NDC","","","facility","both","1","EA","","15.94","15.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Low Calcium With Dextrose: 2500 Ml In 1 Bag (0941-0424-53)","250","RC","0941-0424-53","NDC","","","facility","both","1","EA","","17.43","17.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Low Calcium With Dextrose: 2000 Ml In 1 Bag (0941-0424-52)","250","RC","0941-0424-52","NDC","","","facility","both","1","EA","","17.1","17.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 2000 Ml In 1 Bag (0941-0415-06)","250","RC","0941-0415-06","NDC","","","facility","both","1","EA","","9.5","9.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dianeal Pd-2 With Dextrose: 1000 Ml In 1 Bag (0941-0415-05)","250","RC","0941-0415-05","NDC","","","facility","both","1","EA","","6.64","6.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0944-0493-03","NDC","","","facility","both","1","EA","","52.42","52.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (0904-7218-61)  / 1 Capsule, Extended Release In 1 Blister Pack","250","RC","0904-7218-61","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (0904-7217-61)  / 1 Capsule, Extended Release In 1 Blister Pack","250","RC","0904-7217-61","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 30 Blister Pack In 1 Carton (0904-7016-04)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7016-04","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Blister Pack In 1 Carton (0904-7008-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7008-61","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Blister Pack In 1 Carton (0904-7007-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7007-61","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 100 Blister Pack In 1 Carton (0904-7001-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7001-61","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 100 Blister Pack In 1 Carton (0904-7000-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7000-61","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 50 Blister Pack In 1 Carton (0904-7016-06)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7016-06","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 100 Blister Pack In 1 Carton (0904-6991-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6991-61","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 30 Blister Pack In 1 Carton (0904-6991-04)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6991-04","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicyclomine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6987-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6987-61","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hcl: 118 Ml In 1 Bottle, Plastic (0904-6985-20)","250","RC","0904-6985-20","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6966-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6966-61","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6956-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6956-61","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 100 Blister Pack In 1 Carton (0904-7016-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7016-61","NDC","","","facility","both","1","EA","","1.23","1.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 100 Blister Pack In 1 Carton (0904-7044-61)  / 1 Capsule, Delayed Release In 1 Blister Pack","250","RC","0904-7044-61","NDC","","","facility","both","1","EA","","2.04","2.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 30 Blister Pack In 1 Carton (0904-7043-04)  / 1 Capsule, Delayed Release In 1 Blister Pack","250","RC","0904-7043-04","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amantadine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7042-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7042-61","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amantadine Hydrochloride: 50 Blister Pack In 1 Carton (0904-7042-06)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7042-06","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 100 Blister Pack In 1 Carton (0904-7041-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7041-61","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clomipramine Hydrochloride: 30 Blister Pack In 1 Carton (0904-7039-07)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7039-07","NDC","","","facility","both","1","EA","","16.28","16.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Major Oral Rinse: 15 Ml In 1 Cup, Unit-Dose (0904-7035-88)","250","RC","0904-7035-88","NDC","","","facility","both","1","EA","","1.53","1.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Major Oral Rinse: 1500 Ml In 1 Package (0904-7035-80)","250","RC","0904-7035-80","NDC","","","facility","both","1","EA","","1.54","1.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 100 Blister Pack In 1 Carton (0904-7027-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7027-61","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prazosin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7021-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7021-61","NDC","","","facility","both","1","EA","","1.95","1.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prazosin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7020-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7020-61","NDC","","","facility","both","1","EA","","1.72","1.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naltrexone Hydrochloride: 30 Blister Pack In 1 Carton (0904-7036-04)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7036-04","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6955-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6955-61","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6954-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6954-61","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorthalidone: 100 Blister Pack In 1 Carton (0904-6900-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6900-61","NDC","","","facility","both","1","EA","","2.42","2.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 30 Blister Pack In 1 Carton (0904-6890-04)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6890-04","NDC","","","facility","both","1","EA","","3.35","3.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Minocycline Hydrochloride: 50 Blister Pack In 1 Carton (0904-6888-06)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6888-06","NDC","","","facility","both","1","EA","","1.23","1.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 80 Blister Pack In 1 Carton (0904-6870-45)  / 1 Tablet, Delayed Release In 1 Blister Pack","250","RC","0904-6870-45","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6869-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6869-61","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pseudoephedrine Hydrochloride: 5 Blister Pack In 1 Box (0904-6907-06)  / 10 Tablet In 1 Blister Pack","250","RC","0904-6907-06","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6868-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6868-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6861-61)  / 1 Tablet, Delayed Release In 1 Blister Pack","250","RC","0904-6861-61","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6860-61)  / 1 Tablet, Delayed Release In 1 Blister Pack","250","RC","0904-6860-61","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 1 Bottle In 1 Carton (0904-6852-89)  / 90 Tablet In 1 Bottle","250","RC","0904-6852-89","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 100 Blister Pack In 1 Carton (0904-6852-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6852-61","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loperamide Hydrochloride: 120 Ml In 1 Bottle (0904-6836-20)","250","RC","0904-6836-20","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Finasteride: 100 Blister Pack In 1 Carton (0904-6830-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6830-61","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Finasteride: 50 Blister Pack In 1 Carton (0904-6830-06)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6830-06","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone: 100 Blister Pack In 1 Carton (0904-6914-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6914-61","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6953-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6953-61","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6952-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6952-61","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6951-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6951-61","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6950-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6950-61","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyurea: 100 Blister Pack In 1 Carton (0904-6939-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-6939-61","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paliperidone: 100 Blister Pack In 1 Carton (0904-6936-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-6936-61","NDC","","","facility","both","1","EA","","18.98","18.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paliperidone: 100 Blister Pack In 1 Carton (0904-6935-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-6935-61","NDC","","","facility","both","1","EA","","17.01","17.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polyethylene Glycol 3350: 17 G In 1 Packet (0904-6931-86)","250","RC","0904-6931-86","NDC","","","facility","both","1","EA","","1.87","1.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polyethylene Glycol 3350: 100 Packet In 1 Carton (0904-6931-81)  / 17 G In 1 Packet","250","RC","0904-6931-81","NDC","","","facility","both","1","EA","","2.33","2.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 100 Blister Pack In 1 Carton (0904-6927-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6927-61","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 100 Blister Pack In 1 Carton (0904-6926-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-6926-61","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Blister Pack In 1 Carton (0904-6923-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-6923-61","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 100 Blister Pack In 1 Carton (0904-7045-61)  / 1 Capsule, Delayed Release In 1 Blister Pack","250","RC","0904-7045-61","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxychloroquine Sulfate: 50 Blister Pack In 1 Carton (0904-7046-06)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7046-06","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxychloroquine Sulfate: 100 Blister Pack In 1 Carton (0904-7046-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7046-61","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Urea Cream 40%: 1 Bottle, Plastic In 1 Carton (0904-7167-23)  / 28.35 G In 1 Bottle, Plastic","250","RC","0904-7167-23","NDC","","","facility","both","1","EA","","37.61","37.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7162-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7162-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7158-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7158-61","NDC","","","facility","both","1","EA","","6.35","6.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 100 Blister Pack In 1 Carton (0904-7156-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7156-61","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benzonatate: 100 Blister Pack In 1 Carton (0904-7153-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7153-61","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Emtricitabine And Tenofovir Disoproxil Fumarate: 30 Blister Pack In 1 Carton (0904-7172-07)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7172-07","NDC","","","facility","both","1","EA","","2.47","2.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dronabinol: 30 Blister Pack In 1 Carton (0904-7145-04)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7145-04","NDC","","","facility","both","1","EA","","9.52","9.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sotalol Hydrochloride: 100 Blister Pack In 1 Carton (0904-7143-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7143-61","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 20 Blister Pack In 1 Carton (0904-7141-10)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7141-10","NDC","","","facility","both","1","EA","","3.84","3.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin Monohydrate/ Macrocrystalline: 100 Blister Pack In 1 Carton (0904-7137-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7137-61","NDC","","","facility","both","1","EA","","2.91","2.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7132-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7132-61","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7131-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7131-61","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 100 Blister Pack In 1 Carton (0904-7177-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7177-61","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride Sr: 100 Blister Pack In 1 Carton (0904-7214-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-7214-61","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dantrolene Sodium: 30 Blister Pack In 1 Carton (0904-7211-04)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7211-04","NDC","","","facility","both","1","EA","","1.86","1.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine: 100 Blister Pack In 1 Carton (0904-7208-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","250","RC","0904-7208-61","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Major Bismuth Subsalicylate: 5 Blister Pack In 1 Box (0904-7205-46)  / 6 Tablet, Chewable In 1 Blister Pack","250","RC","0904-7205-46","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Blister Pack In 1 Carton (0904-7200-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7200-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7194-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7194-61","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 100 Blister Pack In 1 Carton (0904-7193-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7193-61","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atenolol: 100 Blister Pack In 1 Carton (0904-7187-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7187-61","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Blister Pack In 1 Carton (0904-7185-61)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7185-61","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docusate Sodium - Stool Softener Laxative: 10 Blister Pack In 1 Carton (0904-7183-61)  / 10 Capsule, Liquid Filled In 1 Blister Pack","250","RC","0904-7183-61","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-7182-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-7182-61","NDC","","","facility","both","1","EA","","1.88","1.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 80 Blister Pack In 1 Carton (0904-7182-45)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-7182-45","NDC","","","facility","both","1","EA","","3.25","3.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 100 Blister Pack In 1 Carton (0904-7179-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7179-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7130-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7130-61","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Blister Pack In 1 Carton (0904-7127-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7127-61","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine: 50 Blister Pack In 1 Carton (0904-7081-06)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-7081-06","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 100 Blister Pack In 1 Capsule (0904-7078-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7078-61","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7077-61)  / 1 Capsule, Extended Release In 1 Blister Pack","250","RC","0904-7077-61","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7076-61)  / 1 Capsule, Extended Release In 1 Blister Pack","250","RC","0904-7076-61","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7075-61)  / 1 Capsule, Extended Release In 1 Blister Pack","250","RC","0904-7075-61","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7083-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7083-61","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nadolol: 30 Blister Pack In 1 Carton (0904-7070-07)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7070-07","NDC","","","facility","both","1","EA","","3.2","3.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Pamoate: 100 Blister Pack In 1 Carton (0904-7065-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7065-61","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 100 Blister Pack In 1 Carton (0904-7058-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7058-61","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 100 Blister Pack In 1 Carton (0904-7057-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7057-61","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losartan Potassium: 100 Blister Pack In 1 Carton (0904-7048-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7048-61","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nadolol: 30 Blister Pack In 1 Carton (0904-7071-07)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7071-07","NDC","","","facility","both","1","EA","","4.59","4.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride Xl: 100 Blister Pack In 1 Carton (0904-7084-61)  / 1 Tablet, Extended Release In 1 Blister Pack","250","RC","0904-7084-61","NDC","","","facility","both","1","EA","","2.39","2.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 100 Blister Pack In 1 Carton (0904-7126-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7126-61","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 100 Blister Pack In 1 Carton (0904-7125-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7125-61","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 100 Blister Pack In 1 Carton (0904-7124-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7124-61","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 100 Blister Pack In 1 Carton (0904-7123-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7123-61","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Blister Pack In 1 Carton (0904-7122-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7122-61","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Acetate: 50 Blister Pack In 1 Carton (0904-7119-06)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7119-06","NDC","","","facility","both","1","EA","","1.69","1.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 100 Blister Pack In 1 Carton (0904-7111-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7111-61","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 100 Blister Pack In 1 Carton (0904-7110-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7110-61","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 100 Blister Pack In 1 Carton (0904-7109-61)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0904-7109-61","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 Blister Pack In 1 Carton (0904-7106-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7106-61","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 Blister Pack In 1 Carton (0904-7105-61)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7105-61","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ezetimibe: 30 Blister Pack In 1 Carton (0904-7103-04)  / 1 Tablet In 1 Blister Pack","250","RC","0904-7103-04","NDC","","","facility","both","1","EA","","13.24","13.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Blister Pack In 1 Carton (0904-7097-61)  / 1 Capsule In 1 Blister Pack","250","RC","0904-7097-61","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-290-31","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone: 1 Vial In 1 Carton (44567-703-01)  / 100 Ml In 1 Vial","250","RC","44567-703-01","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone: 25 Vial In 1 Carton (44567-702-25)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","44567-702-25","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norepinephrine Bitartrate In Sodium Chloride: 10 Bag In 1 Carton (44567-641-10)  / 250 Ml In 1 Bag (44567-641-01)","250","RC","44567-641-10","NDC","","","facility","both","1","EA","","25.18","25.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44567-641-01","NDC","","","facility","both","1","EA","","45.7","45.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate In Sodium Chloride: 24 Pouch In 1 Carton (44567-621-24)  / 1 Bag In 1 Pouch (44567-621-01)  / 100 Ml In 1 Bag","250","RC","44567-621-24","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44567-621-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44567-620-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam In Sodium Chloride: 10 Bag In 1 Carton (44567-611-10)  / 100 Ml In 1 Bag (44567-611-01)","250","RC","44567-611-10","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44567-611-01","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44567-503-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate In Sodium Chloride: 24 Pouch In 1 Carton (44567-620-24)  / 1 Bag In 1 Pouch (44567-620-01)  / 50 Ml In 1 Bag","250","RC","44567-620-24","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44567-450-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 25 Vial In 1 Carton (44567-707-25)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","44567-707-25","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-054-36)  / 80 G In 1 Tube","250","RC","45802-054-36","NDC","","","facility","both","1","EA","","13.54","13.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-054-35)  / 15 G In 1 Tube","250","RC","45802-054-35","NDC","","","facility","both","1","EA","","6.19","6.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 454 G In 1 Jar (45802-054-05)","250","RC","45802-054-05","NDC","","","facility","both","1","EA","","42.5","42.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 1 Tube In 1 Carton (45802-048-35)  / 15 G In 1 Tube","250","RC","45802-048-35","NDC","","","facility","both","1","EA","","12.29","12.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44567-705-01","NDC","","","facility","both","1","EA","","18.33","18.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44677-0102-01","NDC","","","facility","both","1","EA","","2.92","2.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44567-820-01","NDC","","","facility","both","1","EA","","13.92","13.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial In 1 Box (44567-803-10)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","44567-803-10","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial In 1 Box (44567-801-10)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","44567-801-10","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 10 Vial In 1 Carton (44567-708-10)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","44567-708-10","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44567-851-01","NDC","","","facility","both","1","EA","","70.92","70.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 24 Pouch In 1 Carton (44567-435-24)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag","250","RC","44567-435-24","NDC","","","facility","both","1","EA","","4.6","4.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (44567-210-10)  / 10 Ml In 1 Vial","250","RC","44567-210-10","NDC","","","facility","both","1","EA","","3.56","3.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial In 1 Tray (44567-103-10)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","44567-103-10","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial In 1 Tray (44567-101-10)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","44567-101-10","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Urea: 1 Bottle, Plastic In 1 Carton (44523-617-01)  / 28.35 G In 1 Bottle, Plastic","250","RC","44523-617-01","NDC","","","facility","both","1","EA","","66.29","66.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44206-458-96","NDC","","","facility","both","1","EA","","929.05","929.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (44567-211-10)  / 20 Ml In 1 Vial","250","RC","44567-211-10","NDC","","","facility","both","1","EA","","2.94","2.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hizentra: 1 Syringe In 1 Carton (44206-458-24)  / 20 Ml In 1 Syringe (44206-458-96)","250","RC","44206-458-24","NDC","","","facility","both","1","EA","","967.88","967.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hizentra: 1 Syringe In 1 Carton (44206-457-22)  / 10 Ml In 1 Syringe (44206-457-95)","250","RC","44206-457-22","NDC","","","facility","both","1","EA","","486.07","486.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44206-456-94","NDC","","","facility","both","1","EA","","251.57","251.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hizentra: 1 Syringe In 1 Carton (44206-456-21)  / 5 Ml In 1 Syringe (44206-456-94)","250","RC","44206-456-21","NDC","","","facility","both","1","EA","","250.95","250.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44206-454-92","NDC","","","facility","both","1","EA","","949.58","949.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hizentra: 1 Vial, Single-Dose In 1 Carton (44206-454-04)  / 20 Ml In 1 Vial, Single-Dose (44206-454-92)","250","RC","44206-454-04","NDC","","","facility","both","1","EA","","949.58","949.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44206-452-91","NDC","","","facility","both","1","EA","","435.22","435.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hizentra: 1 Vial, Single-Dose In 1 Carton (44206-452-02)  / 10 Ml In 1 Vial, Single-Dose (44206-452-91)","250","RC","44206-452-02","NDC","","","facility","both","1","EA","","474.79","474.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44206-451-90","NDC","","","facility","both","1","EA","","237.4","237.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44206-457-95","NDC","","","facility","both","1","EA","","501.06","501.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 1 Vial In 1 Carton (44567-212-01)  / 100 Ml In 1 Vial","250","RC","44567-212-01","NDC","","","facility","both","1","EA","","3.87","3.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Pouch In 1 Carton (44567-421-24)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","250","RC","44567-421-24","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Pouch In 1 Carton (44567-420-24)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag","250","RC","44567-420-24","NDC","","","facility","both","1","EA","","1.78","1.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin G Potassium: 10 Vial In 1 Tray (44567-311-10)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","44567-311-10","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefoxitin: 25 Vial In 1 Carton (44567-246-25)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","44567-246-25","NDC","","","facility","both","1","EA","","5.9","5.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 10 Vial In 1 Carton (44567-241-10)  / 20 Ml In 1 Vial","250","RC","44567-241-10","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 10 Vial In 1 Carton (44567-240-10)  / 20 Ml In 1 Vial","250","RC","44567-240-10","NDC","","","facility","both","1","EA","","2.43","2.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftazidime: 6 Vial In 1 Carton (44567-237-06)  / 100 Ml In 1 Vial","250","RC","44567-237-06","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftazidime: 10 Vial In 1 Carton (44567-236-10)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","44567-236-10","NDC","","","facility","both","1","EA","","2.42","2.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftazidime: 25 Vial In 1 Carton (44567-235-25)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","44567-235-25","NDC","","","facility","both","1","EA","","2.48","2.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 454 G In 1 Jar (45802-055-05)","250","RC","45802-055-05","NDC","","","facility","both","1","EA","","34.33","34.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hizentra: 1 Vial, Single-Dose In 1 Carton (44206-451-01)  / 5 Ml In 1 Vial, Single-Dose (44206-451-90)","250","RC","44206-451-01","NDC","","","facility","both","1","EA","","237.4","237.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-055-35)  / 15 G In 1 Tube","250","RC","45802-055-35","NDC","","","facility","both","1","EA","","5.51","5.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Good Neighbor Pharmacy Nasal: 1 Bottle, Spray In 1 Carton (46122-165-10)  / 30 Ml In 1 Bottle, Spray","250","RC","46122-165-10","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludarabine Phosphate: 1 Vial, Glass In 1 Carton (45963-609-55)  / 2 Ml In 1 Vial, Glass","250","RC","45963-609-55","NDC","","","facility","both","1","EA","","94.15","94.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enulose: 473 Ml In 1 Bottle (45963-438-64)","250","RC","45963-438-64","NDC","","","facility","both","1","EA","","2.04","2.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diclofenac Sodium: 1 Tube In 1 Carton (45802-953-01)  / 100 G In 1 Tube","250","RC","45802-953-01","NDC","","","facility","both","1","EA","","16.2","16.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine Polacrilex: 3 Container In 1 Carton (45802-873-05)  / 24 Lozenge In 1 Container (45802-873-03)","250","RC","45802-873-05","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gnp Anti Itch: 212 G In 1 Bottle, Pump (46122-573-10)","250","RC","46122-573-10","NDC","","","facility","both","1","EA","","8.8","8.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","45802-873-03","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 12 Blister Pack In 1 Carton (45802-758-30)  / 1 Suppository In 1 Blister Pack (45802-758-00)","250","RC","45802-758-30","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen For Children: 100 Blister Pack In 1 Carton (45802-732-33)  / 1 Suppository In 1 Blister Pack","250","RC","45802-732-33","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen For Children: 12 Blister Pack In 1 Carton (45802-732-30)  / 1 Suppository In 1 Blister Pack","250","RC","45802-732-30","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","45802-732-00","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen Pain Reliever Fever Reducer: 12 Blister Pack In 1 Carton (45802-730-30)  / 1 Suppository In 1 Blister Pack","250","RC","45802-730-30","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Polystyrene Sulfonate: 473 Ml In 1 Bottle (46287-006-01)","250","RC","46287-006-01","NDC","","","facility","both","1","EA","","12.67","12.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Drizalma Sprinkle: 30 Capsule, Delayed Release In 1 Bottle (47335-616-30)","250","RC","47335-616-30","NDC","","","facility","both","1","EA","","12.35","12.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bicalutamide: 100 Tablet, Film Coated In 1 Bottle (47335-485-88)","250","RC","47335-485-88","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bicalutamide: 30 Tablet, Film Coated In 1 Bottle (47335-485-83)","250","RC","47335-485-83","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide Sodium: 1 Vial, Single-Dose In 1 Carton (47335-330-40)  / 18 Ml In 1 Vial, Single-Dose","250","RC","47335-330-40","NDC","","","facility","both","1","EA","","16.4","16.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ambrisentan: 30 Tablet, Film Coated In 1 Bottle (47335-237-83)","250","RC","47335-237-83","NDC","","","facility","both","1","EA","","73.96","73.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ambrisentan: 30 Tablet, Film Coated In 1 Bottle (47335-236-83)","250","RC","47335-236-83","NDC","","","facility","both","1","EA","","77.89","77.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bosentan: 60 Tablet, Film Coated In 1 Bottle (47335-038-86)","250","RC","47335-038-86","NDC","","","facility","both","1","EA","","11.65","11.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entacapone: 100 Tablet, Film Coated In 1 Bottle (47335-007-88)","250","RC","47335-007-88","NDC","","","facility","both","1","EA","","6.3","6.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tadliq: 150 Ml In 1 Bottle (46287-045-15)","250","RC","46287-045-15","NDC","","","facility","both","1","EA","","188.56","188.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","46287-020-20","NDC","","","facility","both","1","EA","","37.18","37.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carospir: 118 Ml In 1 Bottle (46287-020-04)","250","RC","46287-020-04","NDC","","","facility","both","1","EA","","12.06","12.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isoniazid: 473 Ml In 1 Bottle (46287-009-01)","250","RC","46287-009-01","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Polystyrene Sulfonate: 10 Bottle, Unit-Dose In 1 Carton (46287-006-60)  / 60 Ml In 1 Bottle, Unit-Dose","250","RC","46287-006-60","NDC","","","facility","both","1","EA","","35.13","35.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen Pain Reliever Fever Reducer: 1 Suppository In 1 Blister Pack (45802-730-00)","250","RC","45802-730-00","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (45802-700-00)  / 30 G In 1 Tube","250","RC","45802-700-00","NDC","","","facility","both","1","EA","","166","166","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Acetaminophen: 1 Bottle In 1 Carton (45802-201-26)  / 118 Ml In 1 Bottle","250","RC","45802-201-26","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole Vaginal: 1 Tube In 1 Carton (45802-139-70)  / 70 G In 1 Tube","250","RC","45802-139-70","NDC","","","facility","both","1","EA","","56.15","56.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mupirocin: 1 Tube In 1 Carton (45802-112-22)  / 22 G In 1 Tube","250","RC","45802-112-22","NDC","","","facility","both","1","EA","","11.33","11.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 60 Ml In 1 Bottle (45802-098-46)","250","RC","45802-098-46","NDC","","","facility","both","1","EA","","19.9","19.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-065-35)  / 15 G In 1 Tube","250","RC","45802-065-35","NDC","","","facility","both","1","EA","","9.7","9.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-064-36)  / 80 G In 1 Tube","250","RC","45802-064-36","NDC","","","facility","both","1","EA","","10.52","10.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-064-35)  / 15 G In 1 Tube","250","RC","45802-064-35","NDC","","","facility","both","1","EA","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-063-36)  / 80 G In 1 Tube","250","RC","45802-063-36","NDC","","","facility","both","1","EA","","13.54","13.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-063-35)  / 15 G In 1 Tube","250","RC","45802-063-35","NDC","","","facility","both","1","EA","","5.97","5.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 454 G In 1 Jar (45802-063-05)","250","RC","45802-063-05","NDC","","","facility","both","1","EA","","30.24","30.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bacitracin: 1 Tube In 1 Carton (45802-060-03)  / 28 G In 1 Tube","250","RC","45802-060-03","NDC","","","facility","both","1","EA","","4.09","4.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 1 Tube In 1 Carton (45802-059-35)  / 15 G In 1 Tube","250","RC","45802-059-35","NDC","","","facility","both","1","EA","","21.16","21.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gentamicin Sulfate: 1 Tube In 1 Carton (45802-056-35)  / 15 G In 1 Tube","250","RC","45802-056-35","NDC","","","facility","both","1","EA","","52.19","52.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-055-36)  / 80 G In 1 Tube","250","RC","45802-055-36","NDC","","","facility","both","1","EA","","7.35","7.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitroglycerin Lingual: 1 Bottle In 1 Carton (45802-210-01)  / 60 Spray In 1 Bottle","250","RC","45802-210-01","NDC","","","facility","both","1","EA","","282.14","282.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benzoyl Peroxide: 1 Tube In 1 Carton (45802-216-96)  / 60 G In 1 Tube","250","RC","45802-216-96","NDC","","","facility","both","1","EA","","18.04","18.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cetirizine Hydrochloride: 1 Bottle In 1 Carton (45802-626-26)  / 120 Ml In 1 Bottle","250","RC","45802-626-26","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin Phosphate: 1 Bottle, With Applicator In 1 Carton (45802-562-02)  / 60 Ml In 1 Bottle, With Applicator","250","RC","45802-562-02","NDC","","","facility","both","1","EA","","39","39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluocinolone Acetonide: 1 Bottle In 1 Carton (45802-485-26)  / 118.28 Ml In 1 Bottle","250","RC","45802-485-26","NDC","","","facility","both","1","EA","","66.43","66.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketoconazole: 120 Ml In 1 Bottle (45802-465-64)","250","RC","45802-465-64","NDC","","","facility","both","1","EA","","30.47","30.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 1 Tube In 1 Carton (45802-438-03)  / 28 G In 1 Tube","250","RC","45802-438-03","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextromethorphan Polistirex Extended Release: 1 Bottle In 1 Carton (45802-433-21)  / 89 Ml In 1 Bottle","250","RC","45802-433-21","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxymetazoline Hcl: 1 Bottle, Spray In 1 Carton (45802-410-59)  / 30 Ml In 1 Bottle, Spray","250","RC","45802-410-59","NDC","","","facility","both","1","EA","","3.78","3.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (45802-390-01)  / 60 G In 1 Tube","250","RC","45802-390-01","NDC","","","facility","both","1","EA","","232.42","232.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Betamethasone Dipropionate: 1 Tube In 1 Carton (45802-376-35)  / 15 G In 1 Tube","250","RC","45802-376-35","NDC","","","facility","both","1","EA","","5","5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","45802-368-00","NDC","","","facility","both","1","EA","","2.62","2.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","45802-357-58","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine Polacrilex: 3 Container In 1 Carton (45802-344-05)  / 24 Lozenge In 1 Container","250","RC","45802-344-05","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","45802-344-03","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benzoyl Peroxide: 1 Tube In 1 Carton (45802-308-96)  / 60 G In 1 Tube","250","RC","45802-308-96","NDC","","","facility","both","1","EA","","16.74","16.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 1 Tube In 1 Carton (45802-276-03)  / 28 G In 1 Tube","250","RC","45802-276-03","NDC","","","facility","both","1","EA","","2.78","2.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Vial, Multi-Dose In 1 Carton (43598-128-11)  / 8 Ml In 1 Vial, Multi-Dose","250","RC","43598-128-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-106-11","NDC","","","facility","both","1","EA","","7.04","7.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 10 Syringe, Glass In 1 Carton (43598-106-10)  / 2 Ml In 1 Syringe, Glass (43598-106-11)","250","RC","43598-106-10","NDC","","","facility","both","1","EA","","7.83","7.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-085-11","NDC","","","facility","both","1","EA","","146.91","146.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 1 Vial In 1 Carton (43598-053-11)  / 10 Ml In 1 Vial","250","RC","43598-053-11","NDC","","","facility","both","1","EA","","5.21","5.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (43598-051-11)  / 2 Ml In 1 Vial, Multi-Dose","250","RC","43598-051-11","NDC","","","facility","both","1","EA","","530.38","530.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-050-11","NDC","","","facility","both","1","EA","","2.4","2.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 100 Tablet In 1 Bottle (43547-898-10)","250","RC","43547-898-10","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 100 Tablet In 1 Bottle (43547-896-10)","250","RC","43547-896-10","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 100 Tablet In 1 Bottle (43547-689-10)","250","RC","43547-689-10","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 100 Tablet In 1 Bottle (43547-688-10)","250","RC","43547-688-10","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin And Dexamethasone: 1 Bottle, Dropper In 1 Carton (43598-326-75)  / 7.5 Ml In 1 Bottle, Dropper","250","RC","43598-326-75","NDC","","","facility","both","1","EA","","153.19","153.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cycloserine: 3 Blister Pack In 1 Carton (43598-235-31)  / 10 Capsule In 1 Blister Pack (43598-235-10)","250","RC","43598-235-31","NDC","","","facility","both","1","EA","","127.09","127.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-235-10","NDC","","","facility","both","1","EA","","127.09","127.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ssd Cream: 50 G In 1 Jar (43598-210-55)","250","RC","43598-210-55","NDC","","","facility","both","1","EA","","16.16","16.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ssd Cream: 400 G In 1 Jar (43598-210-40)","250","RC","43598-210-40","NDC","","","facility","both","1","EA","","76.56","76.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Vial, Multi-Dose In 1 Carton (43598-130-74)  / 16 Ml In 1 Vial, Multi-Dose","250","RC","43598-130-74","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ssd Cream: 25 G In 1 Tube (43598-210-25)","250","RC","43598-210-25","NDC","","","facility","both","1","EA","","7.43","7.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"amoxicillin and clavulanate potassium: 20 TABLET, FILM COATED in 1 BOTTLE (43598-206-14) ","250","RC","43598-206-14","NDC","","","facility","both","1","EA","","2.4","2.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorthalidone: 100 Tablet In 1 Bottle (43598-170-01)","250","RC","43598-170-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorthalidone: 100 Tablet In 1 Bottle (43598-167-01)","250","RC","43598-167-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 30 Tablet, Film Coated In 1 Bottle (43598-165-30)","250","RC","43598-165-30","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-160-31","NDC","","","facility","both","1","EA","","19.93","19.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 100 Tablet In 1 Bottle (43547-548-10)","250","RC","43547-548-10","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 100 Tablet In 1 Bottle (43547-546-10)","250","RC","43547-546-10","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flucytosine: 100 Capsule In 1 Bottle (43386-770-01)","250","RC","43386-770-01","NDC","","","facility","both","1","EA","","26.49","26.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Sulfate, Potassium Sulfate, Magnesium Sulfate: 2 Bottle In 1 Carton (43386-700-83)  / 177 Ml In 1 Bottle","250","RC","43386-700-83","NDC","","","facility","both","1","EA","","144.65","144.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gavilax: 510 G In 1 Bottle (43386-312-14)","250","RC","43386-312-14","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Misoprostol: 100 Tablet In 1 Bottle (43386-161-01)","250","RC","43386-161-01","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Misoprostol: 120 Tablet In 1 Bottle (43386-160-12)","250","RC","43386-160-12","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43528-003-01","NDC","","","facility","both","1","EA","","231.01","231.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (43386-096-62)  / 60 G In 1 Tube","250","RC","43386-096-62","NDC","","","facility","both","1","EA","","24.95","24.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gavilyte-N: 438.4 G In 1 Bottle (43386-050-19)","250","RC","43386-050-19","NDC","","","facility","both","1","EA","","16.09","16.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Bottle In 1 Carton (43386-038-60)  / 75 Ml In 1 Bottle","250","RC","43386-038-60","NDC","","","facility","both","1","EA","","47.38","47.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fintepla: 1 Bottle, Plastic In 1 Carton (43376-322-36)  / 360 Ml In 1 Bottle, Plastic","250","RC","43376-322-36","NDC","","","facility","both","1","EA","","579.65","579.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fintepla: 1 Bottle, Plastic In 1 Carton (43376-322-30)  / 30 Ml In 1 Bottle, Plastic","250","RC","43376-322-30","NDC","","","facility","both","1","EA","","347.79","347.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fanapt: 60 Tablet In 1 Bottle (43068-106-02)","250","RC","43068-106-02","NDC","","","facility","both","1","EA","","42.35","42.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fanapt: 60 Tablet In 1 Bottle (43068-102-02)","250","RC","43068-102-02","NDC","","","facility","both","1","EA","","46.61","46.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norepinephrine Bitartrate: 10 Vial, Single-Dose In 1 Carton (43066-997-10)  / 4 Ml In 1 Vial, Single-Dose (43066-997-01)","250","RC","43066-997-10","NDC","","","facility","both","1","EA","","3.58","3.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Misoprostol: 60 Tablet In 1 Bottle (43386-160-06)","250","RC","43386-160-06","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tadalafil: 30 Tablet In 1 Bottle (43547-049-03)","250","RC","43547-049-03","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-269-10)","250","RC","43547-269-10","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 100 Tablet In 1 Bottle (43547-545-10)","250","RC","43547-545-10","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 60 Tablet, Extended Release In 1 Bottle (43547-435-06)","250","RC","43547-435-06","NDC","","","facility","both","1","EA","","4.85","4.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losartan Potassium And Hydrochlorothiazide: 30 Tablet, Film Coated In 1 Bottle (43547-423-03)","250","RC","43547-423-03","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irbesartan: 90 Tablet In 1 Bottle (43547-376-09)","250","RC","43547-376-09","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 Tablet In 1 Bottle (43547-365-10)","250","RC","43547-365-10","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 Tablet In 1 Bottle (43547-364-10)","250","RC","43547-364-10","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (43547-360-09)","250","RC","43547-360-09","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Tablet In 1 Bottle (43547-352-10)","250","RC","43547-352-10","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Tablet In 1 Bottle (43547-351-10)","250","RC","43547-351-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 30 Tablet, Film Coated In 1 Bottle (43547-347-03)","250","RC","43547-347-03","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 60 Tablet, Film Coated, Extended Release In 1 Bottle (43547-345-06)","250","RC","43547-345-06","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 60 Tablet In 1 Bottle (43547-341-06)","250","RC","43547-341-06","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 60 Tablet In 1 Bottle (43547-339-06)","250","RC","43547-339-06","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Escitalopram: 100 Tablet, Film Coated In 1 Bottle (43547-282-10)","250","RC","43547-282-10","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irbesartan: 30 TABLET in 1 BOTTLE (43547-278-03) ","250","RC","43547-278-03","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-274-10)","250","RC","43547-274-10","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-272-10)","250","RC","43547-272-10","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-405-11","NDC","","","facility","both","1","EA","","3.49","3.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esomeprazole Magnesium: 3 Bottle In 1 Carton (43598-407-33)  / 14 Capsule, Delayed Release In 1 Bottle","250","RC","43598-407-33","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esomeprazole Magnesium: 1 Bottle In 1 Carton (43598-407-52)  / 14 Capsule, Delayed Release In 1 Bottle","250","RC","43598-407-52","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (43975-350-03)","250","RC","43975-350-03","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (43975-349-03)","250","RC","43975-349-03","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tolterodine Tartrate: 30 Capsule, Extended Release In 1 Bottle (43975-322-03)","250","RC","43975-322-03","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Terlivaz: 1 Vial, Single-Dose In 1 Carton (43825-200-01)  / 5 Ml In 1 Vial, Single-Dose","250","RC","43825-200-01","NDC","","","facility","both","1","EA","","1753.01","1753.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (43975-351-03)","250","RC","43975-351-03","NDC","","","facility","both","1","EA","","2.83","2.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-914-11","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin: 25 Vial In 1 Carton (43598-914-06)  / 1 Ml In 1 Vial (43598-914-11)","250","RC","43598-914-06","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-901-11","NDC","","","facility","both","1","EA","","13.28","13.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-891-16","NDC","","","facility","both","1","EA","","10.45","10.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin: 25 Vial In 1 Carton (43598-914-25)  / 1 Ml In 1 Vial (43598-914-11)","250","RC","43598-914-25","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44206-310-91","NDC","","","facility","both","1","EA","","11.86","11.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44206-310-91","NDC","","","facility","both","1","EA","","12.67","12.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alburx: 1 Vial, Glass In 1 Carton (44206-310-50)  / 500 Ml In 1 Vial, Glass (44206-310-91)","250","RC","44206-310-50","NDC","","","facility","both","1","EA","","11.83","11.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alburx: 1 Vial, Glass In 1 Carton (44206-310-50)  / 500 Ml In 1 Vial, Glass (44206-310-91)","250","RC","44206-310-50","NDC","","","facility","both","1","EA","","13.17","13.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","44206-300-90","NDC","","","facility","both","1","EA","","130.59","130.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rhophylac: 1 Syringe, Glass In 1 Carton (44206-300-01)  / 2 Ml In 1 Syringe, Glass (44206-300-90)","250","RC","44206-300-01","NDC","","","facility","both","1","EA","","130.17","130.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Drizalma Sprinkle: 30 Capsule, Delayed Release In 1 Bottle (47335-617-30)","250","RC","47335-617-30","NDC","","","facility","both","1","EA","","12.36","12.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albendazole: 2 Tablet, Film Coated In 1 Bottle (43598-452-02)","250","RC","43598-452-02","NDC","","","facility","both","1","EA","","53.11","53.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-448-71","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine Transdermal System Step 1: 28 Patch In 1 Carton (43598-448-28)  / 24 H In 1 Patch","250","RC","43598-448-28","NDC","","","facility","both","1","EA","","1.78","1.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine Transdermal System Step 2: 14 Patch In 1 Carton (43598-447-74)  / 24 H In 1 Patch","250","RC","43598-447-74","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-447-71","NDC","","","facility","both","1","EA","","2.53","2.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine Polacrilex: 1 Bottle In 1 Carton (43598-486-24)  / 24 Lozenge In 1 Bottle","250","RC","43598-486-24","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine Transdermal System Step 3: 14 Patch In 1 Carton (43598-446-74)  / 24 H In 1 Patch","250","RC","43598-446-74","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-446-71","NDC","","","facility","both","1","EA","","2.54","2.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dimethyl Fumarate: 1 Bottle In 1 Carton (43598-430-60)  / 60 Capsule, Delayed Release In 1 Bottle","250","RC","43598-430-60","NDC","","","facility","both","1","EA","","4.22","4.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bortezomib: 1 Vial, Single-Dose In 1 Carton (43598-426-60)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","250","RC","43598-426-60","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (43598-413-11)  / 10 Ml In 1 Vial, Single-Dose","250","RC","43598-413-11","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine Polacrilex: 1 Bottle In 1 Carton (43598-487-24)  / 24 Lozenge In 1 Bottle","250","RC","43598-487-24","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 1 Syringe In 1 Box (43598-750-11)  / 2 Ml In 1 Syringe","250","RC","43598-750-11","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 10 Syringe In 1 Box (43598-750-10)  / 2 Ml In 1 Syringe","250","RC","43598-750-10","NDC","","","facility","both","1","EA","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ephedrine Sulfate: 25 Vial, Single-Dose In 1 Carton (43598-725-25)  / 1 Ml In 1 Vial, Single-Dose (43598-725-11)","250","RC","43598-725-25","NDC","","","facility","both","1","EA","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-725-11","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carboprost Tromethamine: 1 Vial, Single-Dose In 1 Carton (43598-698-11)  / 1 Ml In 1 Vial, Single-Dose","250","RC","43598-698-11","NDC","","","facility","both","1","EA","","65.25","65.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-697-11","NDC","","","facility","both","1","EA","","105.21","105.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyrimethamine: 30 Tablet In 1 Bottle, Plastic (43598-672-30)","250","RC","43598-672-30","NDC","","","facility","both","1","EA","","388.39","388.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyrimethamine: 100 Tablet In 1 Bottle, Plastic (43598-672-01)","250","RC","43598-672-01","NDC","","","facility","both","1","EA","","386.45","386.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-637-52","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Nitroprusside: 1 Vial, Single-Dose In 1 Carton (43598-587-23)  / 2 Ml In 1 Vial, Single-Dose","250","RC","43598-587-23","NDC","","","facility","both","1","EA","","23.91","23.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-582-01","NDC","","","facility","both","1","EA","","8.41","8.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-580-01","NDC","","","facility","both","1","EA","","8.41","8.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tadalafil: 60 Tablet, Film Coated In 1 Bottle (43598-578-60)","250","RC","43598-578-60","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43598-839-11","NDC","","","facility","both","1","EA","","5.75","5.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 1 BOTTLE, SPRAY in 1 CARTON (47335-788-91)  / 5 mL in 1 BOTTLE, SPRAY","250","RC","47335-788-91","NDC","","","facility","both","1","EA","","81.32","81.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial","250","RC","50242-041-64","NDC","","","facility","both","1","EA","","157.8","157.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial","250","RC","50242-041-64","NDC","","","facility","both","1","EA","","161.65","161.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xolair: 1 Vial, Single-Use In 1 Carton (50242-040-62)  / 1.2 Ml In 1 Vial, Single-Use","250","RC","50242-040-62","NDC","","","facility","both","1","EA","","84.97","84.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial","250","RC","50242-041-64","NDC","","","facility","both","1","EA","","153.82","153.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50242-037-06","NDC","","","facility","both","1","EA","","289.74","289.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Tablet In 1 Bottle (50228-483-01)","250","RC","50228-483-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Tablet In 1 Bottle (50228-482-01)","250","RC","50228-482-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ranolazine: 60 Tablet, Film Coated, Extended Release In 1 Package (50228-423-60)","250","RC","50228-423-60","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethacrynic Acid: 100 Tablet In 1 Bottle (50228-334-10)","250","RC","50228-334-10","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 100 Tablet In 1 Bottle (50228-226-01)","250","RC","50228-226-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-195-60)","250","RC","50228-195-60","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50242-037-06","NDC","","","facility","both","1","EA","","289.74","289.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50242-044-06","NDC","","","facility","both","1","EA","","138.3","138.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nutropin Aq Nuspin 10: 1 Cartridge In 1 Carton (50242-074-01)  / 2 Ml In 1 Cartridge","250","RC","50242-074-01","NDC","","","facility","both","1","EA","","212.95","212.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01)  / 40 Ml In 1 Vial, Single-Use","250","RC","50242-070-01","NDC","","","facility","both","1","EA","","69.76","69.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avastin: 1 Vial, Single-Use In 1 Carton (50242-060-01)  / 4 Ml In 1 Vial, Single-Use","250","RC","50242-060-01","NDC","","","facility","both","1","EA","","21.96","21.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Activase: 1 Kit In 1 Carton (50242-044-13)  *  50 Ml In 1 Vial, Single-Use *  50 Ml In 1 Vial, Single-Use","250","RC","50242-044-13","NDC","","","facility","both","1","EA","","92.2","92.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-192-60)","250","RC","50228-192-60","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50228-184-01)","250","RC","50228-184-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49884-465-64","NDC","","","facility","both","1","EA","","3.41","3.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49884-401-52","NDC","","","facility","both","1","EA","","4.74","4.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dantrolene Sodium: 100 Capsule In 1 Bottle (49884-364-01)","250","RC","49884-364-01","NDC","","","facility","both","1","EA","","2.18","2.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 3 Blister Pack In 1 Carton (49884-321-55)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack (49884-321-52)","250","RC","49884-321-55","NDC","","","facility","both","1","EA","","2.1","2.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49884-315-52","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49884-311-52","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49884-308-52","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49884-307-52","NDC","","","facility","both","1","EA","","1.54","1.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cholestyramine: 60 Packet In 1 Carton (49884-465-65)  / 9 G In 1 Packet (49884-465-64)","250","RC","49884-465-65","NDC","","","facility","both","1","EA","","4.05","4.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49884-306-52","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49884-283-52","NDC","","","facility","both","1","EA","","4.36","4.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Praziquantel: 6 Tablet, Film Coated In 1 Bottle (49884-231-83)","250","RC","49884-231-83","NDC","","","facility","both","1","EA","","52.52","52.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49884-212-52","NDC","","","facility","both","1","EA","","3.86","3.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49884-159-52","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Varenicline: 56 Tablet, Film Coated In 1 Bottle (49884-156-76)","250","RC","49884-156-76","NDC","","","facility","both","1","EA","","1.27","1.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49884-487-54","NDC","","","facility","both","1","EA","","15.86","15.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49884-768-52","NDC","","","facility","both","1","EA","","79.67","79.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Capsule In 1 Bottle, Plastic (50228-181-01)","250","RC","50228-181-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 1000 Capsule In 1 Bottle, Plastic (50228-179-10)","250","RC","50228-179-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride Sr: 100 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (50228-174-01)","250","RC","50228-174-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Capsule In 1 Bottle (50228-158-01)","250","RC","50228-158-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride (Xl): 30 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (50228-145-30)","250","RC","50228-145-30","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Capsule In 1 Bottle (50228-113-01)","250","RC","50228-113-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Torsemide: 100 Tablet In 1 Bottle (50111-918-01)","250","RC","50111-918-01","NDC","","","facility","both","1","EA","","3.23","3.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Torsemide: 100 Tablet In 1 Bottle (50111-916-01)","250","RC","50111-916-01","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Torsemide: 100 Tablet In 1 Bottle (50111-915-01)","250","RC","50111-915-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Tablet, Film Coated In 1 Bottle (50111-787-10)","250","RC","50111-787-10","NDC","","","facility","both","1","EA","","2.83","2.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Tablet, Film Coated In 1 Bottle (50111-787-10)","250","RC","50111-787-10","NDC","","","facility","both","1","EA","","3.53","3.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Tablet In 1 Bottle (50111-560-01)","250","RC","50111-560-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dapsone: 2 Blister Pack In 1 Carton (49938-101-30)  / 15 Tablet In 1 Blister Pack","250","RC","49938-101-30","NDC","","","facility","both","1","EA","","4.67","4.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Megestrol Acetate: 240 Ml In 1 Bottle, Plastic (49884-907-38)","250","RC","49884-907-38","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50242-901-24","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-088-11","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-087-11","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-086-11","NDC","","","facility","both","1","EA","","25.23","25.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 50 Blister Pack In 1 Bottle, Unit-Dose (50268-062-15)  / 1 Tablet In 1 Blister Pack (50268-062-11)","250","RC","50268-062-15","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-062-11","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-058-11","NDC","","","facility","both","1","EA","","6.6","6.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-057-11","NDC","","","facility","both","1","EA","","2.99","2.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-054-11","NDC","","","facility","both","1","EA","","3.55","3.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 50 Blister Pack In 1 Box (50268-039-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-039-11)","250","RC","50268-039-15","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-039-11","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 50 Blister Pack In 1 Box (50268-037-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-037-11)","250","RC","50268-037-15","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-037-11","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Varenicline: 56 Tablet, Film Coated In 1 Bottle (49884-155-76)","250","RC","49884-155-76","NDC","","","facility","both","1","EA","","1.29","1.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use","250","RC","50242-137-01","NDC","","","facility","both","1","EA","","10.77","10.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pulmozyme: 5 Pouch In 1 Carton (50242-100-40)  / 6 Ampule In 1 Pouch (50242-100-39)  / 2.5 Ml In 1 Ampule","250","RC","50242-100-40","NDC","","","facility","both","1","EA","","78.77","78.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50242-100-39","NDC","","","facility","both","1","EA","","79.61","79.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Activase: 1 Kit In 1 Carton (50242-085-27)  *  100 Ml In 1 Vial, Single-Use *  100 Ml In 1 Vial, Single-Use","250","RC","50242-085-27","NDC","","","facility","both","1","EA","","127.66","127.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50242-085-25","NDC","","","facility","both","1","EA","","116.16","116.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esbriet: 1 Bottle, Plastic In 1 Carton (50242-121-01)  / 270 Capsule In 1 Bottle, Plastic","250","RC","50242-121-01","NDC","","","facility","both","1","EA","","69.67","69.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use","250","RC","50242-137-01","NDC","","","facility","both","1","EA","","11.59","11.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01)  / 10 Ml In 1 Vial, Single-Use","250","RC","50242-136-01","NDC","","","facility","both","1","EA","","11.59","11.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01)  / 10 Ml In 1 Vial, Single-Use","250","RC","50242-136-01","NDC","","","facility","both","1","EA","","11.93","11.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-135-01)  / 4 Ml In 1 Vial, Single-Use","250","RC","50242-135-01","NDC","","","facility","both","1","EA","","12.16","12.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esbriet: 1 Bottle, Plastic In 1 Carton (50242-122-06)  / 270 Tablet, Coated In 1 Bottle, Plastic","250","RC","50242-122-06","NDC","","","facility","both","1","EA","","63.81","63.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use","250","RC","50242-137-01","NDC","","","facility","both","1","EA","","11.58","11.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43066-997-01","NDC","","","facility","both","1","EA","","3.62","3.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (49884-049-01)","250","RC","49884-049-01","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Delflex: 4 Bag In 1 Carton (49230-206-32)  / 3000 Ml In 1 Bag","250","RC","49230-206-32","NDC","","","facility","both","1","EA","","21.6","21.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Delflex: 2 Bag In 1 Carton (49230-191-62)  / 6000 Ml In 1 Bag","250","RC","49230-191-62","NDC","","","facility","both","1","EA","","108","108","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Delflex: 2 Bag In 1 Carton (49230-188-62)  / 6000 Ml In 1 Bag","250","RC","49230-188-62","NDC","","","facility","both","1","EA","","108","108","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Strong Iodine Solution: 14 Ml In 1 Bottle (48433-230-15)","250","RC","48433-230-15","NDC","","","facility","both","1","EA","","35.42","35.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","48433-219-05","NDC","","","facility","both","1","EA","","3.84","3.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mineral Oil: 30 Ml In 1 Cup, Unit-Dose (48433-202-30)","250","RC","48433-202-30","NDC","","","facility","both","1","EA","","2.48","2.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Antacid: 100 Tablet, Chewable In 1 Box, Unit-Dose (48433-106-01)","250","RC","48433-106-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Delflex: 2 Bag In 1 Carton (49230-206-62)  / 6000 Ml In 1 Bag","250","RC","49230-206-62","NDC","","","facility","both","1","EA","","42.94","42.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 2 Blister Pack In 1 Carton (47781-729-02)  / 10 Capsule In 1 Blister Pack","250","RC","47781-729-02","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 90 Tablet In 1 Bottle (47781-671-90)","250","RC","47781-671-90","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 90 Tablet In 1 Bottle (47781-659-90)","250","RC","47781-659-90","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 90 Tablet In 1 Bottle (47781-643-90)","250","RC","47781-643-90","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Disulfiram: 30 Tablet In 1 Bottle, Plastic (47781-607-30)","250","RC","47781-607-30","NDC","","","facility","both","1","EA","","3.39","3.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (47781-568-01)","250","RC","47781-568-01","NDC","","","facility","both","1","EA","","12.13","12.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (47781-565-01)","250","RC","47781-565-01","NDC","","","facility","both","1","EA","","11.84","11.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 2 Blister Pack In 1 Carton (47781-729-02)  / 10 Capsule In 1 Blister Pack","250","RC","47781-729-02","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (47781-564-01)","250","RC","47781-564-01","NDC","","","facility","both","1","EA","","11.74","11.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Delflex: 4 Bag In 1 Carton (49230-209-32)  / 3000 Ml In 1 Bag","250","RC","49230-209-32","NDC","","","facility","both","1","EA","","4.38","4.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Delflex: 4 Bag In 1 Carton (49230-212-30)  / 3000 Ml In 1 Bag","250","RC","49230-212-30","NDC","","","facility","both","1","EA","","16.2","16.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Beyfortus: 1 Syringe In 1 Carton (49281-575-00)  / .5 Ml In 1 Syringe","250","RC","49281-575-00","NDC","","","facility","both","1","EA","","946.49","946.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49281-423-88","NDC","","","facility","both","1","EA","","34.82","34.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49281-422-88","NDC","","","facility","both","1","EA","","29.37","29.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49281-286-58","NDC","","","facility","both","1","EA","","51.2","51.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Delflex: 2 Bag In 1 Carton (49230-209-62)  / 6000 Ml In 1 Bag","250","RC","49230-209-62","NDC","","","facility","both","1","EA","","10.8","10.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49281-125-88","NDC","","","facility","both","1","EA","","93.19","93.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49281-124-88","NDC","","","facility","both","1","EA","","121.83","121.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Velphoro: 1 Bottle In 1 Carton (49230-645-51)  / 90 Tablet, Chewable In 1 Bottle","250","RC","49230-645-51","NDC","","","facility","both","1","EA","","29.66","29.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Delflex: 2 Bag In 1 Carton (49230-212-62)  / 6000 Ml In 1 Bag","250","RC","49230-212-62","NDC","","","facility","both","1","EA","","10.8","10.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49281-215-88","NDC","","","facility","both","1","EA","","67.65","67.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (47781-562-01)","250","RC","47781-562-01","NDC","","","facility","both","1","EA","","11.48","11.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (47781-468-13)  / 10 Capsule In 1 Blister Pack","250","RC","47781-468-13","NDC","","","facility","both","1","EA","","15.54","15.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinvanti: 1 Vial, Glass In 1 Carton (47426-201-01)  / 18 Ml In 1 Vial, Glass","250","RC","47426-201-01","NDC","","","facility","both","1","EA","","2.62","2.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 1 Bag In 1 Pouch (47335-993-01)  / 100 Ml In 1 Bag","250","RC","47335-993-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 24 Pouch In 1 Case (47335-992-02)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","250","RC","47335-992-02","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 24 Pouch In 1 Case (47335-992-01)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag","250","RC","47335-992-01","NDC","","","facility","both","1","EA","","4.63","4.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, Amphetamine Sulfate Tablets,Cii: 100 Tablet In 1 Bottle (47781-176-01)","250","RC","47781-176-01","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","47335-931-40","NDC","","","facility","both","1","EA","","33.06","33.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","47335-930-60","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyridostigmine Bromide: 30 Tablet, Extended Release In 1 Bottle (47781-335-30)","250","RC","47781-335-30","NDC","","","facility","both","1","EA","","9.57","9.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl System: 5 Pouch In 1 Carton (47781-428-47)  / 1 Patch In 1 Pouch (47781-428-11)","250","RC","47781-428-47","NDC","","","facility","both","1","EA","","27.83","27.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","47781-428-11","NDC","","","facility","both","1","EA","","28.06","28.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl System: 5 Pouch In 1 Carton (47781-427-47)  / 1 Patch In 1 Pouch (47781-427-11)","250","RC","47781-427-47","NDC","","","facility","both","1","EA","","26.05","26.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","47781-427-11","NDC","","","facility","both","1","EA","","26.05","26.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl System: 5 Pouch In 1 Carton (47781-426-47)  / 1 Patch In 1 Pouch (47781-426-11)","250","RC","47781-426-47","NDC","","","facility","both","1","EA","","11.71","11.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","47781-426-11","NDC","","","facility","both","1","EA","","11.71","11.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","47781-424-11","NDC","","","facility","both","1","EA","","8.89","8.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl System: 5 Pouch In 1 Carton (47781-423-47)  / 1 Patch In 1 Pouch (47781-423-11)","250","RC","47781-423-47","NDC","","","facility","both","1","EA","","9.45","9.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","47781-423-11","NDC","","","facility","both","1","EA","","9.44","9.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","47781-358-11","NDC","","","facility","both","1","EA","","8.17","8.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","47781-357-11","NDC","","","facility","both","1","EA","","3.74","3.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","47781-356-11","NDC","","","facility","both","1","EA","","5.28","5.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","47781-355-11","NDC","","","facility","both","1","EA","","3","3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Menquadfi: 5 Vial, Single-Dose In 1 Carton (49281-590-05)  / .5 Ml In 1 Vial, Single-Dose (49281-590-58)","250","RC","49281-590-05","NDC","","","facility","both","1","EA","","271.33","271.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49281-590-58","NDC","","","facility","both","1","EA","","271.33","271.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epivir: 60 Tablet, Film Coated In 1 Bottle (49702-203-18)","250","RC","49702-203-18","NDC","","","facility","both","1","EA","","12.1","12.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49591-052-11","NDC","","","facility","both","1","EA","","106.5","106.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hepagam B: 1 Vial, Glass In 1 Carton (49591-051-51)  / 5 Ml In 1 Vial, Glass (49591-051-05)","250","RC","49591-051-51","NDC","","","facility","both","1","EA","","93.23","93.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49591-051-05","NDC","","","facility","both","1","EA","","95.42","95.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Emsam: 30 Pouch In 1 Carton (49502-900-30)  / 1 Patch In 1 Pouch (49502-900-01)  / 24 H In 1 Patch","250","RC","49502-900-30","NDC","","","facility","both","1","EA","","124.61","124.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49502-900-01","NDC","","","facility","both","1","EA","","124.61","124.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 2 Container In 1 Carton (49502-102-02)  / 1 Syringe, Glass In 1 Container (49502-102-01)  / .3 Ml In 1 Syringe, Glass","250","RC","49502-102-02","NDC","","","facility","both","1","EA","","78.84","78.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 2 Container In 1 Carton (49502-102-02)  / 1 Syringe, Glass In 1 Container (49502-102-01)  / .3 Ml In 1 Syringe, Glass","250","RC","49502-102-02","NDC","","","facility","both","1","EA","","236.48","236.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epivir: 240 Ml In 1 Bottle (49702-205-48)","250","RC","49702-205-48","NDC","","","facility","both","1","EA","","9.74","9.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49702-213-01","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 16 Ml In 1 Bottle (49884-042-33)","250","RC","49884-042-33","NDC","","","facility","both","1","EA","","4.96","4.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle (49884-020-01)","250","RC","49884-020-01","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle (49884-009-01)","250","RC","49884-009-01","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabenuva: 1 Kit In 1 Carton (49702-240-15)  *  3 Ml In 1 Vial (49702-238-01)  *  3 Ml In 1 Vial (49702-243-02)","250","RC","49702-240-15","NDC","","","facility","both","1","EA","","62.63","62.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triumeq: 30 Tablet, Film Coated In 1 Bottle (49702-231-13)","250","RC","49702-231-13","NDC","","","facility","both","1","EA","","214.05","214.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tivicay: 30 Tablet, Film Coated In 1 Bottle (49702-228-13)","250","RC","49702-228-13","NDC","","","facility","both","1","EA","","126.77","126.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tivicay: 30 Tablet, Film Coated In 1 Bottle (49702-228-13)","250","RC","49702-228-13","NDC","","","facility","both","1","EA","","127.87","127.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Selzentry: 60 Tablet, Film Coated In 1 Bottle (49702-224-18)","250","RC","49702-224-18","NDC","","","facility","both","1","EA","","47.87","47.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexlansoprazole: 30 Capsule, Delayed Release In 1 Bottle (49884-148-11)","250","RC","49884-148-11","NDC","","","facility","both","1","EA","","10.81","10.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49502-102-01","NDC","","","facility","both","1","EA","","78.84","78.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gas Relief Drops Infants: 1 Bottle, Dropper In 1 Carton (49348-740-27)  / 30 Ml In 1 Bottle, Dropper","250","RC","49348-740-27","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Miconazole Nitrate Antifungal: 1 Tube In 1 Carton (49348-689-72)  / 30 G In 1 Tube","250","RC","49348-689-72","NDC","","","facility","both","1","EA","","3.51","3.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Nicotine: 110 Blister Pack In 1 Carton (49348-573-36)  / 1 Gum, Chewing In 1 Blister Pack","250","RC","49348-573-36","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Nicotine: 50 Blister Pack In 1 Carton (49348-573-08)  / 1 Gum, Chewing In 1 Blister Pack","250","RC","49348-573-08","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Nicotine: 50 Blister Pack In 1 Carton (49348-572-08)  / 1 Gum, Chewing In 1 Blister Pack","250","RC","49348-572-08","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Saline Single Laxative: 1 Bottle In 1 Carton (49348-186-20)  / 133 Ml In 1 Bottle","250","RC","49348-186-20","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Mineral Oil Laxative: 1 Bottle In 1 Carton (49348-185-20)  / 133 Ml In 1 Bottle","250","RC","49348-185-20","NDC","","","facility","both","1","EA","","3.12","3.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Antibiotic Bacitracin Zinc: 1 Tube In 1 Carton (49348-154-72)  / 28.4 G In 1 Tube","250","RC","49348-154-72","NDC","","","facility","both","1","EA","","4.09","4.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miconazole 7: 7 Suppository In 1 Applicator (49348-833-61)","250","RC","49348-833-61","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Lice Treatment: 1 Bottle In 1 Carton (49348-150-78)  / 59 Ml In 1 Bottle","250","RC","49348-150-78","NDC","","","facility","both","1","EA","","10.09","10.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Acid Reducer: 1 Bottle In 1 Carton (49348-128-13)  / 90 Tablet, Film Coated In 1 Bottle","250","RC","49348-128-13","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Childrens Pain And Fever: 1 Bottle In 1 Carton (49348-119-34)  / 118 Ml In 1 Bottle","250","RC","49348-119-34","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Nasal Original: 1 Bottle, Spray In 1 Carton (49348-028-27)  / 30 Ml In 1 Bottle, Spray","250","RC","49348-028-27","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipol: 1 Vial, Multi-Dose In 1 Package (49281-860-10)  / 5 Ml In 1 Vial, Multi-Dose (49281-860-78)","250","RC","49281-860-10","NDC","","","facility","both","1","EA","","74.21","74.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49281-752-78","NDC","","","facility","both","1","EA","","17.57","17.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tubersol: 1 Vial, Multi-Dose In 1 Carton (49281-752-21)  / 1 Ml In 1 Vial, Multi-Dose (49281-752-78)","250","RC","49281-752-21","NDC","","","facility","both","1","EA","","19.01","19.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Miconazole 7: 1 Tube In 1 Carton (49348-872-77)  / 45 G In 1 Tube","250","RC","49348-872-77","NDC","","","facility","both","1","EA","","12.4","12.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allergy Relief: 1 BOTTLE in 1 BOX (49348-983-10)  / 100 TABLET in 1 BOTTLE","250","RC","49348-983-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 2 Container In 1 Carton (49502-101-02)  / 1 Syringe, Glass In 1 Container (49502-101-01)  / .3 Ml In 1 Syringe, Glass","250","RC","49502-101-02","NDC","","","facility","both","1","EA","","135.15","135.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 2 Container In 1 Carton (49502-101-02)  / 1 Syringe, Glass In 1 Container (49502-101-01)  / .3 Ml In 1 Syringe, Glass","250","RC","49502-101-02","NDC","","","facility","both","1","EA","","236.47","236.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49502-101-01","NDC","","","facility","both","1","EA","","118.26","118.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49502-101-01","NDC","","","facility","both","1","EA","","236.48","236.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen Extra Strength: 500 Tablet, Film Coated In 1 Bottle, Plastic (49483-341-50)","250","RC","49483-341-50","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Senna Time: 1000 Tablet, Coated In 1 Bottle, Plastic (49483-080-10)","250","RC","49483-080-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levodopa: 25 G In 1 Bottle (49452-2680-2)","250","RC","49452-2680-2","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","49502-102-01","NDC","","","facility","both","1","EA","","236.48","236.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nexterone: 200 Ml In 1 Bag (43066-360-20)","250","RC","43066-360-20","NDC","","","facility","both","1","EA","","3.59","3.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nexterone: 100 Ml In 1 Bag (43066-150-10)","250","RC","43066-150-10","NDC","","","facility","both","1","EA","","8.26","8.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 10 Vial In 1 Carton (25021-798-10)  / 10 Ml In 1 Vial","250","RC","25021-798-10","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 25 Vial In 1 Carton (25021-798-02)  / 2 Ml In 1 Vial","250","RC","25021-798-02","NDC","","","facility","both","1","EA","","2.72","2.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valproate Sodium: 10 Vial In 1 Carton (25021-797-05)  / 5 Ml In 1 Vial","250","RC","25021-797-05","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide: 10 Vial, Glass In 1 Carton (25021-791-20)  / 20 Ml In 1 Vial, Glass","250","RC","25021-791-20","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Edisylate: 10 Vial In 1 Carton (25021-790-02)  / 2 Ml In 1 Vial","250","RC","25021-790-02","NDC","","","facility","both","1","EA","","2.15","2.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 25 Vial In 1 Carton (25021-777-02)  / 2 Ml In 1 Vial","250","RC","25021-777-02","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 10 Vial In 1 Carton (25021-751-10)  / 10 Ml In 1 Vial","250","RC","25021-751-10","NDC","","","facility","both","1","EA","","2.46","2.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (25021-701-01)  / 1 Ml In 1 Vial","250","RC","25021-701-01","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (25021-700-01)  / 1 Ml In 1 Vial","250","RC","25021-700-01","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rocuronium Bromide: 10 Vial In 1 Carton (25021-687-10)  / 10 Ml In 1 Vial","250","RC","25021-687-10","NDC","","","facility","both","1","EA","","4.01","4.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 10 Vial In 1 Carton (25021-806-01)  / 1 Ml In 1 Vial","250","RC","25021-806-01","NDC","","","facility","both","1","EA","","7.43","7.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 4 Vial In 1 Carton (25021-812-30)  / 30 Ml In 1 Vial","250","RC","25021-812-30","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoledronic Acid: 1 Bag In 1 Carton (25021-830-82)  / 100 Ml In 1 Bag","250","RC","25021-830-82","NDC","","","facility","both","1","EA","","12.46","12.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fomepizole: 1 Vial In 1 Carton (25021-829-02)  / 1.5 Ml In 1 Vial","250","RC","25021-829-02","NDC","","","facility","both","1","EA","","6.65","6.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoledronic Acid: 1 Bag In 1 Carton (25021-826-82)  / 100 Ml In 1 Bag","250","RC","25021-826-82","NDC","","","facility","both","1","EA","","10.35","10.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial In 1 Carton (25021-814-30)  / 10 Ml In 1 Vial","250","RC","25021-814-30","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vecuronium Bromide: 10 Vial In 1 Carton (25021-686-20)  / 20 Ml In 1 Vial","250","RC","25021-686-20","NDC","","","facility","both","1","EA","","50.46","50.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial In 1 Carton (25021-321-10)  / 10 Ml In 1 Vial","250","RC","25021-321-10","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial In 1 Carton (25021-321-04)  / 4 Ml In 1 Vial","250","RC","25021-321-04","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Carton (25021-320-04)  / 4 Ml In 1 Vial","250","RC","25021-320-04","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Carton (25021-320-04)  / 4 Ml In 1 Vial","250","RC","25021-320-04","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milrinone Lactate In Dextrose: 10 Bag In 1 Carton (25021-313-82)  / 100 Ml In 1 Bag","250","RC","25021-313-82","NDC","","","facility","both","1","EA","","3.09","3.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esmolol Hydrochloride: 10 Bag In 1 Carton (25021-308-84)  / 250 Ml In 1 Bag","250","RC","25021-308-84","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide Sodium: 1 Vial In 1 Carton (25021-305-20)  / 18 Ml In 1 Vial","250","RC","25021-305-20","NDC","","","facility","both","1","EA","","24.66","24.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 10 Vial In 1 Carton (25021-319-10)  / 10 Ml In 1 Vial","250","RC","25021-319-10","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Carton (25021-402-01)  / 1 Ml In 1 Vial","250","RC","25021-402-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vecuronium Bromide: 10 Vial In 1 Carton (25021-685-10)  / 10 Ml In 1 Vial","250","RC","25021-685-10","NDC","","","facility","both","1","EA","","11.4","11.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketamine Hydrochloride: 10 Vial In 1 Carton (25021-684-05)  / 5 Ml In 1 Vial","250","RC","25021-684-05","NDC","","","facility","both","1","EA","","10.14","10.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketamine Hydrochloride: 10 Vial In 1 Carton (25021-682-20)  / 20 Ml In 1 Vial","250","RC","25021-682-20","NDC","","","facility","both","1","EA","","13.54","13.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pentobarbital Sodium: 1 Vial In 1 Carton (25021-676-50)  / 50 Ml In 1 Vial","250","RC","25021-676-50","NDC","","","facility","both","1","EA","","34.69","34.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glydo: 10 Syringe In 1 Carton (25021-673-77)  / 11 Ml In 1 Syringe","250","RC","25021-673-77","NDC","","","facility","both","1","EA","","7.67","7.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 10 Bag In 1 Carton (25021-612-81)  / 50 Ml In 1 Bag","250","RC","25021-612-81","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Caffeine Citrate: 1 Vial In 1 Carton (25021-601-03)  / 3 Ml In 1 Vial","250","RC","25021-601-03","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyanocobalamin: 25 Vial In 1 Carton (25021-502-01)  / 1 Ml In 1 Vial","250","RC","25021-502-01","NDC","","","facility","both","1","EA","","2.55","2.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiamine Hydrochloride: 25 Vial In 1 Carton (25021-500-02)  / 2 Ml In 1 Vial","250","RC","25021-500-02","NDC","","","facility","both","1","EA","","2.94","2.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 10 Bag In 1 Carton (25021-418-82)  / 100 Ml In 1 Bag","250","RC","25021-418-82","NDC","","","facility","both","1","EA","","10.62","10.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 10 Vial In 1 Carton (25021-415-10)  / 10 Ml In 1 Vial","250","RC","25021-415-10","NDC","","","facility","both","1","EA","","1.98","1.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (25021-410-78)  / .8 Ml In 1 Syringe","250","RC","25021-410-78","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Soliris: 1 Vial In 1 Carton (25682-001-01)  / 30 Ml In 1 Vial","250","RC","25682-001-01","NDC","","","facility","both","1","EA","","65.02","65.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aminocaproic Acid: 236.5 Ml In 1 Bottle, Plastic (31722-035-23)","250","RC","31722-035-23","NDC","","","facility","both","1","EA","","24.07","24.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 1 Bottle In 1 Carton (31722-016-47)  / 473 Ml In 1 Bottle","250","RC","31722-016-47","NDC","","","facility","both","1","EA","","3.72","3.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Droxidopa: 90 Capsule In 1 Bottle (31722-015-90)","250","RC","31722-015-90","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Droxidopa: 90 Capsule In 1 Bottle (31722-014-90)","250","RC","31722-014-90","NDC","","","facility","both","1","EA","","1.2","1.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferasirox: 30 Tablet, Film Coated In 1 Bottle (31722-013-30)","250","RC","31722-013-30","NDC","","","facility","both","1","EA","","7.14","7.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 2 Blister Pack In 1 Carton (31722-040-31)  / 6 Suppository In 1 Blister Pack","250","RC","31722-040-31","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Droxidopa: 90 Capsule In 1 Bottle (31722-010-90)","250","RC","31722-010-90","NDC","","","facility","both","1","EA","","3.3","3.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 60 Tablet In 1 Bottle, Plastic (29300-477-16)","250","RC","29300-477-16","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (29300-421-01)","250","RC","29300-421-01","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (29300-419-01)","250","RC","29300-419-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amiodarone Hydrochloride: 60 Tablet In 1 Bottle (29300-359-16)","250","RC","29300-359-16","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 100 Tablet In 1 Bottle, Plastic (29300-349-01)","250","RC","29300-349-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Itraconazole: 1 Bottle, Glass In 1 Carton (31722-006-31)  / 150 Ml In 1 Bottle, Glass","250","RC","31722-006-31","NDC","","","facility","both","1","EA","","43.06","43.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (31722-053-60)","250","RC","31722-053-60","NDC","","","facility","both","1","EA","","9.13","9.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (31722-054-60)","250","RC","31722-054-60","NDC","","","facility","both","1","EA","","8.47","8.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 1 Vial In 1 Carton (31722-308-01)  / 2 Ml In 1 Vial","250","RC","31722-308-01","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 30 Tablet, Film Coated, Extended Release In 1 Bottle (31722-245-30)","250","RC","31722-245-30","NDC","","","facility","both","1","EA","","3.2","3.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (31722-230-01)","250","RC","31722-230-01","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (31722-229-01)","250","RC","31722-229-01","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-195-01)","250","RC","31722-195-01","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-188-01)","250","RC","31722-188-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-187-01)","250","RC","31722-187-01","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-186-01)","250","RC","31722-186-01","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-185-01)","250","RC","31722-185-01","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 Tablet In 1 Bottle (31722-143-01)","250","RC","31722-143-01","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Citrate: 100 Tablet, Extended Release In 1 Bottle (31722-130-01)","250","RC","31722-130-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (31722-104-30)","250","RC","31722-104-30","NDC","","","facility","both","1","EA","","2.06","2.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 50 Ml In 1 Bottle (31722-063-31)","250","RC","31722-063-31","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle, Plastic (29300-140-01)","250","RC","29300-140-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (29300-137-01)","250","RC","29300-137-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (29300-136-01)","250","RC","29300-136-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valganciclovir Hydrochloride: 1 Pouch In 1 Carton (27241-159-19)  / 1 Bottle In 1 Pouch / 100 Ml In 1 Bottle","250","RC","27241-159-19","NDC","","","facility","both","1","EA","","91.77","91.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Pouch In 1 Carton (27241-139-09)  / 1 Bottle In 1 Pouch / 60 Ml In 1 Bottle","250","RC","27241-139-09","NDC","","","facility","both","1","EA","","4.95","4.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","27241-134-21","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 60 Tablet, Extended Release In 1 Bottle (27241-108-06)","250","RC","27241-108-06","NDC","","","facility","both","1","EA","","1.89","1.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 30 Capsule, Delayed Release In 1 Bottle (27241-099-03)","250","RC","27241-099-03","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 90 Capsule, Delayed Release In 1 Bottle (27241-098-09)","250","RC","27241-098-09","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 Tablet In 1 Bottle (27241-160-01)","250","RC","27241-160-01","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 30 Capsule, Delayed Release In 1 Bottle (27241-098-03)","250","RC","27241-098-03","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 60 Capsule, Delayed Release In 1 Bottle (27241-097-06)","250","RC","27241-097-06","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 30 Tablet, Film Coated In 1 Bottle (27241-063-03)","250","RC","27241-063-03","NDC","","","facility","both","1","EA","","12.04","12.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 30 Tablet, Film Coated In 1 Bottle (27241-062-03)","250","RC","27241-062-03","NDC","","","facility","both","1","EA","","3.59","3.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entacapone: 100 Tablet In 1 Bottle (27241-049-10)","250","RC","27241-049-10","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 30 Ml In 1 Bottle, Unit-Dose (27808-002-01)","250","RC","27808-002-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zaleplon: 100 Capsule In 1 Bottle, Plastic (29300-132-01)","250","RC","29300-132-01","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zaleplon: 100 Capsule In 1 Bottle, Plastic (29300-131-01)","250","RC","29300-131-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrochlorothiazide: 100 Capsule In 1 Bottle, Plastic (29300-130-01)","250","RC","29300-130-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisoprolol Fumarate: 30 Tablet In 1 Bottle, Plastic (29300-127-13)","250","RC","29300-127-13","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisoprolol Fumarate: 100 Tablet In 1 Bottle, Plastic (29300-126-01)","250","RC","29300-126-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 100 Capsule, Extended Release In 1 Bottle (29033-030-01)","250","RC","29033-030-01","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 120 Capsule, Extended Release In 1 Bottle (29033-020-12)","250","RC","29033-020-12","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 120 Capsule, Extended Release In 1 Bottle (29033-004-12)","250","RC","29033-004-12","NDC","","","facility","both","1","EA","","2.72","2.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline: 500 Capsule In 1 Bottle (27808-233-02)","250","RC","27808-233-02","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (27808-222-01)","250","RC","27808-222-01","NDC","","","facility","both","1","EA","","3.51","3.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Febuxostat: 30 Tablet In 1 Bottle (27808-207-01)","250","RC","27808-207-01","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Colesevelam Hydrochloride: 180 Tablet In 1 Bottle (27808-190-01)","250","RC","27808-190-01","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Bottle, Unit-Dose In 1 Carton (27808-082-01)  / 30 Ml In 1 Bottle, Unit-Dose","250","RC","27808-082-01","NDC","","","facility","both","1","EA","","1.87","1.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Theophylline: 473 Ml In 1 Bottle (27808-033-01)","250","RC","27808-033-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisplatin: 1 Vial In 1 Carton (25021-253-50)  / 50 Ml In 1 Vial","250","RC","25021-253-50","NDC","","","facility","both","1","EA","","2.19","2.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (23155-832-01)","250","RC","23155-832-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabergoline: 8 Tablet In 1 Bottle (23155-823-73)","250","RC","23155-823-73","NDC","","","facility","both","1","EA","","1.69","1.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 100 Tablet In 1 Bottle (23155-773-01)","250","RC","23155-773-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foscarnet Sodium: 1 Bottle, Glass In 1 Carton (23155-771-31)  / 250 Ml In 1 Bottle, Glass","250","RC","23155-771-31","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foscarnet Sodium: 1 Bottle, Glass In 1 Carton (23155-771-31)  / 250 Ml In 1 Bottle, Glass","250","RC","23155-771-31","NDC","","","facility","both","1","EA","","42.78","42.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (23155-833-01)","250","RC","23155-833-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (23155-767-01)","250","RC","23155-767-01","NDC","","","facility","both","1","EA","","2.83","2.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 100 Tablet In 1 Bottle (23155-724-01)","250","RC","23155-724-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-688-31","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-687-31","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitriol: 100 Capsule In 1 Bottle (23155-663-01)","250","RC","23155-663-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rasagiline Mesylate: 30 Tablet In 1 Bottle (23155-747-03)","250","RC","23155-747-03","NDC","","","facility","both","1","EA","","4.76","4.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-661-31","NDC","","","facility","both","1","EA","","108.81","108.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Muro 128: 2 Tube In 1 Carton (24208-385-56)  / 3.5 G In 1 Tube","250","RC","24208-385-56","NDC","","","facility","both","1","EA","","23.23","23.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Muro 128: 1 Tube In 1 Carton (24208-385-55)  / 3.5 G In 1 Tube","250","RC","24208-385-55","NDC","","","facility","both","1","EA","","30.12","30.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 1 Bottle, Pump In 1 Carton (24208-342-05)  / 5 Ml In 1 Bottle, Pump","250","RC","24208-342-05","NDC","","","facility","both","1","EA","","237.62","237.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfacetamide Sodium And Prednisolone Sodium Phosphate: 1 Bottle, Dropper In 1 Carton (24208-317-05)  / 5 Ml In 1 Bottle, Dropper","250","RC","24208-317-05","NDC","","","facility","both","1","EA","","21.77","21.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (24201-400-02)  / 2 Ml In 1 Vial, Multi-Dose","250","RC","24201-400-02","NDC","","","facility","both","1","EA","","1020.77","1020.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 24 Vial, Glass In 1 Carton (24201-100-24)  / 100 Ml In 1 Vial, Glass","250","RC","24201-100-24","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Torsemide: 100 Tablet In 1 Bottle (23155-872-01)","250","RC","23155-872-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultramicrosize Griseofulvin: 100 Tablet In 1 Bottle, Plastic (23155-864-01)","250","RC","23155-864-01","NDC","","","facility","both","1","EA","","6.54","6.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 2 Blister Pack In 1 Carton (23155-858-78)  / 10 Capsule In 1 Blister Pack","250","RC","23155-858-78","NDC","","","facility","both","1","EA","","3.37","3.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 50 Capsule In 1 Bottle (23155-858-25)","250","RC","23155-858-25","NDC","","","facility","both","1","EA","","4.29","4.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 1 Bottle, Plastic In 1 Carton (23155-848-51)  / 225 Ml In 1 Bottle, Plastic","250","RC","23155-848-51","NDC","","","facility","both","1","EA","","2.55","2.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","24201-100-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet In 1 Bottle (23155-486-01)","250","RC","23155-486-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-473-33","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-473-33","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 100 Tablet In 1 Bottle (23155-489-01)","250","RC","23155-489-01","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-473-31","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 5 Ml In 1 Vial, Glass (23155-313-31)","250","RC","23155-313-31","NDC","","","facility","both","1","EA","","23.47","23.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-294-31","NDC","","","facility","both","1","EA","","2.37","2.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-290-32","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-473-32","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 100 Tablet In 1 Bottle (23155-490-01)","250","RC","23155-490-01","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 100 Tablet In 1 Bottle (23155-500-01)","250","RC","23155-500-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 100 Tablet In 1 Bottle (23155-606-01)","250","RC","23155-606-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-601-32","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-600-31","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (23155-594-31)  / 1 Injectable, Liposomal In 1 Vial, Single-Dose","250","RC","23155-594-31","NDC","","","facility","both","1","EA","","27.35","27.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (23155-594-31)  / 1 Injectable, Liposomal In 1 Vial, Single-Dose","250","RC","23155-594-31","NDC","","","facility","both","1","EA","","68.04","68.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 1 Vial In 1 Carton (23155-549-31)  / 20 Ml In 1 Vial","250","RC","23155-549-31","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 25 Vial In 1 Carton (23155-547-42)  / 2 Ml In 1 Vial (23155-547-31)","250","RC","23155-547-42","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-547-31","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethosuximide: 100 Capsule In 1 Bottle (23155-532-01)","250","RC","23155-532-01","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Acetate: 200 Capsule In 1 Bottle (23155-531-02)","250","RC","23155-531-02","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","23155-512-11","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nimodipine: 10 Blister Pack In 1 Carton (23155-512-00)  / 10 Capsule, Liquid Filled In 1 Blister Pack","250","RC","23155-512-00","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 100 Tablet In 1 Bottle (23155-501-01)","250","RC","23155-501-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide: 1 Bottle, Spray In 1 Carton (24208-399-15)  / 165 Spray, Metered In 1 Bottle, Spray","250","RC","24208-399-15","NDC","","","facility","both","1","EA","","48.2","48.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ofloxacin: 1 Bottle, Dropper In 1 Carton (24208-434-05)  / 5 Ml In 1 Bottle, Dropper","250","RC","24208-434-05","NDC","","","facility","both","1","EA","","33.92","33.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ertapenem: 10 Vial In 1 Carton (25021-199-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","25021-199-20","NDC","","","facility","both","1","EA","","12.74","12.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 24 Pouch In 1 Carton (25021-192-87)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag","250","RC","25021-192-87","NDC","","","facility","both","1","EA","","2.34","2.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial In 1 Carton (25021-191-10)  / 5 Ml In 1 Vial","250","RC","25021-191-10","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial In 1 Carton (25021-190-10)  / 5 Ml In 1 Vial","250","RC","25021-190-10","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 10 Pouch In 1 Carton (25021-184-87)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag","250","RC","25021-184-87","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 10 Pouch In 1 Carton (25021-184-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","250","RC","25021-184-82","NDC","","","facility","both","1","EA","","5.14","5.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxacillin: 10 Vial In 1 Carton (25021-162-24)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","25021-162-24","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin: 1 Bottle In 1 Carton (25021-158-99)  / 100 Ml In 1 Bottle","250","RC","25021-158-99","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial In 1 Carton (25021-207-25)  / 25 Ml In 1 Vial","250","RC","25021-207-25","NDC","","","facility","both","1","EA","","2.69","2.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial In 1 Carton (25021-249-51)  / 100 Ml In 1 Vial","250","RC","25021-249-51","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial In 1 Carton (25021-249-51)  / 100 Ml In 1 Vial","250","RC","25021-249-51","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial In 1 Carton (25021-248-51)  / 50 Ml In 1 Vial","250","RC","25021-248-51","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial In 1 Carton (25021-223-20)  / 20 Ml In 1 Vial","250","RC","25021-223-20","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial In 1 Carton (25021-219-20)  / 20 Ml In 1 Vial","250","RC","25021-219-20","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial In 1 Carton (25021-207-51)  / 100 Ml In 1 Vial","250","RC","25021-207-51","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 1 Bottle In 1 Carton (25021-144-99)  / 100 Ml In 1 Bottle","250","RC","25021-144-99","NDC","","","facility","both","1","EA","","7.94","7.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial In 1 Carton (25021-137-20)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","25021-137-20","NDC","","","facility","both","1","EA","","3.11","3.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin: 50 Tube In 1 Box (24208-910-19)  / 1 G In 1 Tube","250","RC","24208-910-19","NDC","","","facility","both","1","EA","","10.19","10.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neomycin Polymyxin B Sulfates And Dexamethasone: 1 Bottle, Dropper In 1 Carton (24208-830-60)  / 5 Ml In 1 Bottle, Dropper","250","RC","24208-830-60","NDC","","","facility","both","1","EA","","26.37","26.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neomycin And Polymyxin B Sulfates And Gramicidin: 1 Bottle, Dropper In 1 Carton (24208-790-62)  / 10 Ml In 1 Bottle, Dropper","250","RC","24208-790-62","NDC","","","facility","both","1","EA","","63.06","63.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neomycin And Polymyxin B Sulfates, Bacitracin Zinc And Hydrocortisone: 1 Tube In 1 Carton (24208-785-55)  / 3.5 G In 1 Tube","250","RC","24208-785-55","NDC","","","facility","both","1","EA","","69.02","69.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neomycin And Polymyxin B Sulfates And Bacitracin Zinc: 1 Tube In 1 Carton (24208-780-55)  / 3.5 G In 1 Tube","250","RC","24208-780-55","NDC","","","facility","both","1","EA","","75.63","75.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclopentolate Hydrochloride: 1 Bottle, Dropper In 1 Carton (24208-735-06)  / 15 Ml In 1 Bottle, Dropper","250","RC","24208-735-06","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclopentolate Hydrochloride: 1 Bottle, Dropper In 1 Carton (24208-735-01)  / 2 Ml In 1 Bottle, Dropper","250","RC","24208-735-01","NDC","","","facility","both","1","EA","","2.07","2.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Proparacaine Hydrochloride: 1 Bottle, Dropper In 1 Carton (24208-730-06)  / 15 Ml In 1 Bottle, Dropper","250","RC","24208-730-06","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 1 Bottle, Dropper In 1 Carton (24208-720-02)  / 5 Ml In 1 Bottle, Dropper","250","RC","24208-720-02","NDC","","","facility","both","1","EA","","71.55","71.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin: 1 Tube In 1 Carton (24208-910-55)  / 3.5 G In 1 Tube","250","RC","24208-910-55","NDC","","","facility","both","1","EA","","20.17","20.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisolone Sodium Phosphate: 1 Bottle, Dropper In 1 Carton (24208-715-10)  / 10 Ml In 1 Bottle, Dropper","250","RC","24208-715-10","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neomycin And Polymyxin B Sulfates And Hydrocortisone: 1 Bottle, Dropper In 1 Carton (24208-635-62)  / 10 Ml In 1 Bottle, Dropper","250","RC","24208-635-62","NDC","","","facility","both","1","EA","","105.76","105.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tropicamide: 1 Bottle, Dropper In 1 Carton (24208-585-59)  / 2 Ml In 1 Bottle, Dropper","250","RC","24208-585-59","NDC","","","facility","both","1","EA","","11.34","11.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gentamicin Sulfate: 1 Bottle, Dropper In 1 Carton (24208-580-60)  / 5 Ml In 1 Bottle, Dropper","250","RC","24208-580-60","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bacitracin Zinc And Polymyxin B Sulfate: 1 Tube In 1 Carton (24208-555-55)  / 3.5 G In 1 Tube","250","RC","24208-555-55","NDC","","","facility","both","1","EA","","9.83","9.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miochol E: 1 Kit In 1 Blister Pack (24208-539-20)  *  2 Ml In 1 Vial *  2 Ml In 1 Ampule","250","RC","24208-539-20","NDC","","","facility","both","1","EA","","42.02","42.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zirgan: 1 Tube, With Applicator In 1 Carton (24208-535-35)  / 5 G In 1 Tube, With Applicator","250","RC","24208-535-35","NDC","","","facility","both","1","EA","","780.21","780.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle, Dropper In 1 Carton (24208-486-10)  / 10 Ml In 1 Bottle, Dropper","250","RC","24208-486-10","NDC","","","facility","both","1","EA","","39.64","39.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dorzolamide Hcl: 1 Bottle, Dropper In 1 Carton (24208-485-10)  / 10 Ml In 1 Bottle, Dropper","250","RC","24208-485-10","NDC","","","facility","both","1","EA","","19.33","19.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Latanoprost: 1 Bottle In 1 Carton (24208-463-25)  / 2.5 Ml In 1 Bottle","250","RC","24208-463-25","NDC","","","facility","both","1","EA","","21.12","21.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfacetamide Sodium: 1 Bottle, Dropper In 1 Carton (24208-670-04)  / 15 Ml In 1 Bottle, Dropper","250","RC","24208-670-04","NDC","","","facility","both","1","EA","","64.71","64.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gliadel: 8 Pouch In 1 Box (24338-050-08)  / 1 Wafer In 1 Pouch","250","RC","24338-050-08","NDC","","","facility","both","1","EA","","6272","6272","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"E.E.S: 100 Ml In 1 Bottle (24338-134-02)","250","RC","24338-134-02","NDC","","","facility","both","1","EA","","9.33","9.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","24338-230-05","NDC","","","facility","both","1","EA","","64.56","64.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 24 Pouch In 1 Carton (25021-132-81)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag","250","RC","25021-132-81","NDC","","","facility","both","1","EA","","11.61","11.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 24 Pouch In 1 Carton (25021-131-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","250","RC","25021-131-82","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin: 25 Vial In 1 Carton (25021-115-04)  / 4 Ml In 1 Vial","250","RC","25021-115-04","NDC","","","facility","both","1","EA","","3.1","3.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 24 Pouch In 1 Carton (25021-114-87)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag","250","RC","25021-114-87","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (25021-052-05)  / 5 Ml In 1 Vial","250","RC","25021-052-05","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolic Acid: 120 Tablet, Delayed Release In 1 Bottle (24979-161-44)","250","RC","24979-161-44","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine: 300 Tablet, Extended Release In 1 Bottle (24979-009-12)","250","RC","24979-009-12","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","24357-701-05","NDC","","","facility","both","1","EA","","4.86","4.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","24338-260-10","NDC","","","facility","both","1","EA","","163.85","163.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nymalize: 237 Ml In 1 Bottle (24338-260-08)","250","RC","24338-260-08","NDC","","","facility","both","1","EA","","10.99","10.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nymalize: 12 Blister Pack In 1 Carton (24338-230-30)  / 1 Syringe, Plastic In 1 Blister Pack (24338-230-15)  / 5 Ml In 1 Syringe, Plastic","250","RC","24338-230-30","NDC","","","facility","both","1","EA","","57.64","57.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","24338-230-15","NDC","","","facility","both","1","EA","","78.34","78.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa, Levodopa, And Entacapone: 100 Tablet, Film Coated In 1 Bottle (0781-5654-01)","250","RC","0781-5654-01","NDC","","","facility","both","1","EA","","4.99","4.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 1 Vial In 1 Carton (31722-308-01)  / 2 Ml In 1 Vial","250","RC","31722-308-01","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (42292-041-20)  / 1 Tablet In 1 Blister Pack (42292-041-01)","250","RC","42292-041-20","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42292-041-01","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42292-039-01","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (42292-038-20)  / 1 Tablet In 1 Blister Pack (42292-038-01)","250","RC","42292-038-20","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42292-038-01","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 100 Capsule In 1 Bottle (42291-923-01)","250","RC","42291-923-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42292-043-01","NDC","","","facility","both","1","EA","","2.76","2.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Teriflunomide: 30 Tablet, Film Coated In 1 Bottle (42291-831-30)","250","RC","42291-831-30","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sucralfate: 420 Ml In 1 Bottle (42291-781-42)","250","RC","42291-781-42","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Riluzole: 60 Tablet, Film Coated In 1 Bottle (42291-775-60)","250","RC","42291-775-60","NDC","","","facility","both","1","EA","","16.26","16.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin Hydrochloride: 90 Tablet, Extended Release In 1 Bottle (42291-497-90)","250","RC","42291-497-90","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (42291-459-30)","250","RC","42291-459-30","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eplerenone: 90 Tablet, Coated In 1 Bottle (42291-454-90)","250","RC","42291-454-90","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valsartan: 30 Tablet In 1 Bottle (42291-856-30)","250","RC","42291-856-30","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42292-044-01","NDC","","","facility","both","1","EA","","19.43","19.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Emtricitabine And Tenofovir Disoproxil Fumarate: 30 Tablet, Film Coated In 1 Bottle (42385-953-30)","250","RC","42385-953-30","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 100 Tablet In 1 Bottle (42571-315-01)","250","RC","42571-315-01","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dalfampridine: 60 Tablet, Extended Release In 1 Bottle (42571-275-60)","250","RC","42571-275-60","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rasagiline: 30 Tablet In 1 Bottle (42571-221-30)","250","RC","42571-221-30","NDC","","","facility","both","1","EA","","13.22","13.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dorzolamide Hydrochloride And Timolol Maleate Ophthalmic Solution: 1 Bottle In 1 Carton (42571-147-26)  / 10 Ml In 1 Bottle","250","RC","42571-147-26","NDC","","","facility","both","1","EA","","83","83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dorzolamide Hydrochloride Ophthalmic Solution: 1 Bottle In 1 Carton (42571-141-26)  / 10 Ml In 1 Bottle","250","RC","42571-141-26","NDC","","","facility","both","1","EA","","23.58","23.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 5 Ml In 1 Bottle (42571-137-25)","250","RC","42571-137-25","NDC","","","facility","both","1","EA","","49.79","49.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital Sodium: 25 Vial In 1 Box, Unit-Dose (42494-416-25)  / 1 Ml In 1 Vial","250","RC","42494-416-25","NDC","","","facility","both","1","EA","","22.51","22.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (42385-947-01)","250","RC","42385-947-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42494-416-01","NDC","","","facility","both","1","EA","","29.75","29.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital Sodium: 25 Vial In 1 Box, Unit-Dose (42494-415-25)  / 1 Ml In 1 Vial","250","RC","42494-415-25","NDC","","","facility","both","1","EA","","31.57","31.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42494-415-01","NDC","","","facility","both","1","EA","","12.19","12.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42494-341-01","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone Acetate: 12 SUPPOSITORY in 1 BOX (42494-301-12) ","250","RC","42494-301-12","NDC","","","facility","both","1","EA","","5.41","5.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Endari: 60 Packet In 1 Carton (42457-420-60)  / 1 Powder, For Solution In 1 Packet (42457-420-01)","250","RC","42457-420-60","NDC","","","facility","both","1","EA","","42.61","42.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42457-420-01","NDC","","","facility","both","1","EA","","42.62","42.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabometyx: 1 Bottle In 1 Carton (42388-023-46)  / 30 Tablet In 1 Bottle","250","RC","42388-023-46","NDC","","","facility","both","1","EA","","1535.09","1535.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin Hydrochloride: 90 Tablet, Extended Release In 1 Bottle (42385-977-90)","250","RC","42385-977-90","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Tablet, Film Coated In 1 Bottle (42291-082-30)","250","RC","42291-082-30","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (42291-077-30)  / 30 G In 1 Tube","250","RC","42291-077-30","NDC","","","facility","both","1","EA","","7.89","7.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (42291-077-15)  / 15 G In 1 Tube","250","RC","42291-077-15","NDC","","","facility","both","1","EA","","4.35","4.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adrenalin (Epinephrine In Sodium Chloride): 10 Bag In 1 Carton (42023-315-10)  / 250 Ml In 1 Bag (42023-315-01)","250","RC","42023-315-10","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adrenalin (Epinephrine In Sodium Chloride): 10 Bag In 1 Carton (42023-315-10)  / 250 Ml In 1 Bag (42023-315-01)","250","RC","42023-315-10","NDC","","","facility","both","1","EA","","14.88","14.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42023-315-01","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42023-315-01","NDC","","","facility","both","1","EA","","52.55","52.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ephedrine Sulfate: 10 Ml In 1 Vial, Single-Dose (42023-243-01)","250","RC","42023-243-01","NDC","","","facility","both","1","EA","","4.73","4.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasostrict: 10 Vial In 1 Carton (42023-237-10)  / 100 Ml In 1 Vial (42023-237-01)","250","RC","42023-237-10","NDC","","","facility","both","1","EA","","4.21","4.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bivalirudin: 1 Vial, Single-Dose In 1 Carton (42023-622-01)  / 1 Injection, Solution In 1 Vial, Single-Dose","250","RC","42023-622-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42023-237-01","NDC","","","facility","both","1","EA","","4.04","4.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42023-230-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (42023-205-01)  / 2 Ml In 1 Vial, Multi-Dose","250","RC","42023-205-01","NDC","","","facility","both","1","EA","","952.31","952.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasostrict: 1 Vial In 1 Carton (42023-190-01)  / 10 Ml In 1 Vial","250","RC","42023-190-01","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (42291-076-30)  / 30 G In 1 Tube","250","RC","42291-076-30","NDC","","","facility","both","1","EA","","5.73","5.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (42291-076-15)  / 15 G In 1 Tube","250","RC","42291-076-15","NDC","","","facility","both","1","EA","","3.54","3.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (42291-068-30)","250","RC","42291-068-30","NDC","","","facility","both","1","EA","","2.3","2.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (42291-067-30)","250","RC","42291-067-30","NDC","","","facility","both","1","EA","","2.25","2.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (42291-066-30)","250","RC","42291-066-30","NDC","","","facility","both","1","EA","","2.28","2.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (42291-065-30)","250","RC","42291-065-30","NDC","","","facility","both","1","EA","","2.19","2.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (42291-064-30)","250","RC","42291-064-30","NDC","","","facility","both","1","EA","","2.45","2.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amiodarone Hydrochloride: 30 Tablet In 1 Bottle (42291-009-30)","250","RC","42291-009-30","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 470 Ml In 1 Bottle (42192-608-16)","250","RC","42192-608-16","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 6 Ml In 1 Cup, Unit-Dose (42192-608-06)","250","RC","42192-608-06","NDC","","","facility","both","1","EA","","6.07","6.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyoscyamine Sulfate Tab: 100 Tablet In 1 Bottle (42192-340-01)","250","RC","42192-340-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyoscyamine Sulfate Sl: 100 Tablet In 1 Bottle (42192-339-01)","250","RC","42192-339-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Np Thyroid 60: 100 Tablet In 1 Bottle (42192-330-01)","250","RC","42192-330-01","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Np Thyroid 30: 100 Tablet In 1 Bottle (42192-329-01)","250","RC","42192-329-01","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 100 Tablet In 1 Bottle (42571-316-01)","250","RC","42571-316-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methenamine Hippurate: 100 Tablet In 1 Bottle (42571-332-01)","250","RC","42571-332-01","NDC","","","facility","both","1","EA","","2.84","2.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clomipramine Hydrochloride: 100 Capsule In 1 Bottle (42571-342-01)","250","RC","42571-342-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-302-25)  / 25 Tablet In 1 Blister Pack","250","RC","42858-302-25","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-302-01)","250","RC","42858-302-01","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-301-25)  / 25 Tablet In 1 Blister Pack","250","RC","42858-301-25","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-301-01)","250","RC","42858-301-01","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dilaudid: 500 Tablet In 1 Bottle, Plastic (42858-234-50)","250","RC","42858-234-50","NDC","","","facility","both","1","EA","","6.52","6.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dilaudid: 100 Tablet In 1 Bottle, Plastic (42858-234-01)","250","RC","42858-234-01","NDC","","","facility","both","1","EA","","6.85","6.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dilaudid: 100 Tablet In 1 Bottle, Plastic (42858-122-01)","250","RC","42858-122-01","NDC","","","facility","both","1","EA","","3.84","3.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-002-10)  / 10 Tablet In 1 Blister Pack","250","RC","42858-002-10","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-001-10)  / 10 Tablet In 1 Blister Pack","250","RC","42858-001-10","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfadiazine: 60 Tablet In 1 Bottle (42806-757-60)","250","RC","42806-757-60","NDC","","","facility","both","1","EA","","24.89","24.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benzonatate: 100 Capsule In 1 Bottle (42806-714-01)","250","RC","42806-714-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entecavir: 30 Tablet In 1 Bottle, Plastic (42806-659-30)","250","RC","42806-659-30","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle, Plastic (42858-161-01)","250","RC","42858-161-01","NDC","","","facility","both","1","EA","","15.33","15.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dilaudid: 473 Ml In 1 Bottle, Plastic (42858-416-16)","250","RC","42858-416-16","NDC","","","facility","both","1","EA","","10.14","10.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine: 30 Tablet In 1 Bottle (42858-501-03)","250","RC","42858-501-03","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Edisylate: 25 Vial In 1 Carton (43066-090-25)  / 2 Ml In 1 Vial (43066-090-01)","250","RC","43066-090-25","NDC","","","facility","both","1","EA","","2.61","2.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43066-090-01","NDC","","","facility","both","1","EA","","2.94","2.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cardene Iv: 10 Bag In 1 Carton (43066-016-10)  / 200 Ml In 1 Bag","250","RC","43066-016-10","NDC","","","facility","both","1","EA","","103.69","103.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","43066-008-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dronabinol: 60 Capsule In 1 Bottle (42858-868-06)","250","RC","42858-868-06","NDC","","","facility","both","1","EA","","2.58","2.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate Extended Release: 100 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (42858-803-01)","250","RC","42858-803-01","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate Extended Release: 100 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (42858-801-01)","250","RC","42858-801-01","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ms Contin: 100 Tablet In 1 Bottle, Plastic (42858-760-01)","250","RC","42858-760-01","NDC","","","facility","both","1","EA","","30.05","30.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, And Amphetamine Sulfate: 100 Tablet In 1 Bottle (42858-723-01)","250","RC","42858-723-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 30 Tablet, Film Coated, Extended Release In 1 Bottle (42858-703-03)","250","RC","42858-703-03","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ms Contin: 100 Tablet In 1 Bottle, Plastic (42858-631-01)","250","RC","42858-631-01","NDC","","","facility","both","1","EA","","14.67","14.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ms Contin: 100 Tablet In 1 Bottle, Plastic (42858-515-01)","250","RC","42858-515-01","NDC","","","facility","both","1","EA","","7.67","7.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine: 30 Tablet In 1 Bottle (42858-502-03)","250","RC","42858-502-03","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmedetomidine Hydrochloride: 10 Vial In 1 Carton (42023-187-10)  / 100 Ml In 1 Vial","250","RC","42023-187-10","NDC","","","facility","both","1","EA","","24.48","24.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entecavir: 30 Tablet In 1 Bottle, Plastic (42806-658-30)","250","RC","42806-658-30","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (42806-410-01)","250","RC","42806-410-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"SANCUSO: 1 POUCH in 1 CARTON (42747-726-01)  / 1 PATCH in 1 POUCH / 168 h in 1 PATCH","250","RC","42747-726-01","NDC","","","facility","both","1","EA","","1099.14","1099.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irbesartan: 90 Tablet, Film Coated In 1 Bottle (42658-122-04)","250","RC","42658-122-04","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Protriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (42794-004-02)","250","RC","42794-004-02","NDC","","","facility","both","1","EA","","8.3","8.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daunorubicin Hydrochloride: 1 Vial In 1 Box (42658-021-01)  / 4 Ml In 1 Vial","250","RC","42658-021-01","NDC","","","facility","both","1","EA","","42.31","42.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cladribine: 1 Ml In 1 Vial, Single-Dose (42658-010-01)","250","RC","42658-010-01","NDC","","","facility","both","1","EA","","14.9","14.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 120 Tablet In 1 Bottle (42571-392-12)","250","RC","42571-392-12","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin Hydrochloride Oral Solution: 473 Ml In 1 Bottle (42571-360-07)","250","RC","42571-360-07","NDC","","","facility","both","1","EA","","9.04","9.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clomipramine Hydrochloride: 100 Capsule In 1 Bottle (42571-343-01)","250","RC","42571-343-01","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flucytosine: 30 Capsule In 1 Bottle (42794-009-08)","250","RC","42794-009-08","NDC","","","facility","both","1","EA","","29.88","29.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opium Tincture Deodorized: 118 Ml In 1 Bottle, Plastic (42799-217-01)","250","RC","42799-217-01","NDC","","","facility","both","1","EA","","2.71","2.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ivermectin: 2 Blister Pack In 1 Carton (42799-806-01)  / 10 Tablet In 1 Blister Pack","250","RC","42799-806-01","NDC","","","facility","both","1","EA","","6.26","6.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 25 Tablet In 1 Bottle (42806-359-25)","250","RC","42806-359-25","NDC","","","facility","both","1","EA","","8.61","8.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 100 Tablet In 1 Bottle (42806-358-01)","250","RC","42806-358-01","NDC","","","facility","both","1","EA","","1.95","1.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle, Plastic (42806-341-01)","250","RC","42806-341-01","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle, Plastic (42806-339-01)","250","RC","42806-339-01","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine Er: 100 Tablet, Extended Release In 1 Bottle (42806-275-01)","250","RC","42806-275-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cholestyramine: 378 G In 1 Can (42806-267-97)","250","RC","42806-267-97","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42806-266-98","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cholestyramine: 60 Pouch In 1 Carton (42806-266-95)  / 9 G In 1 Pouch (42806-266-98)","250","RC","42806-266-95","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isradipine: 100 Capsule In 1 Bottle (42806-263-01)","250","RC","42806-263-01","NDC","","","facility","both","1","EA","","16.26","16.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Ml In 1 Bottle, Plastic (42806-151-34)","250","RC","42806-151-34","NDC","","","facility","both","1","EA","","2.73","2.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethambutol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (42806-102-01)","250","RC","42806-102-01","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Protriptyline Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (42806-097-30)","250","RC","42806-097-30","NDC","","","facility","both","1","EA","","4.05","4.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Estradiol: 100 Tablet In 1 Bottle (42806-088-01)","250","RC","42806-088-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Estradiol: 100 Tablet In 1 Bottle (42806-087-01)","250","RC","42806-087-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisolone Sodium Phosphate: 237 Ml In 1 Bottle, Plastic (42799-815-01)","250","RC","42799-815-01","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Omega-3-Acid Ethyl Esters: 120 Capsule, Liquid Filled In 1 Bottle (42806-552-12)","250","RC","42806-552-12","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42023-187-01","NDC","","","facility","both","1","EA","","24.48","24.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Capsule In 1 Bottle (33342-157-11)","250","RC","33342-157-11","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tolterodine Tartrate: 60 Tablet, Film Coated In 1 Bottle (33342-098-09)","250","RC","33342-098-09","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tolterodine Tartrate: 60 Tablet, Film Coated In 1 Bottle (33342-097-09)","250","RC","33342-097-09","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rivastigmine Tartrate: 60 Capsule In 1 Bottle (33342-091-09)","250","RC","33342-091-09","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rivastigmine Tartrate: 60 Capsule In 1 Bottle (33342-090-09)","250","RC","33342-090-09","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rivastigmine Tartrate: 60 Capsule In 1 Bottle (33342-089-09)","250","RC","33342-089-09","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","33342-088-02","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevelamer Carbonate: 270 Tablet, Film Coated In 1 Bottle (33342-215-58)","250","RC","33342-215-58","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valsartan: 30 Tablet, Film Coated In 1 Bottle (33342-062-07)","250","RC","33342-062-07","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pioglitazone: 90 Tablet In 1 Bottle (33342-055-10)","250","RC","33342-055-10","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irbesartan: 90 Tablet In 1 Bottle (33342-047-10)","250","RC","33342-047-10","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (31722-955-01)","250","RC","31722-955-01","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 1 Bottle In 1 Carton (31722-878-01)  / 100 Capsule In 1 Bottle","250","RC","31722-878-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 1 Bottle, Glass In 1 Carton (31722-865-25)  / 150 Ml In 1 Bottle, Glass","250","RC","31722-865-25","NDC","","","facility","both","1","EA","","110.06","110.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eltrombopag: 30 Tablet, Film Coated In 1 Bottle (31722-844-30)","250","RC","31722-844-30","NDC","","","facility","both","1","EA","","926.39","926.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eltrombopag: 30 Tablet, Film Coated In 1 Bottle (31722-842-30)","250","RC","31722-842-30","NDC","","","facility","both","1","EA","","341.35","341.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (31722-830-30)","250","RC","31722-830-30","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-256-66)  / 10 Capsule In 1 Blister Pack","250","RC","33342-256-66","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-258-66)  / 10 Capsule In 1 Blister Pack","250","RC","33342-258-66","NDC","","","facility","both","1","EA","","3.12","3.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 10 AMPULE in 1 BLISTER PACK (36000-092-10)  / 2 mL in 1 AMPULE","250","RC","36000-092-10","NDC","","","facility","both","1","EA","","1.89","1.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tadalafil: 30 Tablet, Film Coated In 1 Bottle (35573-461-30)","250","RC","35573-461-30","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carglumic Acid: 60 Tablet, For Suspension In 1 Bottle (35573-459-60)","250","RC","35573-459-60","NDC","","","facility","both","1","EA","","237.96","237.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketoconazole: 100 Tablet In 1 Bottle (35573-433-02)","250","RC","35573-433-02","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","35573-428-51","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sacubitril And Valsartan: 180 Tablet In 1 Bottle (33342-570-57)","250","RC","33342-570-57","NDC","","","facility","both","1","EA","","1.24","1.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 1 Tube In 1 Carton (33342-405-35)  / 35.44 G In 1 Tube","250","RC","33342-405-35","NDC","","","facility","both","1","EA","","16.57","16.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Tablet In 1 Bottle (33342-394-11)","250","RC","33342-394-11","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dimethyl Fumarate: 60 Capsule, Delayed Release In 1 Bottle (33342-350-09)","250","RC","33342-350-09","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 454 G In 1 Jar (33342-333-54)","250","RC","33342-333-54","NDC","","","facility","both","1","EA","","41.68","41.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (33342-333-15)  / 15 G In 1 Tube","250","RC","33342-333-15","NDC","","","facility","both","1","EA","","4.71","4.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (33342-329-80)  / 80 G In 1 Tube","250","RC","33342-329-80","NDC","","","facility","both","1","EA","","10.66","10.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (33342-327-80)  / 80 G In 1 Tube","250","RC","33342-327-80","NDC","","","facility","both","1","EA","","9.51","9.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Febuxostat: 30 Film In 1 Bottle (33342-274-07)","250","RC","33342-274-07","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entacapone: 100 Tablet In 1 Bottle (33342-260-11)","250","RC","33342-260-11","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (31722-829-30)","250","RC","31722-829-30","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetrabenazine: 112 Tablet, Coated In 1 Bottle (31722-821-11)","250","RC","31722-821-11","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 10 Capsule In 1 Carton (31722-631-31)","250","RC","31722-631-31","NDC","","","facility","both","1","EA","","4.32","4.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atovaquone: 1 Bottle In 1 Carton (31722-629-21)  / 210 Ml In 1 Bottle","250","RC","31722-629-21","NDC","","","facility","both","1","EA","","2.46","2.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Roflumilast: 30 Tablet In 1 Bottle (31722-623-30)","250","RC","31722-623-30","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 120 Tablet, Film Coated In 1 Bottle (31722-598-12)","250","RC","31722-598-12","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nebivolol: 90 Tablet In 1 Bottle (31722-586-90)","250","RC","31722-586-90","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Maraviroc: 60 Tablet, Film Coated In 1 Bottle (31722-580-60)","250","RC","31722-580-60","NDC","","","facility","both","1","EA","","29.34","29.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Maraviroc: 60 Tablet, Film Coated In 1 Bottle (31722-579-60)","250","RC","31722-579-60","NDC","","","facility","both","1","EA","","31.07","31.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 473 Ml In 1 Bottle (31722-574-47)","250","RC","31722-574-47","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indomethacin: 12 Bottle In 1 Case (31722-542-01)  / 100 Capsule In 1 Bottle","250","RC","31722-542-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Torsemide: 100 Tablet In 1 Bottle (31722-532-01)","250","RC","31722-532-01","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Torsemide: 100 Tablet In 1 Bottle (31722-531-01)","250","RC","31722-531-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Torsemide: 100 Tablet In 1 Bottle (31722-530-01)","250","RC","31722-530-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levocetirizine Dihydrochloride: 90 Tablet In 1 Bottle (31722-551-90)","250","RC","31722-551-90","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 10 Capsule In 1 Carton (31722-632-31)","250","RC","31722-632-31","NDC","","","facility","both","1","EA","","4.31","4.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tadalafil: 30 Tablet, Film Coated In 1 Bottle (31722-644-30)","250","RC","31722-644-30","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esomeprazole Magnesium: 90 Capsule, Delayed Release In 1 Bottle (31722-665-90)","250","RC","31722-665-90","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 100 Tablet In 1 Bottle (31722-778-01)","250","RC","31722-778-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 100 Tablet In 1 Bottle (31722-777-01)","250","RC","31722-777-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 20 Tablet, Film Coated In 1 Bottle (31722-749-20)","250","RC","31722-749-20","NDC","","","facility","both","1","EA","","3.97","3.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irbesartan: 90 Tablet In 1 Bottle (31722-731-90)","250","RC","31722-731-90","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irbesartan: 90 Tablet In 1 Bottle (31722-729-90)","250","RC","31722-729-90","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irbesartan: 30 Tablet In 1 Bottle (31722-729-30)","250","RC","31722-729-30","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Montelukast Sodium: 30 Tablet, Chewable In 1 Bottle (31722-728-30)","250","RC","31722-728-30","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Montelukast Sodium: 30 Tablet, Chewable In 1 Bottle (31722-727-30)","250","RC","31722-727-30","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (31722-718-30)","250","RC","31722-718-30","NDC","","","facility","both","1","EA","","2.35","2.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir: 30 Tablet, Film Coated In 1 Bottle (31722-705-30)","250","RC","31722-705-30","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (31722-700-90)","250","RC","31722-700-90","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 118 Ml In 1 Bottle (31722-691-11)","250","RC","31722-691-11","NDC","","","facility","both","1","EA","","3.57","3.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 473 Ml In 1 Bottle (31722-681-47)","250","RC","31722-681-47","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","36000-162-01","NDC","","","facility","both","1","EA","","2.35","2.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","39822-3050-1","NDC","","","facility","both","1","EA","","57.18","57.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dactinomycin: 1 Vial, Single-Dose In 1 Carton (39822-2100-2)  / 1 Ml In 1 Vial, Single-Dose (39822-2100-1)","250","RC","39822-2100-2","NDC","","","facility","both","1","EA","","522.84","522.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","39822-2100-1","NDC","","","facility","both","1","EA","","406.57","406.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folic Acid: 1 Vial, Multi-Dose In 1 Carton (39822-1100-1)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","39822-1100-1","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 10 Ml In 1 Vial (39822-1055-5)","250","RC","39822-1055-5","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","39822-4200-5","NDC","","","facility","both","1","EA","","7.13","7.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 10 Vial In 1 Carton (39822-1000-1)  / 10 Ml In 1 Vial","250","RC","39822-1000-1","NDC","","","facility","both","1","EA","","4.82","4.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","39822-0310-7","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Liothyronine Sodium: 1 Vial In 1 Carton (39822-0151-1)  / 1 Ml In 1 Vial","250","RC","39822-0151-1","NDC","","","facility","both","1","EA","","572.62","572.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyproheptadine Hydrochloride: 473 Ml In 1 Bottle, Glass (39328-544-16)","250","RC","39328-544-16","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","39822-5525-2","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dehydrated Alcohol: 10 Ampule In 1 Carton (39822-9300-2)  / 5 Ml In 1 Ampule (39822-9300-1)","250","RC","39822-9300-2","NDC","","","facility","both","1","EA","","785.05","785.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42023-179-01","NDC","","","facility","both","1","EA","","7.11","7.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adrenalin: 1 Vial In 1 Carton (42023-168-01)  / 30 Ml In 1 Vial","250","RC","42023-168-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasostrict: 25 Vial In 1 Carton (42023-164-25)  / 1 Ml In 1 Vial (42023-164-01)","250","RC","42023-164-25","NDC","","","facility","both","1","EA","","1.78","1.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42023-164-01","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adrenalin: 25 Vial In 1 Carton (42023-159-25)  / 1 Ml In 1 Vial (42023-159-01)","250","RC","42023-159-25","NDC","","","facility","both","1","EA","","2.3","2.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","42023-159-01","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethacrynate Sodium: 1 Vial In 1 Carton (42023-157-01)  / 50 Ml In 1 Vial","250","RC","42023-157-01","NDC","","","facility","both","1","EA","","924.43","924.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pitocin: 25 Vial In 1 Carton (42023-116-02)  / 10 Ml In 1 Vial","250","RC","42023-116-02","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketalar: 10 Vial In 1 Carton (42023-115-10)  / 5 Ml In 1 Vial","250","RC","42023-115-10","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketalar: 10 Vial In 1 Carton (42023-113-10)  / 20 Ml In 1 Vial","250","RC","42023-113-10","NDC","","","facility","both","1","EA","","4.93","4.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ammonia Inhalants: 12 AMPULE in 1 CARTON (39822-9900-2)  / .3 mL in 1 AMPULE","250","RC","39822-9900-2","NDC","","","facility","both","1","EA","","1.27","1.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amantadine Hydrochloride: 10 Tray In 1 Case (39328-530-99)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose (39328-530-10)","250","RC","39328-530-99","NDC","","","facility","both","1","EA","","4.57","4.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amantadine Hydrochloride: 473 Ml In 1 Bottle, Plastic (39328-530-16)","250","RC","39328-530-16","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 40 Bag In 1 Carton (36000-306-60)  / 100 Ml In 1 Bag","250","RC","36000-306-60","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose","250","RC","36000-284-25","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose","250","RC","36000-284-25","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose","250","RC","36000-284-25","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","36000-308-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-283-25)  / 4 Ml In 1 Vial, Single-Dose","250","RC","36000-283-25","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-282-25)  / 2 Ml In 1 Vial, Single-Dose","250","RC","36000-282-25","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-282-25)  / 2 Ml In 1 Vial, Single-Dose","250","RC","36000-282-25","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","36000-244-01","NDC","","","facility","both","1","EA","","3.04","3.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 1 Vial, Multi-Dose In 1 Carton (36000-242-01)  / 30 Ml In 1 Vial, Multi-Dose","250","RC","36000-242-01","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-283-25)  / 4 Ml In 1 Vial, Single-Dose","250","RC","36000-283-25","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 10 Vial, Single-Dose In 1 Carton (36000-308-10)  / 1 Ml In 1 Vial, Single-Dose (36000-308-01)","250","RC","36000-308-10","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 1 Tube In 1 Carton (39328-024-15)  / 15 G In 1 Tube","250","RC","39328-024-15","NDC","","","facility","both","1","EA","","16.18","16.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 5 G In 1 Vial, Glass (38779-1756-3)","250","RC","38779-1756-3","NDC","","","facility","both","1","EA","","2.78","2.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","38779-0640-9","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","38779-0640-8","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","38779-0545-5","NDC","","","facility","both","1","EA","","208.95","208.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 5 G In 1 Bottle, Glass (38779-0524-3)","250","RC","38779-0524-3","NDC","","","facility","both","1","EA","","4.46","4.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Beclomethasone Dipropionate: 1 G In 1 Vial (38779-0364-6)","250","RC","38779-0364-6","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metamucil Therapy For Regularity: 5.8 G In 1 Packet (37000-024-10)","250","RC","37000-024-10","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metamucil Therapy For Regularity: 30 Packet In 1 Carton (37000-024-04)  / 5.8 G In 1 Packet","250","RC","37000-024-04","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","36000-354-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 1 Vial In 1 Carton (36000-324-02)  / 40 Ml In 1 Vial (36000-324-01)","250","RC","36000-324-02","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","36000-324-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 1 Vial In 1 Carton (36000-322-02)  / 20 Ml In 1 Vial (36000-322-01)","250","RC","36000-322-02","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","36000-322-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","36000-310-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","39328-063-25","NDC","","","facility","both","1","EA","","23.84","23.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 50 Blister Pack In 1 Box, Unit-Dose (50268-088-15)  / 1 Tablet In 1 Blister Pack (50268-088-11)","250","RC","50268-088-15","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (0781-5439-20)","250","RC","0781-5439-20","NDC","","","facility","both","1","EA","","8.52","8.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (0781-5438-20)","250","RC","0781-5438-20","NDC","","","facility","both","1","EA","","5.88","5.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9506-01","NDC","","","facility","both","1","EA","","2.66","2.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 1 Vial In 1 Box, Unit-Dose (0143-9503-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","0143-9503-01","NDC","","","facility","both","1","EA","","25.2","25.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9501-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meropenem: 10 Vial In 1 Carton (0143-9431-10)  / 30 Ml In 1 Vial (0143-9431-01)","250","RC","0143-9431-10","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9431-01","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9398-01","NDC","","","facility","both","1","EA","","20.34","20.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9397-01","NDC","","","facility","both","1","EA","","6.64","6.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisatracurium Besylate: 1 Vial In 1 Carton (0143-9396-01)  / 5 Ml In 1 Vial","250","RC","0143-9396-01","NDC","","","facility","both","1","EA","","3.14","3.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9393-01","NDC","","","facility","both","1","EA","","92.34","92.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9392-01","NDC","","","facility","both","1","EA","","189.96","189.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Remifentanil Hydrochloride: 10 Vial In 1 Carton (0143-9391-10)  / 3 Ml In 1 Vial (0143-9391-01)","250","RC","0143-9391-10","NDC","","","facility","both","1","EA","","100.42","100.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9391-01","NDC","","","facility","both","1","EA","","12.21","12.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9386-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9507-01","NDC","","","facility","both","1","EA","","2.36","2.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9508-01","NDC","","","facility","both","1","EA","","4.35","4.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9551-01","NDC","","","facility","both","1","EA","","45.46","45.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9525-01","NDC","","","facility","both","1","EA","","26.24","26.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9514-01","NDC","","","facility","both","1","EA","","6.18","6.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial In 1 Box, Unit-Dose (0143-9511-01)  / 25 Ml In 1 Vial","250","RC","0143-9511-01","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial In 1 Box, Unit-Dose (0143-9510-01)  / 5 Ml In 1 Vial","250","RC","0143-9510-01","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketamine Hydrochloride: 10 Vial In 1 Box (0143-9509-10)  / 5 Ml In 1 Vial (0143-9509-01)","250","RC","0143-9509-10","NDC","","","facility","both","1","EA","","10.58","10.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9509-01","NDC","","","facility","both","1","EA","","9.77","9.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketamine Hydrochloride: 10 Vial In 1 Box (0143-9508-10)  / 10 Ml In 1 Vial (0143-9508-01)","250","RC","0143-9508-10","NDC","","","facility","both","1","EA","","9.56","9.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9519-01","NDC","","","facility","both","1","EA","","2.98","2.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (0143-9385-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","250","RC","0143-9385-01","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9333-10)  / 30 Ml In 1 Vial, Single-Dose (0143-9333-01)","250","RC","0143-9333-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9333-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9330-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norepinephrine Bitartrate: 10 Vial In 1 Carton (0143-9318-10)  / 4 Ml In 1 Vial (0143-9318-01)","250","RC","0143-9318-10","NDC","","","facility","both","1","EA","","5.12","5.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9315-01","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9334-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Estradiol Valerate: 1 Vial In 1 Carton (0143-9291-01)  / 5 Ml In 1 Vial","250","RC","0143-9291-01","NDC","","","facility","both","1","EA","","9.56","9.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Tablet, Coated In 1 Bottle (0143-9285-01)","250","RC","0143-9285-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9284-01","NDC","","","facility","both","1","EA","","10.05","10.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Box, Unit-Dose (0143-9280-01)  / 80 Ml In 1 Vial","250","RC","0143-9280-01","NDC","","","facility","both","1","EA","","22.1","22.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial In 1 Box, Unit-Dose (0143-9292-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","0143-9292-01","NDC","","","facility","both","1","EA","","11","11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9334-10)  / 30 Ml In 1 Vial, Single-Dose (0143-9334-01)","250","RC","0143-9334-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9384-01)  / 5 Ml In 1 Vial, Single-Dose","250","RC","0143-9384-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime Hydrochloride: 10 Vial In 1 Carton (0143-9383-10)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","0143-9383-10","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9383-01","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9380-01","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial In 1 Carton (0143-9362-01)  / 5 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","0143-9362-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial In 1 Carton (0143-9361-01)  / 5 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","0143-9361-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Succinylcholine Chloride: 25 Vial In 1 Carton (0143-9338-25)  / 10 Ml In 1 Vial","250","RC","0143-9338-25","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9335-10)  / 30 Ml In 1 Vial, Single-Dose (0143-9335-01)","250","RC","0143-9335-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9335-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9335-01","NDC","","","facility","both","1","EA","","2.7","2.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial In 1 Box, Unit-Dose (0143-9553-01)  / 20 Ml In 1 Vial","250","RC","0143-9553-01","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Injection, Powder, For Solution In 1 Vial, Multi-Dose (0143-9850-01)","250","RC","0143-9850-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate: 50 Capsule In 1 Bottle, Plastic (0143-9803-50)","250","RC","0143-9803-50","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valproate Sodium: 10 Vial, Single-Dose In 1 Carton (0143-9785-10)  / 5 Ml In 1 Vial, Single-Dose (0143-9785-01)","250","RC","0143-9785-10","NDC","","","facility","both","1","EA","","6.07","6.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9785-01","NDC","","","facility","both","1","EA","","2.78","2.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Injection, Powder, For Solution In 1 Vial, Multi-Dose (0143-9851-01)","250","RC","0143-9851-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9783-01","NDC","","","facility","both","1","EA","","11.12","11.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9746-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9744-01","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 3 Ml In 1 Vial (0143-9924-90)","250","RC","0143-9924-90","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Ml In 1 Bottle (0143-9889-01)","250","RC","0143-9889-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Ml In 1 Bottle (0143-9887-01)","250","RC","0143-9887-01","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9875-01","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cladribine: 1 Vial In 1 Box, Unit-Dose (0143-9871-01)  / 10 Ml In 1 Vial","250","RC","0143-9871-01","NDC","","","facility","both","1","EA","","11.95","11.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Injection, Powder, For Solution In 1 Vial, Multi-Dose (0143-9851-01)","250","RC","0143-9851-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cladribine: 1 Vial In 1 Box, Unit-Dose (0143-9871-01)  / 10 Ml In 1 Vial","250","RC","0143-9871-01","NDC","","","facility","both","1","EA","","11.95","11.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9857-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone: 25 Vial In 1 Box (0143-9856-25)  / 1 Injection, Powder, For Solution In 1 Vial (0143-9856-01)","250","RC","0143-9856-25","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9856-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 75 Ml In 1 Bottle (0143-9853-75)","250","RC","0143-9853-75","NDC","","","facility","both","1","EA","","2.37","2.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levocarnitine: 10 Vial, Single-Use In 1 Carton (0143-9852-10)  / 5 Ml In 1 Vial, Single-Use (0143-9852-01)","250","RC","0143-9852-10","NDC","","","facility","both","1","EA","","34.89","34.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9852-01","NDC","","","facility","both","1","EA","","27.55","27.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9721-01","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicardipine Hydrochloride: 10 Bag In 1 Carton (0143-9633-10)  / 200 Ml In 1 Bag (0143-9633-01)","250","RC","0143-9633-10","NDC","","","facility","both","1","EA","","77.6","77.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9633-01","NDC","","","facility","both","1","EA","","80.35","80.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Vial In 1 Carton (0143-9606-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","0143-9606-01","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Vial In 1 Carton (0143-9606-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","0143-9606-01","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9595-01","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9594-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9594-01","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 10 Vial, Multi-Dose In 1 Package (0143-9575-10)  / 50 Ml In 1 Vial, Multi-Dose (0143-9575-01)","250","RC","0143-9575-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phentolamine Mesylate: 1 Vial In 1 Box (0143-9564-01)  / 1 Ml In 1 Vial","250","RC","0143-9564-01","NDC","","","facility","both","1","EA","","657.79","657.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone: 1 Injection, Powder, For Solution In 1 Carton (0143-9678-01)","250","RC","0143-9678-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9681-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9720-01","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9719-01","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9710-01","NDC","","","facility","both","1","EA","","3.15","3.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milrinone Lactate: 20 Ml In 1 Box (0143-9709-01)","250","RC","0143-9709-01","NDC","","","facility","both","1","EA","","2.07","2.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milrinone Lactate: 50 Ml In 1 Box (0143-9708-01)","250","RC","0143-9708-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9689-01","NDC","","","facility","both","1","EA","","42.32","42.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9682-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9682-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial In 1 Carton (0143-9681-25)  / 2 Ml In 1 Vial (0143-9681-01)","250","RC","0143-9681-25","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9681-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-1775-05","NDC","","","facility","both","1","EA","","4.49","4.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mag-Al Plus: 10 Tray In 1 Case (0121-1761-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose","250","RC","0121-1761-30","NDC","","","facility","both","1","EA","","2.71","2.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-1744-05","NDC","","","facility","both","1","EA","","2.65","2.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 10 Tray In 1 Case (0121-1576-10)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose","250","RC","0121-1576-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 10 Tray In 1 Case (0121-1576-10)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose","250","RC","0121-1576-10","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Acetaminophen: 10 Tray In 1 Case (0121-1781-00)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-1781-05)","250","RC","0121-1781-00","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-1488-10","NDC","","","facility","both","1","EA","","2.64","2.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guaifenesin: 10 Tray In 1 Case (0121-1488-00)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose (0121-1488-10)","250","RC","0121-1488-00","NDC","","","facility","both","1","EA","","2.67","2.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"POTASSIUM CHLORIDE: 10 TRAY in 1 CASE (0121-1465-15)  / 10 CUP, UNIT-DOSE in 1 TRAY / 15 mL in 1 CUP, UNIT-DOSE","250","RC","0121-1465-15","NDC","","","facility","both","1","EA","","13.37","13.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-1350-10","NDC","","","facility","both","1","EA","","3.99","3.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactulose: 4 Tray In 1 Case (0121-1154-40)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose (0121-1154-30)","250","RC","0121-1154-40","NDC","","","facility","both","1","EA","","2.7","2.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-1154-30","NDC","","","facility","both","1","EA","","2.47","2.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-4675-05","NDC","","","facility","both","1","EA","","2.2","2.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valproic Acid: 10 Tray In 1 Case (0121-4675-00)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-4675-05)","250","RC","0121-4675-00","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-4577-15","NDC","","","facility","both","1","EA","","2.46","2.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-2823-21","NDC","","","facility","both","1","EA","","2.88","2.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 10 Tray In 1 Case (0121-2520-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose","250","RC","0121-2520-30","NDC","","","facility","both","1","EA","","18.63","18.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-1781-05","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-2232-15","NDC","","","facility","both","1","EA","","2.02","2.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dye Free Childrens Ibuprofen: 10 Cup, Unit-Dose In 1 Tray (0121-2044-10)  / 10 Ml In 1 Cup, Unit-Dose","250","RC","0121-2044-10","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-1896-30","NDC","","","facility","both","1","EA","","14.72","14.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 3 Tray In 1 Case (0121-1894-94)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose (0121-1894-10)","250","RC","0121-1894-94","NDC","","","facility","both","1","EA","","4.29","4.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-1870-10","NDC","","","facility","both","1","EA","","2.1","2.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docusate Sodium: 10 Tray In 1 Case (0121-1870-00)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose (0121-1870-10)","250","RC","0121-1870-00","NDC","","","facility","both","1","EA","","2.02","2.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-1828-10","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guaifenesin: 10 Tray In 1 Case (0121-2232-00)  / 10 Cup, Unit-Dose In 1 Tray / 15 Ml In 1 Cup, Unit-Dose (0121-2232-15)","250","RC","0121-2232-00","NDC","","","facility","both","1","EA","","2.02","2.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 473 Ml In 1 Bottle (0121-1045-16)","250","RC","0121-1045-16","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 473 Ml In 1 Bottle (0121-1034-16)","250","RC","0121-1034-16","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-0893-15","NDC","","","facility","both","1","EA","","2.06","2.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorhexidine Gluconate: 10 Tray In 1 Case (0121-0893-00)  / 10 Cup, Unit-Dose In 1 Tray / 15 Ml In 1 Cup, Unit-Dose (0121-0893-15)","250","RC","0121-0893-00","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisolone: 480 Ml In 1 Bottle (0121-0885-16)","250","RC","0121-0885-16","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactulose: 473 Ml In 1 Bottle (0121-0873-16)","250","RC","0121-0873-16","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 473 Ml In 1 Bottle (0121-0868-16)","250","RC","0121-0868-16","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-0868-05","NDC","","","facility","both","1","EA","","2.24","2.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-0908-05","NDC","","","facility","both","1","EA","","1.82","1.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 2 Blister Pack In 1 Carton (0121-0867-20)  / 10 Capsule In 1 Blister Pack","250","RC","0121-0867-20","NDC","","","facility","both","1","EA","","2.18","2.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 1 Bottle, Dropper In 1 Carton (0121-0770-01)  / 30 Ml In 1 Bottle, Dropper","250","RC","0121-0770-01","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Carbonate: 12 Bottle In 1 Case (0121-0766-16)  / 473 Ml In 1 Bottle","250","RC","0121-0766-16","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisolone Sodium Phosphate: 237 Ml In 1 Bottle (0121-0759-08)","250","RC","0121-0759-08","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 120 Ml In 1 Bottle (0121-0721-04)","250","RC","0121-0721-04","NDC","","","facility","both","1","EA","","3.03","3.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 473 Ml In 1 Bottle (0121-0678-16)","250","RC","0121-0678-16","NDC","","","facility","both","1","EA","","7.64","7.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 10 Cup, Unit-Dose In 1 Tray (0121-0853-20)  / 20 Ml In 1 Cup, Unit-Dose","250","RC","0121-0853-20","NDC","","","facility","both","1","EA","","26.55","26.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 4 Tray In 1 Case (0121-0908-40)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-0908-05)","250","RC","0121-0908-40","NDC","","","facility","both","1","EA","","4.18","4.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-0914-05","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-1016-05","NDC","","","facility","both","1","EA","","40.87","40.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-0978-10","NDC","","","facility","both","1","EA","","6.86","6.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-0978-10","NDC","","","facility","both","1","EA","","7.23","7.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hydrochloride: 10 Tray In 1 Case (0121-0978-00)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose (0121-0978-10)","250","RC","0121-0978-00","NDC","","","facility","both","1","EA","","13.72","13.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-0977-55","NDC","","","facility","both","1","EA","","30.9","30.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-0974-10","NDC","","","facility","both","1","EA","","11.19","11.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 1 Bottle, Glass In 1 Carton (0121-0972-51)  / 50 Ml In 1 Bottle, Glass","250","RC","0121-0972-51","NDC","","","facility","both","1","EA","","25.92","25.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-0970-01","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atovaquone: 1 Bottle In 1 Carton (0121-0956-08)  / 210 Ml In 1 Bottle","250","RC","0121-0956-08","NDC","","","facility","both","1","EA","","3.16","3.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 473 Ml In 1 Bottle (0121-0948-16)","250","RC","0121-0948-16","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-0945-10","NDC","","","facility","both","1","EA","","6.93","6.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital Oral Solution: 473 Ml In 1 Bottle, Plastic (0121-0942-16)","250","RC","0121-0942-16","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital Oral Solution: 473 Ml In 1 Bottle, Plastic (0121-0942-16)","250","RC","0121-0942-16","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-4721-05","NDC","","","facility","both","1","EA","","6.44","6.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Carbonate: 4 Tray In 1 Case (0121-4766-05)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose","250","RC","0121-4766-05","NDC","","","facility","both","1","EA","","3.2","3.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Megestrol Acetate: 10 mL in 1 CUP, UNIT-DOSE (0121-4776-10) ","250","RC","0121-4776-10","NDC","","","facility","both","1","EA","","4.07","4.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9180-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0143-9164-01)  / 10.25 G In 1 Vial, Pharmacy Bulk Package","250","RC","0143-9164-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foscarnet Sodium: 10 Carton In 1 Case (0143-9192-01)  / 1 Bottle In 1 Carton / 250 Ml In 1 Bottle","250","RC","0143-9192-01","NDC","","","facility","both","1","EA","","41.33","41.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0143-9163-01)  / 5.13 G In 1 Vial, Pharmacy Bulk Package","250","RC","0143-9163-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial In 1 Package (0143-9162-10)  / 1025 Mg In 1 Vial (0143-9162-01)","250","RC","0143-9162-10","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial In 1 Package (0143-9162-10)  / 1025 Mg In 1 Vial (0143-9162-01)","250","RC","0143-9162-10","NDC","","","facility","both","1","EA","","2.83","2.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9162-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9157-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foscarnet Sodium: 10 Carton In 1 Case (0143-9192-01)  / 1 Bottle In 1 Carton / 250 Ml In 1 Bottle","250","RC","0143-9192-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9273-01","NDC","","","facility","both","1","EA","","59.01","59.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9250-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Idarubicin Hydrochloride: 1 Vial, Glass In 1 Box (0143-9218-01)  / 10 Ml In 1 Vial, Glass","250","RC","0143-9218-01","NDC","","","facility","both","1","EA","","44.46","44.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chloroprocaine Hydrochloride: 10 Vial In 1 Carton (0143-9210-10)  / 20 Ml In 1 Vial (0143-9210-01)","250","RC","0143-9210-10","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9210-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chloroprocaine Hydrochloride: 10 Vial In 1 Carton (0143-9209-10)  / 20 Ml In 1 Vial (0143-9209-01)","250","RC","0143-9209-10","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9156-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9156-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle, Plastic (0143-1772-01)","250","RC","0143-1772-01","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle, Plastic (0143-1769-01)","250","RC","0143-1769-01","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Digoxin: 100 Tablet In 1 Bottle, Plastic (0143-1240-01)","250","RC","0143-1240-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fleet: 133 Ml In 1 Bottle, With Applicator (0132-0301-40)","250","RC","0132-0301-40","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pedia-Lax: 66 Ml In 1 Bottle, With Applicator (0132-0202-20)","250","RC","0132-0202-20","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fleet: 133 Ml In 1 Bottle, With Applicator (0132-0201-40)","250","RC","0132-0201-40","NDC","","","facility","both","1","EA","","1.88","1.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pedia-Lax: 6 Applicator In 1 Carton (0132-0190-12)  / 4 Ml In 1 Applicator","250","RC","0132-0190-12","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vimpat: 6 Blister Pack In 1 Carton (0131-2480-60)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","0131-2480-60","NDC","","","facility","both","1","EA","","36.3","36.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vimpat: 6 Blister Pack In 1 Carton (0131-2477-60)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","0131-2477-60","NDC","","","facility","both","1","EA","","22.04","22.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-4967-05","NDC","","","facility","both","1","EA","","2.5","2.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-4950-15","NDC","","","facility","both","1","EA","","8.11","8.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-4827-05","NDC","","","facility","both","1","EA","","7.93","7.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-4799-05","NDC","","","facility","both","1","EA","","4.01","4.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fleet: 12 SUPPOSITORY in 1 JAR (0132-0079-12) ","250","RC","0132-0079-12","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9156-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 25 Vial In 1 Carton (0143-9139-25)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","0143-9139-25","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 25 Vial In 1 Carton (0143-9139-25)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","0143-9139-25","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9139-01","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9139-01","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bortezomib: 1 Vial In 1 Carton (0143-9098-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","0143-9098-01","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 10 Vial, Pharmacy Bulk Package In 1 Carton (0143-9983-03)  / 1 Injection, Powder, For Solution In 1 Vial, Pharmacy Bulk Package (0143-9983-91)","250","RC","0143-9983-03","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Container In 1 Case (0264-7800-00)  / 1000 Ml In 1 Container","250","RC","0264-7800-00","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose In Lactated Ringers: 12 Container In 1 Case (0264-7751-00)  / 1000 Ml In 1 Container","250","RC","0264-7751-00","NDC","","","facility","both","1","EA","","5.38","5.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 24 Container In 1 Case (0264-7750-10)  / 500 Ml In 1 Container","250","RC","0264-7750-10","NDC","","","facility","both","1","EA","","4.3","4.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 12 Container In 1 Case (0264-7750-07)  / 1000 Ml In 1 Container","250","RC","0264-7750-07","NDC","","","facility","both","1","EA","","2.88","2.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isolyte S Ph 7.4: 24 Container In 1 Case (0264-7707-10)  / 500 Ml In 1 Container","250","RC","0264-7707-10","NDC","","","facility","both","1","EA","","7.55","7.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7652-00)  / 1000 Ml In 1 Container","250","RC","0264-7652-00","NDC","","","facility","both","1","EA","","7.36","7.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7645-00)  / 1000 Ml In 1 Container","250","RC","0264-7645-00","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7638-00)  / 1000 Ml In 1 Container","250","RC","0264-7638-00","NDC","","","facility","both","1","EA","","10.8","10.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7635-00)  / 1000 Ml In 1 Container","250","RC","0264-7635-00","NDC","","","facility","both","1","EA","","5.4","5.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7634-00)  / 1000 Ml In 1 Container","250","RC","0264-7634-00","NDC","","","facility","both","1","EA","","12.6","12.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 24 Container In 1 Case (0264-7623-20)  / 250 Ml In 1 Container","250","RC","0264-7623-20","NDC","","","facility","both","1","EA","","3.15","3.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7622-00)  / 1000 Ml In 1 Container","250","RC","0264-7622-00","NDC","","","facility","both","1","EA","","12.11","12.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7616-00)  / 1000 Ml In 1 Container","250","RC","0264-7616-00","NDC","","","facility","both","1","EA","","7.2","7.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isolyte S Ph 7.4: 12 Container In 1 Case (0264-7707-00)  / 1000 Ml In 1 Container","250","RC","0264-7707-00","NDC","","","facility","both","1","EA","","8.2","8.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-7800-20)  / 250 Ml In 1 Container","250","RC","0264-7800-20","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Dextrose: 24 Container In 1 Case (0264-9598-20)  / 250 Ml In 1 Container","250","RC","0264-9598-20","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Dextrose: 24 Container In 1 Case (0264-9598-20)  / 250 Ml In 1 Container","250","RC","0264-9598-20","NDC","","","facility","both","1","EA","","12.23","12.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium In Dextrose: 24 Container In 1 Case (0264-9587-20)  / 250 Ml In 1 Container","250","RC","0264-9587-20","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-7800-10)  / 500 Ml In 1 Container","250","RC","0264-7800-10","NDC","","","facility","both","1","EA","","4.18","4.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Sodium Chloride: 12 Container In 1 Case (0264-7865-00)  / 1000 Ml In 1 Container","250","RC","0264-7865-00","NDC","","","facility","both","1","EA","","3.24","3.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-7805-10)  / 500 Ml In 1 Container","250","RC","0264-7805-10","NDC","","","facility","both","1","EA","","6.84","6.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-7802-10)  / 500 Ml In 1 Container","250","RC","0264-7802-10","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Container In 1 Case (0264-7802-00)  / 1000 Ml In 1 Container","250","RC","0264-7802-00","NDC","","","facility","both","1","EA","","2.7","2.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Container In 1 Case (0264-7802-00)  / 1000 Ml In 1 Container","250","RC","0264-7802-00","NDC","","","facility","both","1","EA","","2.91","2.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-7800-20)  / 250 Ml In 1 Container","250","RC","0264-7800-20","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 12 Container In 1 Case (0264-7850-00)  / 1000 Ml In 1 Container","250","RC","0264-7850-00","NDC","","","facility","both","1","EA","","4.25","4.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 24 Container In 1 Case (0264-7612-10)  / 500 Ml In 1 Container","250","RC","0264-7612-10","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7612-00)  / 1000 Ml In 1 Container","250","RC","0264-7612-00","NDC","","","facility","both","1","EA","","5.39","5.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 4 Container In 1 Case (0264-7385-50)  / 2000 Ml In 1 Container","250","RC","0264-7385-50","NDC","","","facility","both","1","EA","","1.23","1.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Container In 1 Case (0264-5804-00)  / 1000 Ml In 1 Container","250","RC","0264-5804-00","NDC","","","facility","both","1","EA","","5.4","5.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-5802-10)  / 500 Ml In 1 Container","250","RC","0264-5802-10","NDC","","","facility","both","1","EA","","2.15","2.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-5802-10)  / 500 Ml In 1 Container","250","RC","0264-5802-10","NDC","","","facility","both","1","EA","","2.56","2.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Container In 1 Case (0264-5802-00)  / 1000 Ml In 1 Container","250","RC","0264-5802-00","NDC","","","facility","both","1","EA","","1.58","1.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 4 Container In 1 Case (0264-7387-50)  / 2000 Ml In 1 Container","250","RC","0264-7387-50","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Container In 1 Case (0264-4206-54)  / 100 Ml In 1 Container","250","RC","0264-4206-54","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Container In 1 Case (0264-4204-52)  / 50 Ml In 1 Container","250","RC","0264-4204-52","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 24 Container In 1 Case (0264-4100-90)  / 100 Ml In 1 Container","250","RC","0264-4100-90","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetic Acid: 16 Container In 1 Case (0264-2304-00)  / 1000 Ml In 1 Container","250","RC","0264-2304-00","NDC","","","facility","both","1","EA","","10.8","10.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"8 CONTAINER in 1 CASE (0264-2201-50)  / 2000 mL in 1 CONTAINER","250","RC","0264-2201-50","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Dextrose: 24 Container In 1 Case (0264-4400-54)  / 100 Ml In 1 Container","250","RC","0264-4400-54","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride For Irrigation: 4 Container In 1 Case (0264-7388-50)  / 2000 Ml In 1 Container","250","RC","0264-7388-50","NDC","","","facility","both","1","EA","","18","18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride For Irrigation: 4 Container In 1 Case (0264-7388-50)  / 2000 Ml In 1 Container","250","RC","0264-7388-50","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7610-00)  / 1000 Ml In 1 Container","250","RC","0264-7610-00","NDC","","","facility","both","1","EA","","2.7","2.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mannitol: 24 Container In 1 Case (0264-7578-10)  / 500 Ml In 1 Container","250","RC","0264-7578-10","NDC","","","facility","both","1","EA","","8.41","8.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Container In 1 Case (0264-7520-20)  / 250 Ml In 1 Container","250","RC","0264-7520-20","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Container In 1 Case (0264-7520-10)  / 500 Ml In 1 Container","250","RC","0264-7520-10","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Container In 1 Case (0264-7520-10)  / 500 Ml In 1 Container","250","RC","0264-7520-10","NDC","","","facility","both","1","EA","","3.18","3.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 Container In 1 Case (0264-7520-00)  / 1000 Ml In 1 Container","250","RC","0264-7520-00","NDC","","","facility","both","1","EA","","2.66","2.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 Container In 1 Case (0264-7520-00)  / 1000 Ml In 1 Container","250","RC","0264-7520-00","NDC","","","facility","both","1","EA","","6.98","6.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Container In 1 Case (0264-7510-20)  / 250 Ml In 1 Container","250","RC","0264-7510-20","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Container In 1 Case (0264-7510-20)  / 250 Ml In 1 Container","250","RC","0264-7510-20","NDC","","","facility","both","1","EA","","2.4","2.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Container In 1 Case (0264-7510-10)  / 500 Ml In 1 Container","250","RC","0264-7510-10","NDC","","","facility","both","1","EA","","3.89","3.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 Container In 1 Case (0264-7510-00)  / 1000 Ml In 1 Container","250","RC","0264-7510-00","NDC","","","facility","both","1","EA","","5.4","5.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride For Irrigation: 4 Container In 1 Case (0264-7388-60)  / 3000 Ml In 1 Container","250","RC","0264-7388-60","NDC","","","facility","both","1","EA","","10.8","10.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium In Sodium Chloride: 24 Container In 1 Case (0264-9872-10)  / 500 Ml In 1 Container","250","RC","0264-9872-10","NDC","","","facility","both","1","EA","","6.3","6.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kinevac: 10 Vial In 1 Package (0270-0556-15)  / 5 Ml In 1 Vial","250","RC","0270-0556-15","NDC","","","facility","both","1","EA","","86.64","86.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1000 Ml In 1 Bag (0338-0043-04)","250","RC","0338-0043-04","NDC","","","facility","both","1","EA","","4.32","4.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1000 Ml In 1 Bag (0338-0043-04)","250","RC","0338-0043-04","NDC","","","facility","both","1","EA","","6.68","6.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 500 Ml In 1 Bag (0338-0043-03)","250","RC","0338-0043-03","NDC","","","facility","both","1","EA","","6.42","6.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 1000 Ml In 1 Bag (0338-0023-04)","250","RC","0338-0023-04","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 1000 Ml In 1 Bag (0338-0023-04)","250","RC","0338-0023-04","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 500 Ml In 1 Bag (0338-0023-03)","250","RC","0338-0023-03","NDC","","","facility","both","1","EA","","3.15","3.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 500 Ml In 1 Bag (0338-0023-03)","250","RC","0338-0023-03","NDC","","","facility","both","1","EA","","3.47","3.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 250 Ml In 1 Bag (0338-0023-02)","250","RC","0338-0023-02","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 250 Ml In 1 Bag (0338-0023-02)","250","RC","0338-0023-02","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 1 Bag In 1 Package (0338-0017-48)  / 100 Ml In 1 Bag","250","RC","0338-0017-48","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 1 Bag In 1 Package (0338-0017-41)  / 50 Ml In 1 Bag","250","RC","0338-0017-41","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 16 Bag In 1 Pouch (0338-0017-31)  / 50 Ml In 1 Bag","250","RC","0338-0017-31","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 4 Bag In 1 Pouch (0338-0017-18)  / 100 Ml In 1 Bag","250","RC","0338-0017-18","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 4 Bag In 1 Pouch (0338-0017-18)  / 100 Ml In 1 Bag","250","RC","0338-0017-18","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 6 Bag In 1 Carton (0338-0047-46)  / 2000 Ml In 1 Bag","250","RC","0338-0047-46","NDC","","","facility","both","1","EA","","32.4","32.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 6 Bag In 1 Carton (0338-0047-46)  / 2000 Ml In 1 Bag","250","RC","0338-0047-46","NDC","","","facility","both","1","EA","","8.1","8.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-10)  / 25 Ml In 1 Bag","250","RC","0338-0049-10","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1000 Ml In 1 Bag (0338-0049-04)","250","RC","0338-0049-04","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1000 Ml In 1 Bag (0338-0049-04)","250","RC","0338-0049-04","NDC","","","facility","both","1","EA","","2.52","2.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 500 Ml In 1 Bag (0338-0049-03)","250","RC","0338-0049-03","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 500 Ml In 1 Bag (0338-0049-03)","250","RC","0338-0049-03","NDC","","","facility","both","1","EA","","4.4","4.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02)","250","RC","0338-0049-02","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02)","250","RC","0338-0049-02","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Bottle, Plastic In 1 Carton (0338-0048-04)  / 1000 Ml In 1 Bottle, Plastic","250","RC","0338-0048-04","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Bottle, Plastic In 1 Carton (0338-0048-04)  / 1000 Ml In 1 Bottle, Plastic","250","RC","0338-0048-04","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 18 Bottle, Plastic In 1 Carton (0338-0048-03)  / 500 Ml In 1 Bottle, Plastic","250","RC","0338-0048-03","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 18 Bottle, Plastic In 1 Carton (0338-0048-03)  / 500 Ml In 1 Bottle, Plastic","250","RC","0338-0048-03","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Carton (0338-0047-47)  / 3000 Ml In 1 Bag","250","RC","0338-0047-47","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Carton (0338-0047-47)  / 3000 Ml In 1 Bag","250","RC","0338-0047-47","NDC","","","facility","both","1","EA","","5.4","5.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 4 Bag In 1 Pouch (0338-0017-11)  / 50 Ml In 1 Bag","250","RC","0338-0017-11","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 16 Container In 1 Case (0264-2201-10)  / 500 Ml In 1 Container","250","RC","0264-2201-10","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 500 Ml In 1 Bag (0338-0017-03)","250","RC","0338-0017-03","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lokelma: 11 Packet In 1 Box (0310-1110-39)  / 10 G In 1 Packet (0310-1110-01)","250","RC","0310-1110-39","NDC","","","facility","both","1","EA","","15.73","15.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0310-1110-01","NDC","","","facility","both","1","EA","","14.4","14.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0310-1105-01","NDC","","","facility","both","1","EA","","14.75","14.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Koselugo: 60 Capsule In 1 Bottle (0310-0625-60)","250","RC","0310-0625-60","NDC","","","facility","both","1","EA","","428.16","428.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Koselugo: 28 Capsule In 1 Bottle (0310-0625-28)","250","RC","0310-0625-28","NDC","","","facility","both","1","EA","","434.94","434.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Koselugo: 28 Capsule In 1 Bottle (0310-0610-28)","250","RC","0310-0610-28","NDC","","","facility","both","1","EA","","171.47","171.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daliresp: 30 Tablet In 1 Bottle, Plastic (0310-0095-30)","250","RC","0310-0095-30","NDC","","","facility","both","1","EA","","22.54","22.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hurricaine Topical Anesthetic: 59.7 G In 1 Can (0283-0679-02)","250","RC","0283-0679-02","NDC","","","facility","both","1","EA","","53.57","53.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitro-Bid: 60 G In 1 Tube (0281-0326-60)","250","RC","0281-0326-60","NDC","","","facility","both","1","EA","","113.08","113.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitro-Bid: 30 G In 1 Tube (0281-0326-30)","250","RC","0281-0326-30","NDC","","","facility","both","1","EA","","56.54","56.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitro-Bid: 48 Packet In 1 Box (0281-0326-08)  / 1 G In 1 Packet","250","RC","0281-0326-08","NDC","","","facility","both","1","EA","","3.66","3.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Koselugo: 60 Capsule In 1 Bottle (0310-0610-60)","250","RC","0310-0610-60","NDC","","","facility","both","1","EA","","171.37","171.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 500 Ml In 1 Bag (0338-0017-03)","250","RC","0338-0017-03","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 250 Ml In 1 Bag (0338-0017-02)","250","RC","0338-0017-02","NDC","","","facility","both","1","EA","","3.55","3.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 2000 Ml In 1 Bag (0338-0013-06)","250","RC","0338-0013-06","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 1000 Ml In 1 Bag (0338-0013-04)","250","RC","0338-0013-04","NDC","","","facility","both","1","EA","","7.65","7.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 12 Bottle, Plastic In 1 Carton (0338-0004-04)  / 1000 Ml In 1 Bottle, Plastic","250","RC","0338-0004-04","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 18 Bottle, Plastic In 1 Carton (0338-0004-03)  / 500 Ml In 1 Bottle, Plastic","250","RC","0338-0004-03","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 24 Bottle, Plastic In 1 Carton (0338-0004-02)  / 250 Ml In 1 Bottle, Plastic","250","RC","0338-0004-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clorpactin Wcs-90: 5 Vial In 1 Box (0327-0001-10)  / 2 G In 1 Vial","250","RC","0327-0001-10","NDC","","","facility","both","1","EA","","10.26","10.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sarna: 222 Ml In 1 Bottle, Pump (0316-0229-75)","250","RC","0316-0229-75","NDC","","","facility","both","1","EA","","11.99","11.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide And Formoterol Fumarate Dihydrate: 1 Pouch In 1 Carton (0310-7370-20)  / 1 Canister In 1 Pouch / 120 Aerosol In 1 Canister","250","RC","0310-7370-20","NDC","","","facility","both","1","EA","","317.54","317.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Farxiga: 3 Blister Pack In 1 Carton (0310-6210-39)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","0310-6210-39","NDC","","","facility","both","1","EA","","22.28","22.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Farxiga: 30 Tablet, Film Coated In 1 Bottle, Plastic (0310-6210-30)","250","RC","0310-6210-30","NDC","","","facility","both","1","EA","","21.86","21.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 1000 Ml In 1 Bag (0338-0017-04)","250","RC","0338-0017-04","NDC","","","facility","both","1","EA","","7.19","7.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 16 Container In 1 Case (0264-2201-10)  / 500 Ml In 1 Container","250","RC","0264-2201-10","NDC","","","facility","both","1","EA","","2.28","2.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 16 Container In 1 Case (0264-2201-00)  / 1000 Ml In 1 Container","250","RC","0264-2201-00","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Arnuity Ellipta: 1 Inhaler In 1 Carton (0173-0876-10)  / 30 Powder In 1 Inhaler","250","RC","0173-0876-10","NDC","","","facility","both","1","EA","","463.32","463.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Arnuity Ellipta: 1 Inhaler In 1 Carton (0173-0874-14)  / 14 Powder In 1 Inhaler","250","RC","0173-0874-14","NDC","","","facility","both","1","EA","","115.31","115.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Anoro Ellipta: 1 Tray In 1 Carton (0173-0869-06)  / 1 Inhaler In 1 Tray / 7 Powder In 1 Inhaler","250","RC","0173-0869-06","NDC","","","facility","both","1","EA","","127.66","127.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Breo Ellipta: 1 Tray In 1 Carton (0173-0859-14)  / 1 Inhaler In 1 Tray / 14 Powder In 1 Inhaler","250","RC","0173-0859-14","NDC","","","facility","both","1","EA","","105.83","105.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Breo Ellipta: 1 Tray In 1 Carton (0173-0859-10)  / 1 Inhaler In 1 Tray / 30 Powder In 1 Inhaler","250","RC","0173-0859-10","NDC","","","facility","both","1","EA","","675.87","675.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamictal Odt: 1 Dose Pack In 1 Carton (0173-0777-02)  / 30 Tablet, Orally Disintegrating In 1 Dose Pack","250","RC","0173-0777-02","NDC","","","facility","both","1","EA","","26.24","26.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamictal Xr: 30 Tablet, Film Coated, Extended Release In 1 Bottle (0173-0761-00)","250","RC","0173-0761-00","NDC","","","facility","both","1","EA","","81.2","81.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ventolin Hfa: 1 Inhaler In 1 Carton (0173-0682-24)  / 60 Aerosol, Metered In 1 Inhaler","250","RC","0173-0682-24","NDC","","","facility","both","1","EA","","37.33","37.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mepron: 42 Pouch In 1 Dose Pack (0173-0547-00)  / 5 Ml In 1 Pouch","250","RC","0173-0547-00","NDC","","","facility","both","1","EA","","54.48","54.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Arnuity Ellipta: 1 Inhaler In 1 Carton (0173-0876-14)  / 14 Powder In 1 Inhaler","250","RC","0173-0876-14","NDC","","","facility","both","1","EA","","154.37","154.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Beconase Aq: 1 Bottle, Pump In 1 Carton (0173-0388-79)  / 180 Spray, Suspension In 1 Bottle, Pump","250","RC","0173-0388-79","NDC","","","facility","both","1","EA","","482.04","482.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 100 Tablet, Film Coated In 1 Bottle (0172-5729-60)","250","RC","0172-5729-60","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 100 Tablet In 1 Bottle (0172-3925-60)","250","RC","0172-3925-60","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrochlorothiazide: 100 Tablet In 1 Bottle (0172-2089-60)","250","RC","0172-2089-60","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flolan: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0173-0519-00)","250","RC","0173-0519-00","NDC","","","facility","both","1","EA","","25.46","25.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrochlorothiazide: 100 Tablet In 1 Bottle (0172-2083-60)","250","RC","0172-2083-60","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Breo Ellipta: 1 Tray In 1 Carton (0173-0882-14)  / 1 Inhaler In 1 Tray / 14 Powder In 1 Inhaler","250","RC","0173-0882-14","NDC","","","facility","both","1","EA","","105.84","105.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retin-A: 1 Tube In 1 Carton (0187-5160-20)  / 20 G In 1 Tube","250","RC","0187-5160-20","NDC","","","facility","both","1","EA","","24.92","24.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ancobon: 100 Capsule In 1 Bottle (0187-3555-10)","250","RC","0187-3555-10","NDC","","","facility","both","1","EA","","181.5","181.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Efudex: 1 Tube In 1 Carton (0187-3204-47)  / 40 G In 1 Tube","250","RC","0187-3204-47","NDC","","","facility","both","1","EA","","99.58","99.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mestinon: 30 Tablet, Extended Release In 1 Bottle (0187-3013-30)","250","RC","0187-3013-30","NDC","","","facility","both","1","EA","","68.07","68.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mestinon: 473 Ml In 1 Bottle (0187-3012-20)","250","RC","0187-3012-20","NDC","","","facility","both","1","EA","","43.22","43.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Timoptic In Ocudose: 4 Pouch In 1 Carton (0187-1498-25)  / 15 Container In 1 Pouch / .3 Ml In 1 Container","250","RC","0187-1498-25","NDC","","","facility","both","1","EA","","2.59","2.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nexium: 30 Capsule, Delayed Release In 1 Bottle (0186-5040-31)","250","RC","0186-5040-31","NDC","","","facility","both","1","EA","","15.22","15.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pulmicort Flexhaler: 1 Inhaler In 1 Carton (0186-0916-12)  / 120 Aerosol, Powder In 1 Inhaler","250","RC","0186-0916-12","NDC","","","facility","both","1","EA","","440.37","440.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brilinta: 10 Blister Pack In 1 Box, Unit-Dose (0186-0777-39)  / 10 Tablet In 1 Blister Pack","250","RC","0186-0777-39","NDC","","","facility","both","1","EA","","12.64","12.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brilinta: 60 Tablet In 1 Bottle (0186-0776-60)","250","RC","0186-0776-60","NDC","","","facility","both","1","EA","","11.94","11.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Symbicort: 1 Pouch In 1 Carton (0186-0372-28)  / 1 Canister In 1 Pouch / 60 Aerosol In 1 Canister","250","RC","0186-0372-28","NDC","","","facility","both","1","EA","","69.96","69.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Symbicort: 1 Pouch In 1 Carton (0186-0370-28)  / 1 Canister In 1 Pouch / 60 Aerosol In 1 Canister","250","RC","0186-0370-28","NDC","","","facility","both","1","EA","","32.22","32.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Symbicort: 1 Pouch In 1 Carton (0186-0370-20)  / 1 Canister In 1 Pouch / 120 Aerosol In 1 Canister","250","RC","0186-0370-20","NDC","","","facility","both","1","EA","","388.78","388.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Pamoate: 100 Capsule In 1 Bottle (0185-0676-01)","250","RC","0185-0676-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norditropin: 1 Syringe, Plastic In 1 Carton (0169-7705-21)  / 1.5 Ml In 1 Syringe, Plastic","250","RC","0169-7705-21","NDC","","","facility","both","1","EA","","2953.19","2953.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norditropin: 1 Syringe, Plastic In 1 Carton (0169-7704-21)  / 1.5 Ml In 1 Syringe, Plastic","250","RC","0169-7704-21","NDC","","","facility","both","1","EA","","1476.6","1476.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolin R: 1 Vial In 1 Carton (0169-1833-11)  / 10 Ml In 1 Vial","250","RC","0169-1833-11","NDC","","","facility","both","1","EA","","2.93","2.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (0168-0417-30)  / 30 G In 1 Tube","250","RC","0168-0417-30","NDC","","","facility","both","1","EA","","110.38","110.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (0168-0416-30)  / 30 G In 1 Tube","250","RC","0168-0416-30","NDC","","","facility","both","1","EA","","199.1","199.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine And Prilocaine: 1 Tube In 1 Carton (0168-0357-55)  / 5 G In 1 Tube (0168-0357-05)","250","RC","0168-0357-55","NDC","","","facility","both","1","EA","","12.74","12.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine And Prilocaine: 1 Tube In 1 Carton (0168-0357-30)  / 30 G In 1 Tube","250","RC","0168-0357-30","NDC","","","facility","both","1","EA","","23.32","23.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0168-0357-05","NDC","","","facility","both","1","EA","","12.74","12.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 45 G In 1 Tube (0168-0323-46)","250","RC","0168-0323-46","NDC","","","facility","both","1","EA","","53.38","53.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolin R: 1 Vial In 1 Carton (0169-1833-11)  / 10 Ml In 1 Vial","250","RC","0169-1833-11","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin Phosphate: 1 Bottle In 1 Carton (0168-0201-60)  / 60 Ml In 1 Bottle","250","RC","0168-0201-60","NDC","","","facility","both","1","EA","","55.62","55.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vitamin A and Vitamin D: 1 PACKET in 1 CARTON (0168-0035-45)  / 5 g in 1 PACKET","250","RC","0168-0035-45","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Betamethasone Valerate: 45 G In 1 Tube (0168-0033-46)","250","RC","0168-0033-46","NDC","","","facility","both","1","EA","","31.68","31.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triple Antibiotic: 144 PACKET in 1 CARTON (0168-0012-09)  / .9 g in 1 PACKET","250","RC","0168-0012-09","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 15 G In 1 Tube (0168-0006-15)","250","RC","0168-0006-15","NDC","","","facility","both","1","EA","","4.46","4.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0003-80)  / 80 G In 1 Tube","250","RC","0168-0003-80","NDC","","","facility","both","1","EA","","9.36","9.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0003-15)  / 15 G In 1 Tube","250","RC","0168-0003-15","NDC","","","facility","both","1","EA","","3.73","3.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (0168-0002-15)  / 15 G In 1 Tube","250","RC","0168-0002-15","NDC","","","facility","both","1","EA","","9.05","9.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0143-9983-91","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketoconazole: 1 Tube In 1 Carton (0168-0099-60)  / 60 G In 1 Tube","250","RC","0168-0099-60","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolin N: 1 Vial In 1 Carton (0169-1834-11)  / 10 Ml In 1 Vial","250","RC","0169-1834-11","NDC","","","facility","both","1","EA","","7.33","7.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolin 70/30: 1 Vial In 1 Carton (0169-1837-11)  / 10 Ml In 1 Vial","250","RC","0169-1837-11","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolog: 1 Vial, Glass In 1 Carton (0169-7501-11)  / 10 Ml In 1 Vial, Glass","250","RC","0169-7501-11","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolog: 1 Vial, Glass In 1 Carton (0169-7501-11)  / 10 Ml In 1 Vial, Glass","250","RC","0169-7501-11","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolog: 5 Syringe, Plastic In 1 Carton (0169-6339-10)  / 3 Ml In 1 Syringe, Plastic","250","RC","0169-6339-10","NDC","","","facility","both","1","EA","","4.1","4.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolog: 5 Syringe, Plastic In 1 Carton (0169-6339-10)  / 3 Ml In 1 Syringe, Plastic","250","RC","0169-6339-10","NDC","","","facility","both","1","EA","","26.98","26.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ozempic: 1 Syringe, Plastic In 1 Carton (0169-4772-12)  / 3 Ml In 1 Syringe, Plastic (0169-4772-11)","250","RC","0169-4772-12","NDC","","","facility","both","1","EA","","404.91","404.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0169-4525-01","NDC","","","facility","both","1","EA","","559.65","559.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ozempic: 1 Syringe, Plastic In 1 Carton (0169-4181-13)  / 3 Ml In 1 Syringe, Plastic (0169-4181-03)","250","RC","0169-4181-13","NDC","","","facility","both","1","EA","","282.22","282.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0169-4181-03","NDC","","","facility","both","1","EA","","275.94","275.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ozempic: 1 Syringe, Plastic In 1 Carton (0169-4130-13)  / 3 Ml In 1 Syringe, Plastic (0169-4130-01)","250","RC","0169-4130-13","NDC","","","facility","both","1","EA","","827.89","827.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tresiba: 5 Syringe, Plastic In 1 Carton (0169-2660-15)  / 3 Ml In 1 Syringe, Plastic","250","RC","0169-2660-15","NDC","","","facility","both","1","EA","","177.55","177.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retin-A: 1 Tube In 1 Carton (0187-5162-20)  / 20 G In 1 Tube","250","RC","0187-5162-20","NDC","","","facility","both","1","EA","","25.16","25.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0206-8852-08","NDC","","","facility","both","1","EA","","3.15","3.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cuvposa: 1 Bottle In 1 Carton (0259-0501-16)  / 473 Ml In 1 Bottle","250","RC","0259-0501-16","NDC","","","facility","both","1","EA","","8.02","8.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (0254-3029-02)","250","RC","0254-3029-02","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (0254-3028-02)","250","RC","0254-3028-02","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0254-3012-78","NDC","","","facility","both","1","EA","","195","195","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 16 Container In 1 Case (0264-2101-10)  / 500 Ml In 1 Container","250","RC","0264-2101-10","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 16 Container In 1 Case (0264-2101-00)  / 1000 Ml In 1 Container","250","RC","0264-2101-00","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trophamine: 12 Container In 1 Case (0264-1933-10)  / 500 Ml In 1 Container","250","RC","0264-1933-10","NDC","","","facility","both","1","EA","","12.76","12.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 116 Container In 1 Case (0264-1800-36)  / 25 Ml In 1 Container","250","RC","0264-1800-36","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 116 Container In 1 Case (0264-1800-36)  / 25 Ml In 1 Container","250","RC","0264-1800-36","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 64 Container In 1 Case (0264-1800-32)  / 100 Ml In 1 Container","250","RC","0264-1800-32","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 64 Container In 1 Case (0264-1800-32)  / 100 Ml In 1 Container","250","RC","0264-1800-32","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 84 Container In 1 Case (0264-1800-31)  / 50 Ml In 1 Container","250","RC","0264-1800-31","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 84 Container In 1 Case (0264-1800-31)  / 50 Ml In 1 Container","250","RC","0264-1800-31","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 64 Container In 1 Case (0264-1510-32)  / 100 Ml In 1 Container","250","RC","0264-1510-32","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 84 Container In 1 Case (0264-1510-31)  / 50 Ml In 1 Container","250","RC","0264-1510-31","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alvimopan: 6 Blister Pack In 1 Carton (0254-3012-55)  / 5 Capsule In 1 Blister Pack","250","RC","0254-3012-55","NDC","","","facility","both","1","EA","","195","195","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Citrate: 100 Tablet In 1 Bottle (0245-0070-11)","250","RC","0245-0070-11","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prevalite: 42 Packet In 1 Carton (0245-0036-42)  / 5.5 G In 1 Packet (0245-0036-89)","250","RC","0245-0036-42","NDC","","","facility","both","1","EA","","3.41","3.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0245-0013-89","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 60 Tablet, Extended Release In 1 Bottle (0228-4241-06)","250","RC","0228-4241-06","NDC","","","facility","both","1","EA","","5.54","5.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (0228-3063-11)","250","RC","0228-3063-11","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (0228-3062-11)","250","RC","0228-3062-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (0228-3060-11)","250","RC","0228-3060-11","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (0228-3059-11)","250","RC","0228-3059-11","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0245-0144-89","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2891-03)","250","RC","0228-2891-03","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 100 Tablet In 1 Bottle (0228-2128-10)","250","RC","0228-2128-10","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 100 Tablet In 1 Bottle (0228-2127-10)","250","RC","0228-2127-10","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxazepam: 100 Capsule, Gelatin Coated In 1 Blister Pack (0228-2069-10)","250","RC","0228-2069-10","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0223-1760-02","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0223-1760-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2892-03)","250","RC","0228-2892-03","NDC","","","facility","both","1","EA","","2.28","2.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0245-0147-89","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 100 Blister Pack In 1 Carton (0245-0212-01)  / 1 Tablet In 1 Blister Pack (0245-0212-89)","250","RC","0245-0212-01","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 1 Bottle, Glass In 1 Carton (0254-1016-36)  / 105 Ml In 1 Bottle, Glass","250","RC","0254-1016-36","NDC","","","facility","both","1","EA","","62.47","62.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0245-5319-89","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Klor-Con M: 500 Tablet, Extended Release In 1 Bottle (0245-5319-15)","250","RC","0245-5319-15","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Klor-Con M: 100 Tablet, Extended Release In 1 Bottle (0245-5319-11)","250","RC","0245-5319-11","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Klor-Con M: 100 Blister Pack In 1 Carton (0245-5319-01)  / 1 Tablet, Extended Release In 1 Blister Pack (0245-5319-89)","250","RC","0245-5319-01","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0245-5317-89","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Klor-Con M: 100 Blister Pack In 1 Carton (0245-5317-01)  / 1 Tablet, Extended Release In 1 Blister Pack (0245-5317-89)","250","RC","0245-5317-01","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0245-5316-89","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Klor-Con: 100 Blister Pack In 1 Blister Pack (0245-5316-01)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (0245-5316-89)","250","RC","0245-5316-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0245-5315-89","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Klor-Con: 100 Blister Pack In 1 Blister Pack (0245-5315-01)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (0245-5315-89)","250","RC","0245-5315-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0245-0360-89","NDC","","","facility","both","1","EA","","2.02","2.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 100 Tablet In 1 Bottle (0245-0213-11)","250","RC","0245-0213-11","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0245-0212-89","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Colchicine: 100 Tablet, Film Coated In 1 Bottle, Plastic (0254-2008-01)","250","RC","0254-2008-01","NDC","","","facility","both","1","EA","","9.35","9.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-10)  / 25 Ml In 1 Bag","250","RC","0338-0049-10","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valproic Acid: 473 Ml In 1 Bottle (0121-0675-85)","250","RC","0121-0675-85","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethosuximide: 473 Ml In 1 Bottle (0121-0670-16)","250","RC","0121-0670-16","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0049-0520-84","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pfizerpen: 10 Vial In 1 Carton (0049-0520-83)  / 1 Powder, For Solution In 1 Vial (0049-0520-84)","250","RC","0049-0520-83","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Premarin: 100 Tablet, Film Coated In 1 Bottle (0046-1104-81)","250","RC","0046-1104-81","NDC","","","facility","both","1","EA","","11.74","11.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Premarin: 100 Tablet, Film Coated In 1 Bottle (0046-1102-81)","250","RC","0046-1102-81","NDC","","","facility","both","1","EA","","11.72","11.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Premarin: 100 Tablet, Film Coated In 1 Bottle (0046-1100-81)","250","RC","0046-1100-81","NDC","","","facility","both","1","EA","","11.74","11.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pfizerpen: 1 Vial In 1 Carton (0049-0530-28)  / 1 Powder, For Solution In 1 Vial","250","RC","0049-0530-28","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Premarin Vaginal: 1 Tube, With Applicator In 1 Carton (0046-0872-21)  / 30 G In 1 Tube, With Applicator","250","RC","0046-0872-21","NDC","","","facility","both","1","EA","","762.02","762.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Premarin: 1 Vial In 1 Carton (0046-0749-05)  / 5 Ml In 1 Vial","250","RC","0046-0749-05","NDC","","","facility","both","1","EA","","610.89","610.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0045-0930-32","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epifoam: 1 Canister In 1 Carton (0037-6824-10)  / 10 G In 1 Canister","250","RC","0037-6824-10","NDC","","","facility","both","1","EA","","156.19","156.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Proctofoam Hc: 1 Canister In 1 Carton (0037-6822-10)  / 10 G In 1 Canister","250","RC","0037-6822-10","NDC","","","facility","both","1","EA","","304.29","304.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gastrocrom: 12 Pouch In 1 Carton (0037-0678-96)  / 8 Ampule In 1 Pouch (0037-0678-08)  / 5 Ml In 1 Ampule","250","RC","0037-0678-96","NDC","","","facility","both","1","EA","","17.17","17.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0037-0678-08","NDC","","","facility","both","1","EA","","17.18","17.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Felbatol: 237 Ml In 1 Bottle, Plastic (0037-0442-67)","250","RC","0037-0442-67","NDC","","","facility","both","1","EA","","11.86","11.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Felbatol: 100 Tablet In 1 Bottle, Plastic (0037-0431-01)","250","RC","0037-0431-01","NDC","","","facility","both","1","EA","","29.35","29.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vfend: 1 Bottle In 1 Carton (0049-3160-44)  / 75 Ml In 1 Bottle","250","RC","0049-3160-44","NDC","","","facility","both","1","EA","","62.49","62.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Citalopram: 1 Bottle, Plastic In 1 Carton (0054-0062-58)  / 240 Ml In 1 Bottle, Plastic","250","RC","0054-0062-58","NDC","","","facility","both","1","EA","","2.36","2.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Digoxin: 60 Ml In 1 Bottle (0054-0057-46)","250","RC","0054-0057-46","NDC","","","facility","both","1","EA","","2.93","2.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle, Plastic (0054-0019-25)","250","RC","0054-0019-25","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 10 Blister Pack In 1 Carton (0054-0019-20)  / 10 Tablet In 1 Blister Pack","250","RC","0054-0019-20","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 10 Blister Pack In 1 Carton (0054-0018-20)  / 10 Tablet In 1 Blister Pack","250","RC","0054-0018-20","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 10 Blister Pack In 1 Carton (0054-0017-20)  / 10 Tablet In 1 Blister Pack","250","RC","0054-0017-20","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vfend: 1 Vial, Single-Dose In 1 Carton (0049-3190-28)  / 20 Ml In 1 Vial, Single-Dose","250","RC","0049-3190-28","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flecainide Acetate: 100 Tablet In 1 Bottle (0054-0011-25)","250","RC","0054-0011-25","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flecainide Acetate: 100 Blister Pack In 1 Carton (0054-0010-20)  / 1 Tablet In 1 Blister Pack","250","RC","0054-0010-20","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitriol: 100 Capsule In 1 Bottle, Plastic (0054-0007-25)","250","RC","0054-0007-25","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diflucan: 1 Bottle In 1 Carton (0049-3450-19)  / 35 Ml In 1 Bottle","250","RC","0049-3450-19","NDC","","","facility","both","1","EA","","8.13","8.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flecainide Acetate: 100 Blister Pack In 1 Carton (0054-0011-20)  / 1 Tablet In 1 Blister Pack","250","RC","0054-0011-20","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 250 Capsule, Delayed Release Pellets In 1 Bottle (0032-3016-28)","250","RC","0032-3016-28","NDC","","","facility","both","1","EA","","19.81","19.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-3016-13)","250","RC","0032-3016-13","NDC","","","facility","both","1","EA","","22.47","22.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0024-5154-11","NDC","","","facility","both","1","EA","","654.42","654.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elitek: 3 Kit In 1 Carton (0024-5150-10)  / 1 Kit In 1 Kit *  1 Ml In 1 Vial, Single-Use (0024-5154-11)  *  1 Ml In 1 Ampule (0024-5152-11)","250","RC","0024-5150-10","NDC","","","facility","both","1","EA","","654.38","654.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Multaq: 60 Tablet, Film Coated In 1 Bottle (0024-4142-60)","250","RC","0024-4142-60","NDC","","","facility","both","1","EA","","20.88","20.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Primaquine Phosphate: 100 Tablet, Film Coated In 1 Bottle (0024-1596-01)","250","RC","0024-1596-01","NDC","","","facility","both","1","EA","","3.4","3.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0023-9637-01","NDC","","","facility","both","1","EA","","3.91","3.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Refresh Liquigel: 1 Bottle, Dropper In 1 Carton (0023-9205-15)  / 15 Ml In 1 Bottle, Dropper","250","RC","0023-9205-15","NDC","","","facility","both","1","EA","","15.64","15.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Restasis: 30 Vial, Single-Use In 1 Tray (0023-9163-30)  / .4 Ml In 1 Vial, Single-Use","250","RC","0023-9163-30","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ubrelvy: 10 Packet In 1 Box (0023-6501-10)  / 1 Tablet In 1 Packet (0023-6501-02)","250","RC","0023-6501-10","NDC","","","facility","both","1","EA","","180.07","180.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0023-6501-02","NDC","","","facility","both","1","EA","","135.36","135.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10)  / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)","250","RC","0023-6082-10","NDC","","","facility","both","1","EA","","30.19","30.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-2636-01)","250","RC","0032-2636-01","NDC","","","facility","both","1","EA","","14.76","14.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 250 Capsule, Delayed Release Pellets In 1 Bottle (0032-1224-07)","250","RC","0032-1224-07","NDC","","","facility","both","1","EA","","12.84","12.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 250 Capsule, Delayed Release Pellets In 1 Bottle (0032-1212-07)","250","RC","0032-1212-07","NDC","","","facility","both","1","EA","","6.58","6.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 250 Capsule, Delayed Release Pellets In 1 Bottle (0032-1206-07)","250","RC","0032-1206-07","NDC","","","facility","both","1","EA","","3.3","3.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 1 Bottle In 1 Carton (0032-1203-70)  / 70 Capsule, Delayed Release In 1 Bottle","250","RC","0032-1203-70","NDC","","","facility","both","1","EA","","3.07","3.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-0047-70)","250","RC","0032-0047-70","NDC","","","facility","both","1","EA","","7.45","7.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-0046-70)","250","RC","0032-0046-70","NDC","","","facility","both","1","EA","","3.74","3.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 70 Capsule, Delayed Release In 1 Bottle (0032-0045-70)","250","RC","0032-0045-70","NDC","","","facility","both","1","EA","","3.17","3.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norpace Cr: 100 Capsule, Extended Release In 1 Bottle (0025-2742-31)","250","RC","0025-2742-31","NDC","","","facility","both","1","EA","","8.48","8.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norpace Cr: 100 Capsule, Extended Release In 1 Bottle (0025-2732-31)","250","RC","0025-2732-31","NDC","","","facility","both","1","EA","","7.1","7.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celebrex: 100 Capsule In 1 Bottle (0025-1520-31)","250","RC","0025-1520-31","NDC","","","facility","both","1","EA","","16.62","16.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytotec: 60 Tablet In 1 Bottle, Unit-Dose (0025-1451-60)","250","RC","0025-1451-60","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aldactone: 100 Tablet, Film Coated In 1 Bottle (0025-1001-31)","250","RC","0025-1001-31","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 30 mL in 1 BOTTLE (0054-0063-44) ","250","RC","0054-0063-44","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clotrimazole: 70 Lozenge In 1 Bottle, Plastic (0054-4146-22)","250","RC","0054-4146-22","NDC","","","facility","both","1","EA","","3.29","3.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 500 Ml In 1 Bottle, Plastic (0054-3727-63)","250","RC","0054-3727-63","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam Hydrochloride: 118 Ml In 1 Bottle, Glass (0054-3566-99)","250","RC","0054-3566-99","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 1 Bottle In 1 Carton (0054-3532-44)  / 30 Ml In 1 Bottle","250","RC","0054-3532-44","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 50 Ml In 1 Bottle (0054-3505-47)","250","RC","0054-3505-47","NDC","","","facility","both","1","EA","","66.42","66.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4181-25)","250","RC","0054-4181-25","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Viscous: 1 Bottle In 1 Carton (0054-3500-49)  / 100 Ml In 1 Bottle","250","RC","0054-3500-49","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 60 Ml In 1 Bottle (0054-3294-46)","250","RC","0054-3294-46","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluticasone Propionate: 1 Bottle, Glass In 1 Carton (0054-3270-99)  / 120 Spray, Metered In 1 Bottle, Glass","250","RC","0054-3270-99","NDC","","","facility","both","1","EA","","14.13","14.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 500 Ml In 1 Bottle, Plastic (0054-3188-63)","250","RC","0054-3188-63","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 500 Ml In 1 Bottle, Plastic (0054-3177-63)","250","RC","0054-3177-63","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 120 Ml In 1 Bottle (0054-3294-50)","250","RC","0054-3294-50","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 240 Ml In 1 Bottle, Plastic (0054-3177-57)","250","RC","0054-3177-57","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4183-25)","250","RC","0054-4183-25","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 10 Blister Pack In 1 Carton (0054-8297-25)  / 10 Tablet In 1 Blister Pack","250","RC","0054-8297-25","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8183-25)  / 1 Tablet In 1 Blister Pack","250","RC","0054-8183-25","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8181-25)  / 1 Tablet In 1 Blister Pack","250","RC","0054-8181-25","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8180-25)  / 1 Tablet In 1 Blister Pack","250","RC","0054-8180-25","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4182-25)","250","RC","0054-4182-25","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8175-25)  / 1 Tablet In 1 Blister Pack","250","RC","0054-8175-25","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8174-25)  / 1 Tablet In 1 Blister Pack","250","RC","0054-8174-25","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mercaptopurine: 250 Tablet In 1 Bottle, Plastic (0054-4581-27)","250","RC","0054-4581-27","NDC","","","facility","both","1","EA","","3.46","3.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mercaptopurine: 25 Tablet In 1 Bottle, Plastic (0054-4581-11)","250","RC","0054-4581-11","NDC","","","facility","both","1","EA","","4.34","4.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 100 Tablet In 1 Bottle, Plastic (0054-4297-25)","250","RC","0054-4297-25","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8176-25)  / 1 Tablet In 1 Blister Pack","250","RC","0054-8176-25","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Intensol: 30 Ml In 1 Bottle, Glass (0054-3176-44)","250","RC","0054-3176-44","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitriol: 1 Bottle, Glass In 1 Carton (0054-3120-41)  / 15 Ml In 1 Bottle, Glass","250","RC","0054-3120-41","NDC","","","facility","both","1","EA","","5.94","5.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 500 Ml In 1 Bottle (0054-0390-63)","250","RC","0054-0390-63","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 473 Ml In 1 Bottle (0054-0386-63)","250","RC","0054-0386-63","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cevimeline Hydrochloride: 100 Capsule In 1 Bottle (0054-0334-25)","250","RC","0054-0334-25","NDC","","","facility","both","1","EA","","4.29","4.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 150 Ml In 1 Bottle (0054-0319-50)","250","RC","0054-0319-50","NDC","","","facility","both","1","EA","","132.79","132.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Codeine Sulfate: 100 Tablet In 1 Bottle (0054-0244-25)","250","RC","0054-0244-25","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Codeine Sulfate: 10 Blister Pack In 1 Box (0054-0244-24)  / 10 Tablet In 1 Blister Pack","250","RC","0054-0244-24","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1000 Ml In 1 Bottle (0054-0391-68)","250","RC","0054-0391-68","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Codeine Sulfate: 10 Blister Pack In 1 Box (0054-0243-24)  / 10 Tablet In 1 Blister Pack","250","RC","0054-0243-24","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 500 Ml In 1 Bottle (0054-0237-63)","250","RC","0054-0237-63","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 100 Blister Pack In 1 Carton (0054-0236-24)  / 1 Tablet In 1 Blister Pack","250","RC","0054-0236-24","NDC","","","facility","both","1","EA","","1.6","1.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 100 Tablet In 1 Bottle (0054-0235-25)","250","RC","0054-0235-25","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 100 Blister Pack In 1 Carton (0054-0235-24)  / 1 Tablet In 1 Blister Pack","250","RC","0054-0235-24","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine: 30 Tablet In 1 Bottle (0054-0176-13)","250","RC","0054-0176-13","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1000 Ml In 1 Bottle (0054-0391-68)","250","RC","0054-0391-68","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine: 30 Tablet, Film Coated, Extended Release In 1 Bottle (0054-0400-13)","250","RC","0054-0400-13","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium Carbonate: 100 Capsule, Gelatin Coated In 1 Bottle (0054-2527-25)","250","RC","0054-2527-25","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prucalopride: 30 Tablet, Film Coated In 1 Bottle (0054-0750-13)","250","RC","0054-0750-13","NDC","","","facility","both","1","EA","","20.1","20.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prucalopride: 30 Tablet, Film Coated In 1 Bottle (0054-0749-13)","250","RC","0054-0749-13","NDC","","","facility","both","1","EA","","20.1","20.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuterol Sulfate: 1 Canister In 1 Carton (0054-0742-87)  / 200 Aerosol, Metered In 1 Canister","250","RC","0054-0742-87","NDC","","","facility","both","1","EA","","39.57","39.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1 Blister Pack In 1 Carton (0054-0710-20)  / 100 Tablet In 1 Blister Pack","250","RC","0054-0710-20","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicyclomine Hydrochloride: 473 Ml In 1 Bottle (0054-0622-63)","250","RC","0054-0622-63","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferiprone: 100 Tablet, Coated In 1 Bottle (0054-0576-25)","250","RC","0054-0576-25","NDC","","","facility","both","1","EA","","102.05","102.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Droxidopa: 90 CAPSULE in 1 BOTTLE (0054-0534-22) ","250","RC","0054-0534-22","NDC","","","facility","both","1","EA","","6.93","6.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Droxidopa: 90 CAPSULE in 1 BOTTLE (0054-0533-22) ","250","RC","0054-0533-22","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Droxidopa: 90 CAPSULE in 1 BOTTLE (0054-0532-22) ","250","RC","0054-0532-22","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 1 Bottle In 1 Carton (0054-0528-63)  / 460 Ml In 1 Bottle","250","RC","0054-0528-63","NDC","","","facility","both","1","EA","","130.14","130.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Icosapent Ethyl: 120 Capsule In 1 Bottle (0054-0508-23)","250","RC","0054-0508-23","NDC","","","facility","both","1","EA","","3.69","3.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 1 Bottle, Glass In 1 Carton (0054-0449-49)  / 105 Ml In 1 Bottle, Glass","250","RC","0054-0449-49","NDC","","","facility","both","1","EA","","43.01","43.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 120 Tablet, Film Coated In 1 Bottle (0054-0426-23)","250","RC","0054-0426-23","NDC","","","facility","both","1","EA","","5.65","5.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 120 Tablet, Film Coated In 1 Bottle (0054-0425-23)","250","RC","0054-0425-23","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 120 mL in 1 BOTTLE (0054-0404-50) ","250","RC","0054-0404-50","NDC","","","facility","both","1","EA","","3.06","3.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine: 90 Tablet, Film Coated, Extended Release In 1 Bottle (0054-0400-22)","250","RC","0054-0400-22","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0023-6082-01","NDC","","","facility","both","1","EA","","29.47","29.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0023-6082-01","NDC","","","facility","both","1","EA","","29.6","29.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mylotarg: 1 Vial, Single-Dose In 1 Carton (0008-4510-01)  / 5 Ml In 1 Vial, Single-Dose","250","RC","0008-4510-01","NDC","","","facility","both","1","EA","","394.65","394.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","00074-7362-01","NDC","","","facility","both","1","EA","","8.24","8.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bridion: 10 Vial, Single-Dose In 1 Carton (0006-5425-15)  / 5 Ml In 1 Vial, Single-Dose (0006-5425-05)","250","RC","0006-5425-15","NDC","","","facility","both","1","EA","","184.03","184.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-5425-05","NDC","","","facility","both","1","EA","","278.53","278.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bridion: 10 Vial, Single-Dose In 1 Carton (0006-5423-12)  / 2 Ml In 1 Vial, Single-Dose (0006-5423-02)","250","RC","0006-5423-12","NDC","","","facility","both","1","EA","","199.87","199.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-5423-02","NDC","","","facility","both","1","EA","","198.54","198.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-5423-02","NDC","","","facility","both","1","EA","","257.06","257.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-5085-99","NDC","","","facility","both","1","EA","","123.48","123.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prevymis: 30 Packet In 1 Carton (0006-5085-01)  / 48 Pellet In 1 Packet","250","RC","0006-5085-01","NDC","","","facility","both","1","EA","","123.48","123.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-5004-02","NDC","","","facility","both","1","EA","","683","683","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bridion: 10 Vial, Single-Dose In 1 Carton (0006-5423-12)  / 2 Ml In 1 Vial, Single-Dose (0006-5423-02)","250","RC","0006-5423-12","NDC","","","facility","both","1","EA","","186.79","186.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prevymis: 1 Vial, Single-Dose In 1 Carton (0006-5004-01)  / 24 Ml In 1 Vial, Single-Dose (0006-5004-02)","250","RC","0006-5004-01","NDC","","","facility","both","1","EA","","683","683","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0003-02)  / 4 Ml In 1 Vial","250","RC","0009-0003-02","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0039-30","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0039-30","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0039-30","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0018-20)  / 8 Ml In 1 Vial","250","RC","0009-0018-20","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0018-20)  / 8 Ml In 1 Vial","250","RC","0009-0018-20","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Cortef: 1 Vial, Single-Dose In 1 Carton (0009-0013-05)  / 2 Ml In 1 Vial, Single-Dose","250","RC","0009-0013-05","NDC","","","facility","both","1","EA","","28.76","28.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cortef: 50 Tablet In 1 Bottle (0009-0012-01)","250","RC","0009-0012-01","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Cortef: 25 Vial, Single-Dose In 1 Carton (0009-0011-04)  / 2 Ml In 1 Vial, Single-Dose (0009-0011-03)","250","RC","0009-0011-04","NDC","","","facility","both","1","EA","","23.42","23.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0011-03","NDC","","","facility","both","1","EA","","12.27","12.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0011-03","NDC","","","facility","both","1","EA","","19.94","19.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-4897-01","NDC","","","facility","both","1","EA","","50.83","50.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Keytruda: 2 Vial In 1 Carton (0006-3026-04)  / 4 Ml In 1 Vial (0006-3026-01)","250","RC","0006-3026-04","NDC","","","facility","both","1","EA","","98.98","98.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-3026-01","NDC","","","facility","both","1","EA","","98.98","98.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isentress: 60 Tablet, Chewable In 1 Bottle (0006-0477-61)","250","RC","0006-0477-61","NDC","","","facility","both","1","EA","","14.41","14.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-0277-01","NDC","","","facility","both","1","EA","","19.83","19.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-3061-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-4837-01","NDC","","","facility","both","1","EA","","204.42","204.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Varivax: 10 Vial, Single-Dose In 1 Carton (0006-4827-00)  / .5 Ml In 1 Vial, Single-Dose (0006-4827-01)","250","RC","0006-4827-00","NDC","","","facility","both","1","EA","","313.01","313.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-4681-01","NDC","","","facility","both","1","EA","","158.54","158.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-4095-01","NDC","","","facility","both","1","EA","","50.65","50.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-3856-01","NDC","","","facility","both","1","EA","","4.06","4.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-3603-01","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isentress: 60 Tablet, Film Coated In 1 Bottle (0006-3080-01)","250","RC","0006-3080-01","NDC","","","facility","both","1","EA","","57.63","57.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-3076-01","NDC","","","facility","both","1","EA","","489.57","489.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-3075-03","NDC","","","facility","both","1","EA","","484.63","484.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-3075-01","NDC","","","facility","both","1","EA","","489.38","489.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pifeltro: 30 Tablet, Film Coated In 1 Bottle (0006-3069-01)","250","RC","0006-3069-01","NDC","","","facility","both","1","EA","","101.19","101.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0039-33","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Refresh Classic: 50 Vial, Single-Use In 1 Carton (0023-0506-50)  / .4 Ml In 1 Vial, Single-Use","250","RC","0023-0506-50","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Refresh Classic: 30 Vial, Single-Use In 1 Carton (0023-0506-01)  / .4 Ml In 1 Vial, Single-Use","250","RC","0023-0506-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Refresh Lacri-Lube: 1 Tube In 1 Carton (0023-0312-04)  / 3.5 G In 1 Tube","250","RC","0023-0312-04","NDC","","","facility","both","1","EA","","17.59","17.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"1 TUBE in 1 CARTON (0023-0240-04)  / 3.5 g in 1 TUBE","250","RC","0023-0240-04","NDC","","","facility","both","1","EA","","15.45","15.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"1 TUBE in 1 CARTON (0023-0240-04)  / 3.5 g in 1 TUBE","250","RC","0023-0240-04","NDC","","","facility","both","1","EA","","15.45","15.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Idamycin Pfs: 1 Vial, Single-Dose In 1 Carton (0013-2576-05)  / 5 Ml In 1 Vial, Single-Dose","250","RC","0013-2576-05","NDC","","","facility","both","1","EA","","49.66","49.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0013-1114-01","NDC","","","facility","both","1","EA","","11.11","11.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Delzicol: 180 Capsule, Delayed Release In 1 Bottle (0023-5853-18)","250","RC","0023-5853-18","NDC","","","facility","both","1","EA","","6.44","6.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Refresh Celluvisc: 30 Vial, Single-Use In 1 Carton (0023-4554-30)  / .4 Ml In 1 Vial, Single-Use","250","RC","0023-4554-30","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.66","11.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.66","11.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0698-01)  / 16 Ml In 1 Vial","250","RC","0009-0698-01","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"R-Gene: 1 Container In 1 Carton (0009-0436-01)  / 300 Ml In 1 Container","250","RC","0009-0436-01","NDC","","","facility","both","1","EA","","8.13","8.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0047-27","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0047-27","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0047-25","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0047-25","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0047-25","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 25 Vial In 1 Carton (0009-0047-22)  / 2 Ml In 1 Vial (0009-0047-25)","250","RC","0009-0047-22","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 25 Vial In 1 Carton (0009-0047-22)  / 2 Ml In 1 Vial (0009-0047-25)","250","RC","0009-0047-22","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0039-33","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0728-05","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zyvox: 150 Ml In 1 Bottle (0009-5136-04)","250","RC","0009-5136-04","NDC","","","facility","both","1","EA","","76.11","76.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zyvox: 150 Ml In 1 Bottle (0009-5136-01)","250","RC","0009-5136-01","NDC","","","facility","both","1","EA","","226.97","226.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-3169-01","NDC","","","facility","both","1","EA","","96.55","96.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Depo-Medrol: 1 Vial, Single-Dose In 1 Package (0009-3073-01)  / 1 Ml In 1 Vial, Single-Dose","250","RC","0009-3073-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0902-11","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0009-0870-21","NDC","","","facility","both","1","EA","","2.78","2.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hemabate: 1 Ml In 1 Ampule (0009-0856-05)","250","RC","0009-0856-05","NDC","","","facility","both","1","EA","","220.69","220.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Cortef: 1 Vial In 1 Carton (0009-0825-01)  / 2 Ml In 1 Vial","250","RC","0009-0825-01","NDC","","","facility","both","1","EA","","9.9","9.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0758-01)  / 8 Ml In 1 Vial","250","RC","0009-0758-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 10 Blister Pack In 1 Carton (0054-8299-25)  / 10 Tablet In 1 Blister Pack","250","RC","0054-8299-25","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 10 Blister Pack In 1 Carton (0054-8301-25)  / 10 Tablet In 1 Blister Pack","250","RC","0054-8301-25","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-0135-01)","250","RC","0093-0135-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Tablet In 1 Bottle (0093-0053-01)","250","RC","0093-0053-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33)  / 10 Ml In 1 Vial, Glass","250","RC","0088-2220-33","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33)  / 10 Ml In 1 Vial, Glass","250","RC","0088-2220-33","NDC","","","facility","both","1","EA","","2.33","2.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loperamide Hydrochloride: 100 Capsule In 1 Bottle (0093-0311-01)","250","RC","0093-0311-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lantus Solostar: 5 Syringe In 1 Carton (0088-2219-05)  / 3 Ml In 1 Syringe (0088-2219-01)","250","RC","0088-2219-05","NDC","","","facility","both","1","EA","","32.13","32.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0088-2219-01","NDC","","","facility","both","1","EA","","32.13","32.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0088-2102-01","NDC","","","facility","both","1","EA","","8.24","8.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Noxafil: 60 Tablet, Coated In 1 Bottle (0085-4324-02)","250","RC","0085-4324-02","NDC","","","facility","both","1","EA","","113.75","113.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0085-2224-01","NDC","","","facility","both","1","EA","","197.64","197.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Noxafil: 1 Bottle, Glass In 1 Carton (0085-1328-01)  / 105 Ml In 1 Bottle, Glass","250","RC","0085-1328-01","NDC","","","facility","both","1","EA","","54.35","54.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entresto: 60 Pellet In 1 Bottle (0078-1238-20)","250","RC","0078-1238-20","NDC","","","facility","both","1","EA","","19.51","19.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mekinist: 90 Ml In 1 Bottle (0078-1161-47)","250","RC","0078-1161-47","NDC","","","facility","both","1","EA","","175.09","175.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tafinlar: 210 Tablet, For Suspension In 1 Bottle (0078-1154-21)","250","RC","0078-1154-21","NDC","","","facility","both","1","EA","","35.66","35.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Warfarin Sodium: 100 Tablet In 1 Bottle (0093-1723-01)","250","RC","0093-1723-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Warfarin Sodium: 100 Tablet In 1 Bottle (0093-1720-01)","250","RC","0093-1720-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neomycin Sulfate: 100 Tablet In 1 Bottle (0093-1177-01)","250","RC","0093-1177-01","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mupirocin: 1 Tube In 1 Carton (0093-1010-42)  / 22 G In 1 Tube","250","RC","0093-1010-42","NDC","","","facility","both","1","EA","","10.08","10.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Tablet In 1 Bottle (0093-1003-01)","250","RC","0093-1003-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0093-0318-01)","250","RC","0093-0318-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 500 Tablet In 1 Bottle (0093-0832-05)","250","RC","0093-0832-05","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0813-01)","250","RC","0093-0813-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0812-01)","250","RC","0093-0812-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 500 Capsule In 1 Bottle (0093-0811-05)","250","RC","0093-0811-05","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0811-01)","250","RC","0093-0811-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 500 Capsule In 1 Bottle (0093-0810-05)","250","RC","0093-0810-05","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0093-0319-01)","250","RC","0093-0319-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mekinist: 30 Tablet, Film Coated In 1 Bottle (0078-1112-15)","250","RC","0078-1112-15","NDC","","","facility","both","1","EA","","1018.82","1018.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Scemblix: 60 Tablet, Film Coated In 1 Bottle (0078-1098-20)","250","RC","0078-1098-20","NDC","","","facility","both","1","EA","","657","657","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Votrient: 120 Tablet, Film Coated In 1 Bottle (0078-1077-66)","250","RC","0078-1077-66","NDC","","","facility","both","1","EA","","260.76","260.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0777-20)","250","RC","0078-0777-20","NDC","","","facility","both","1","EA","","18.41","18.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0078-0698-02","NDC","","","facility","both","1","EA","","356.48","356.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0696-20)","250","RC","0078-0696-20","NDC","","","facility","both","1","EA","","19.24","19.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promacta: 30 Tablet, Film Coated In 1 Bottle (0078-0687-15)","250","RC","0078-0687-15","NDC","","","facility","both","1","EA","","1260.77","1260.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promacta: 30 Tablet, Film Coated In 1 Bottle (0078-0686-15)","250","RC","0078-0686-15","NDC","","","facility","both","1","EA","","849.8","849.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promacta: 30 Tablet, Film Coated In 1 Bottle (0078-0685-15)","250","RC","0078-0685-15","NDC","","","facility","both","1","EA","","456.41","456.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tafinlar: 120 Capsule In 1 Bottle (0078-0681-66)","250","RC","0078-0681-66","NDC","","","facility","both","1","EA","","233.97","233.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0659-20)","250","RC","0078-0659-20","NDC","","","facility","both","1","EA","","17.72","17.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0078-0635-06","NDC","","","facility","both","1","EA","","418.59","418.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tasigna: 28 Capsule In 1 Blister Pack (0078-0592-51)","250","RC","0078-0592-51","NDC","","","facility","both","1","EA","","322.1","322.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Coartem: 24 Tablet In 1 Bottle (0078-0568-45)","250","RC","0078-0568-45","NDC","","","facility","both","1","EA","","9.32","9.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tasigna: 28 Capsule In 1 Blister Pack (0078-0526-51)","250","RC","0078-0526-51","NDC","","","facility","both","1","EA","","324.04","324.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tegretol: 450 Ml In 1 Bottle (0078-0508-83)","250","RC","0078-0508-83","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entresto: 180 Tablet, Film Coated In 1 Bottle (0078-0659-67)","250","RC","0078-0659-67","NDC","","","facility","both","1","EA","","18.14","18.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0811-81)  *  6 Ml In 1 Vial (0078-0790-61)  *  2 Ml In 1 Syringe","250","RC","0078-0811-81","NDC","","","facility","both","1","EA","","578.97","578.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0078-0911-05","NDC","","","facility","both","1","EA","","19.9","19.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobradex: 3.5 G In 1 Tube (0078-0876-01)","250","RC","0078-0876-01","NDC","","","facility","both","1","EA","","488.57","488.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciloxan: 3.5 G In 1 Tube (0078-0841-01)","250","RC","0078-0841-01","NDC","","","facility","both","1","EA","","451.21","451.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobrex: 3.5 G In 1 Tube (0078-0813-01)","250","RC","0078-0813-01","NDC","","","facility","both","1","EA","","462.2","462.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Ml In 1 Bottle (0093-2026-31)","250","RC","0093-2026-31","NDC","","","facility","both","1","EA","","13.39","13.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0093-2055-19","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cilostazol: 60 Tablet In 1 Bottle (0093-2065-06)","250","RC","0093-2065-06","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 100 Tablet In 1 Bottle (0093-2203-01)","250","RC","0093-2203-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dantrolene Sodium: 100 Capsule In 1 Bottle (0115-4411-01)","250","RC","0115-4411-01","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0115-1801-01)","250","RC","0115-1801-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyproheptadine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0115-1757-01)","250","RC","0115-1757-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 1 Case In 1 Carton (0115-1694-30)  / 1 Syringe, Glass In 1 Case / .3 Ml In 1 Syringe, Glass","250","RC","0115-1694-30","NDC","","","facility","both","1","EA","","248.95","248.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule In 1 Bottle (0115-1487-01)","250","RC","0115-1487-01","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0115-1366-30","NDC","","","facility","both","1","EA","","2.92","2.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dantrolene Sodium: 100 Capsule In 1 Bottle (0115-4433-01)","250","RC","0115-4433-01","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0115-1365-30","NDC","","","facility","both","1","EA","","2.5","2.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Tablet In 1 Bottle (0093-9701-01)","250","RC","0093-9701-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0093-9292-19","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0093-9291-19","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0093-9290-19","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 Tablet In 1 Bottle (0093-9148-01)","250","RC","0093-9148-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclosporine Modified: 30 Blister Pack In 1 Carton (0093-9018-65)  / 1 Capsule, Liquid Filled In 1 Blister Pack (0093-9018-19)","250","RC","0093-9018-65","NDC","","","facility","both","1","EA","","1.43","1.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Colesevelam Hydrochloride: 180 Tablet, Film Coated In 1 Bottle (0115-1320-19)","250","RC","0115-1320-19","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle, Plastic (0115-9918-01)","250","RC","0115-9918-01","NDC","","","facility","both","1","EA","","3.75","3.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trihexyphenidyl Hydrochloride: 473 Ml In 1 Bottle (0121-0658-16)","250","RC","0121-0658-16","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 120 Ml In 1 Bottle, Dropper (0121-0653-04)","250","RC","0121-0653-04","NDC","","","facility","both","1","EA","","4.17","4.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amantadine Hydrochloride: 473 Ml In 1 Bottle (0121-0646-16)","250","RC","0121-0646-16","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amantadine Hydrochloride: 10 Tray In 1 Case (0121-0646-10)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose","250","RC","0121-0646-10","NDC","","","facility","both","1","EA","","6","6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 473 Ml In 1 Bottle (0121-0576-16)","250","RC","0121-0576-16","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-0489-05","NDC","","","facility","both","1","EA","","6.76","6.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0121-0489-05","NDC","","","facility","both","1","EA","","6.92","6.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milk Of Magnesia: 10 Tray In 1 Case (0121-0431-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose","250","RC","0121-0431-30","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactulose: 30 Ml In 1 Cup, Unit-Dose (0116-4005-30)","250","RC","0116-4005-30","NDC","","","facility","both","1","EA","","2.06","2.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactulose: 15 Ml In 1 Cup, Unit-Dose (0116-4005-15)","250","RC","0116-4005-15","NDC","","","facility","both","1","EA","","2.07","2.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorhexidine Gluconate: 473 Ml In 1 Bottle (0116-2001-16)","250","RC","0116-2001-16","NDC","","","facility","both","1","EA","","3.31","3.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle, Plastic (0115-9919-01)","250","RC","0115-9919-01","NDC","","","facility","both","1","EA","","4.14","4.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0093-9018-19","NDC","","","facility","both","1","EA","","1.43","1.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (0093-8739-01)","250","RC","0093-8739-01","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0093-5247-19","NDC","","","facility","both","1","EA","","2.44","2.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0093-5246-19","NDC","","","facility","both","1","EA","","2.62","2.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 30 Blister Pack In 1 Carton (0093-5245-65)  / 1 Tablet, Orally Disintegrating In 1 Blister Pack (0093-5245-19)","250","RC","0093-5245-65","NDC","","","facility","both","1","EA","","2.29","2.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0093-5245-19","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cephalexin: 100 Ml In 1 Bottle (0093-4177-73)","250","RC","0093-4177-73","NDC","","","facility","both","1","EA","","3.82","3.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Ml In 1 Bottle (0093-4161-73)","250","RC","0093-4161-73","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin V Potassium: 200 Ml In 1 Bottle (0093-4127-74)","250","RC","0093-4127-74","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0093-5417-19","NDC","","","facility","both","1","EA","","3.67","3.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin V Potassium: 100 Ml In 1 Bottle (0093-4127-73)","250","RC","0093-4127-73","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefadroxil: 50 Tablet In 1 Bottle (0093-4059-53)","250","RC","0093-4059-53","NDC","","","facility","both","1","EA","","4.17","4.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 100 Tablet In 1 Bottle, Plastic (0093-3427-01)","250","RC","0093-3427-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuterol Sulfate Hfa: 1 Inhaler In 1 Carton (0093-3174-31)  / 200 Aerosol, Metered In 1 Inhaler","250","RC","0093-3174-31","NDC","","","facility","both","1","EA","","55.74","55.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Disopyramide Phosphate: 100 Capsule In 1 Bottle (0093-3127-01)","250","RC","0093-3127-01","NDC","","","facility","both","1","EA","","2.65","2.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicloxacillin Sodium: 100 Capsule In 1 Bottle (0093-3125-01)","250","RC","0093-3125-01","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Capsule In 1 Bottle (0093-3107-01)","250","RC","0093-3107-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0093-5419-19","NDC","","","facility","both","1","EA","","10.55","10.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabergoline: 1 Bottle In 1 Carton (0093-5420-88)  / 8 Tablet In 1 Bottle","250","RC","0093-5420-88","NDC","","","facility","both","1","EA","","3.24","3.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 125 Ml In 1 Bottle (0093-8675-75)","250","RC","0093-8675-75","NDC","","","facility","both","1","EA","","4.59","4.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 200 Ml In 1 Bottle (0093-8675-74)","250","RC","0093-8675-74","NDC","","","facility","both","1","EA","","4.86","4.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glyburide: 100 Tablet In 1 Bottle (0093-8344-01)","250","RC","0093-8344-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glyburide: 100 Tablet In 1 Bottle (0093-8343-01)","250","RC","0093-8343-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clozapine: 100 TABLET in 1 BOTTLE (0093-7772-01) ","250","RC","0093-7772-01","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Emtricitabine And Tenofovir Disoproxil Fumarate: 30 Tablet, Film Coated In 1 Bottle (0093-7704-56)","250","RC","0093-7704-56","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imatinib Mesylate: 90 Tablet, Film Coated In 1 Bottle (0093-7629-98)","250","RC","0093-7629-98","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Letrozole: 30 Tablet, Film Coated In 1 Bottle (0093-7620-56)","250","RC","0093-7620-56","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Anastrozole: 30 Tablet, Film Coated In 1 Bottle (0093-7536-56)","250","RC","0093-7536-56","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losartan Potassium And Hydrochlorothiazide: 1000 Tablet, Film Coated In 1 Bottle (0093-7367-10)","250","RC","0093-7367-10","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 100 Capsule In 1 Bottle (0093-7334-01)","250","RC","0093-7334-01","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pioglitazone: 90 Tablet In 1 Bottle (0093-7272-98)","250","RC","0093-7272-98","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0093-6816-19","NDC","","","facility","both","1","EA","","7.14","7.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0093-6816-19","NDC","","","facility","both","1","EA","","9.18","9.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 180 Capsule, Delayed Release In 1 Bottle (0093-5907-86)","250","RC","0093-5907-86","NDC","","","facility","both","1","EA","","4.67","4.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin: 100 Tablet, Film Coated In 1 Bottle (0093-5571-01)","250","RC","0093-5571-01","NDC","","","facility","both","1","EA","","10.98","10.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (0093-8740-01)","250","RC","0093-8740-01","NDC","","","facility","both","1","EA","","2.61","2.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"473 mL in 1 BOTTLE (0121-0675-16) ","250","RC","0121-0675-16","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lopressor: 100 TABLET in 1 BOTTLE (0078-0458-05) ","250","RC","0078-0458-05","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-1306-01","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1305-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1305-01)","250","RC","0069-1305-10","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-1305-01","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeljanz: 60 Tablet, Film Coated In 1 Bottle (0069-1002-01)","250","RC","0069-1002-01","NDC","","","facility","both","1","EA","","167.97","167.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeljanz: 60 Tablet, Film Coated In 1 Bottle (0069-1001-01)","250","RC","0069-1001-01","NDC","","","facility","both","1","EA","","168.01","168.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Inflectra: 1 Vial, Single-Use In 1 Carton (0069-0809-01)  / 10 Ml In 1 Vial, Single-Use","250","RC","0069-0809-01","NDC","","","facility","both","1","EA","","78.17","78.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Inflectra: 1 Vial, Single-Use In 1 Carton (0069-0809-01)  / 10 Ml In 1 Vial, Single-Use","250","RC","0069-0809-01","NDC","","","facility","both","1","EA","","78.17","78.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chantix: 56 Tablet, Film Coated In 1 Bottle (0069-0469-56)","250","RC","0069-0469-56","NDC","","","facility","both","1","EA","","13.55","13.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chantix: 56 Tablet, Film Coated In 1 Bottle (0069-0468-56)","250","RC","0069-0468-56","NDC","","","facility","both","1","EA","","13.55","13.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-1309-01","NDC","","","facility","both","1","EA","","15.52","15.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-1308-01","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1306-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1306-01)","250","RC","0069-1306-10","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-1308-01","NDC","","","facility","both","1","EA","","3.09","3.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1307-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1307-01)","250","RC","0069-1307-10","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-1307-01","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-1307-01","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nyvepria: 1 Carton In 1 Carton (0069-0324-01)  / 1 Syringe In 1 Carton / .6 Ml In 1 Syringe","250","RC","0069-0324-01","NDC","","","facility","both","1","EA","","296.74","296.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Genteal Tears Night-Time: 1 Tube In 1 Carton (0065-0518-01)  / 3.5 G In 1 Tube","250","RC","0065-0518-01","NDC","","","facility","both","1","EA","","12.88","12.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Systane: 1 Tube In 1 Carton (0065-0474-01)  / 10 G In 1 Tube","250","RC","0065-0474-01","NDC","","","facility","both","1","EA","","17.63","17.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Betadine: 1 Bottle In 1 Carton (0065-0411-30)  / 30 Ml In 1 Bottle","250","RC","0065-0411-30","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclogyl: 1 Bottle, Plastic In 1 Carton (0065-0397-02)  / 2 Ml In 1 Bottle, Plastic","250","RC","0065-0397-02","NDC","","","facility","both","1","EA","","10.35","10.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclogyl: 1 Bottle, Plastic In 1 Carton (0065-0395-15)  / 15 Ml In 1 Bottle, Plastic","250","RC","0065-0395-15","NDC","","","facility","both","1","EA","","157.03","157.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclomydril: 5 Ml In 1 Bottle, Plastic (0065-0359-05)","250","RC","0065-0359-05","NDC","","","facility","both","1","EA","","103.04","103.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclomydril: 2 Ml In 1 Bottle, Plastic (0065-0359-02)","250","RC","0065-0359-02","NDC","","","facility","both","1","EA","","32.8","32.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorescite: 12 Vial In 1 Carton (0065-0092-65)  / 5 Ml In 1 Vial","250","RC","0065-0092-65","NDC","","","facility","both","1","EA","","50.7","50.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miostat: 12 Vial, Glass In 1 Carton (0065-0023-15)  / 1.5 Ml In 1 Vial, Glass","250","RC","0065-0023-15","NDC","","","facility","both","1","EA","","25.23","25.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 10 Blister Pack In 1 Carton (0054-8724-25)  / 10 Tablet In 1 Blister Pack","250","RC","0054-8724-25","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium Carbonate: 10 Capsule, Gelatin Coated In 1 Blister Pack (0054-8527-25)","250","RC","0054-8527-25","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium Carbonate: 10 Capsule, Gelatin Coated In 1 Blister Pack (0054-8526-25)","250","RC","0054-8526-25","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 5 Blister Pack In 1 Carton (0054-8496-19)  / 10 Tablet In 1 Blister Pack","250","RC","0054-8496-19","NDC","","","facility","both","1","EA","","2.62","2.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 10 Blister Pack In 1 Carton (0054-8740-25)  / 10 Tablet In 1 Blister Pack","250","RC","0054-8740-25","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"TOBREX: 3.5 g in 1 TUBE (0065-0644-35) ","250","RC","0065-0644-35","NDC","","","facility","both","1","EA","","356.77","356.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetracaine Hydrochloride: 12 Blister Pack In 1 Carton (0065-0741-14)  / 1 Bottle, Dropper In 1 Blister Pack / 4 Ml In 1 Bottle, Dropper","250","RC","0065-0741-14","NDC","","","facility","both","1","EA","","14.3","14.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"1 VIAL in 1 CARTON (0069-0248-01)  / 100 mL in 1 VIAL","250","RC","0069-0248-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"1 VIAL in 1 CARTON (0069-0234-01)  / 50 mL in 1 VIAL","250","RC","0069-0234-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorbrena: 30 Tablet, Film Coated In 1 Bottle (0069-0227-01)","250","RC","0069-0227-01","NDC","","","facility","both","1","EA","","427.19","427.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-0207-01","NDC","","","facility","both","1","EA","","430.89","430.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bosulif: 120 Tablet, Film Coated In 1 Bottle (0069-0135-01)","250","RC","0069-0135-01","NDC","","","facility","both","1","EA","","322.44","322.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-0059-04","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Container (0069-0059-03)  / 1 Ml In 1 Vial (0069-0059-04)","250","RC","0069-0059-03","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rifadin Iv: 1 Vial, Glass In 1 Carton (0068-0597-01)  / 10 Ml In 1 Vial, Glass","250","RC","0068-0597-01","NDC","","","facility","both","1","EA","","59.87","59.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voltaren Arthritis Pain: 1 Tube In 1 Carton (0067-8152-02)  / 50 G In 1 Tube","250","RC","0067-8152-02","NDC","","","facility","both","1","EA","","16.11","16.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ex-Lax Regular Strength Chocolated Stimulant Laxative: 2 Package In 1 Box (0067-8140-02)  / 12 Tablet, Chewable In 1 Package","250","RC","0067-8140-02","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Genteal Tears Severe: 1 Tube In 1 Carton (0065-8064-01)  / 10 G In 1 Tube","250","RC","0065-8064-01","NDC","","","facility","both","1","EA","","12.87","12.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bss Plus: 1 Kit In 1 Package (0065-0800-50)  *  480 Ml In 1 Bottle, Glass *  20 Ml In 1 Vial, Single-Dose","250","RC","0065-0800-50","NDC","","","facility","both","1","EA","","117","117","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bss: 15 Ml In 1 Bottle (0065-0795-15)","250","RC","0065-0795-15","NDC","","","facility","both","1","EA","","8.12","8.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (0069-1542-20)  / 100 Ml In 1 Vial, Multi-Dose","250","RC","0069-1542-20","NDC","","","facility","both","1","EA","","5.1","5.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-2432-01","NDC","","","facility","both","1","EA","","192","192","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nimbex: 5 mL in 1 VIAL, SINGLE-DOSE (0074-4378-05) ","250","RC","0074-4378-05","NDC","","","facility","both","1","EA","","21.08","21.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3663-03)  *  1.5 Ml In 1 Syringe *  1 Ml In 1 Packet","250","RC","0074-3663-03","NDC","","","facility","both","1","EA","","2894.57","2894.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3663-03)  *  1.5 Ml In 1 Syringe *  1 Ml In 1 Packet","250","RC","0074-3663-03","NDC","","","facility","both","1","EA","","2989.34","2989.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3641-03)  *  1 Ml In 1 Syringe *  1 Ml In 1 Packet","250","RC","0074-3641-03","NDC","","","facility","both","1","EA","","2847.1","2847.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nimbex: 10 mL in 1 VIAL, MULTI-DOSE (0074-4380-10) ","250","RC","0074-4380-10","NDC","","","facility","both","1","EA","","45.65","45.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gengraf: 5 Blister Pack In 1 Carton (0074-3109-32)  / 6 Capsule In 1 Blister Pack","250","RC","0074-3109-32","NDC","","","facility","both","1","EA","","6.09","6.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-4552-11)  / 10 Tablet In 1 Blister Pack","250","RC","0074-4552-11","NDC","","","facility","both","1","EA","","2.55","2.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Synthroid: 90 Tablet In 1 Bottle (0074-4552-90)","250","RC","0074-4552-90","NDC","","","facility","both","1","EA","","2.73","2.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0078-0422-61","NDC","","","facility","both","1","EA","","18.2","18.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0078-0248-61","NDC","","","facility","both","1","EA","","19.52","19.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Synthroid: 90 Tablet In 1 Bottle (0074-7149-90)","250","RC","0074-7149-90","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-7148-11)  / 10 Tablet In 1 Blister Pack","250","RC","0074-7148-11","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Qulipta: 30 Tablet In 1 Bottle (0074-7096-30)","250","RC","0074-7096-30","NDC","","","facility","both","1","EA","","61.89","61.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Qulipta: 30 Tablet In 1 Bottle (0074-7094-30)","250","RC","0074-7094-30","NDC","","","facility","both","1","EA","","62.45","62.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-6624-11)  / 10 Tablet In 1 Blister Pack","250","RC","0074-6624-11","NDC","","","facility","both","1","EA","","2.71","2.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zemplar: 25 Vial, Single-Dose In 1 Tray (0074-4637-01)  / 1 Ml In 1 Vial, Single-Dose","250","RC","0074-4637-01","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gengraf: 3 Blister Pack In 1 Carton (0074-3108-32)  / 10 Capsule In 1 Blister Pack","250","RC","0074-3108-32","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tikosyn: 40 Blister Pack In 1 Carton (0069-5810-43)  / 1 Capsule In 1 Blister Pack","250","RC","0069-5810-43","NDC","","","facility","both","1","EA","","19.95","19.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tikosyn: 40 Blister Pack In 1 Carton (0069-5800-43)  / 1 Capsule In 1 Blister Pack","250","RC","0069-5800-43","NDC","","","facility","both","1","EA","","19.95","19.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paxlovid: 10 Blister Pack In 1 Carton (0069-5321-30)  / 1 Kit In 1 Blister Pack (0069-5321-03)  *  2 Tablet, Film Coated In 1 Blister Pack (0069-2085-02)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-1735-11)","250","RC","0069-5321-30","NDC","","","facility","both","1","EA","","82.78","82.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-5321-03","NDC","","","facility","both","1","EA","","82.77","82.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paxlovid: 10 Blister Pack In 1 Carton (0069-5317-20)  / 1 Kit In 1 Blister Pack (0069-5317-02)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-2085-11)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-1735-11)","250","RC","0069-5317-20","NDC","","","facility","both","1","EA","","124.16","124.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-5317-02","NDC","","","facility","both","1","EA","","124.17","124.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tikosyn: 14 Capsule In 1 Bottle (0069-5820-61)","250","RC","0069-5820-61","NDC","","","facility","both","1","EA","","14.13","14.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-5045-06","NDC","","","facility","both","1","EA","","82.76","82.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zithromax: 1 Bottle In 1 Carton (0069-3120-19)  / 15 Ml In 1 Bottle","250","RC","0069-3120-19","NDC","","","facility","both","1","EA","","73.01","73.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-2528-01","NDC","","","facility","both","1","EA","","165.96","165.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paxlovid: 10 Blister Pack In 1 Carton (0069-5045-30)  / 1 Kit In 1 Blister Pack (0069-5045-06)  *  2 Tablet, Film Coated In 1 Blister Pack (0069-2085-02)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-1345-11)","250","RC","0069-5045-30","NDC","","","facility","both","1","EA","","82.76","82.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0069-8730-01","NDC","","","facility","both","1","EA","","1339.94","1339.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"84 TABLET, FILM COATED in 1 BOTTLE (0074-2625-80) ","250","RC","0074-2625-80","NDC","","","facility","both","1","EA","","274.37","274.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mavyret: 4 Carton In 1 Carton (0074-2625-28)  / 7 Dose Pack In 1 Carton / 3 Tablet, Film Coated In 1 Dose Pack","250","RC","0074-2625-28","NDC","","","facility","both","1","EA","","260.82","260.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mavyret: 1 Dose Pack In 1 Carton (0074-2625-01)  / 3 Tablet, Film Coated In 1 Dose Pack","250","RC","0074-2625-01","NDC","","","facility","both","1","EA","","260.82","260.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rinvoq: 30 Tablet, Extended Release In 1 Bottle (0074-2310-30)","250","RC","0074-2310-30","NDC","","","facility","both","1","EA","","371.37","371.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rinvoq: 30 Tablet, Extended Release In 1 Bottle (0074-2306-30)","250","RC","0074-2306-30","NDC","","","facility","both","1","EA","","362.66","362.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rinvoq: 28 Tablet, Extended Release In 1 Bottle (0074-1043-28)","250","RC","0074-1043-28","NDC","","","facility","both","1","EA","","746.62","746.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venclexta: 1 Bottle In 1 Carton (0074-0576-30)  / 28 Tablet, Film Coated In 1 Bottle","250","RC","0074-0576-30","NDC","","","facility","both","1","EA","","233.89","233.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venclexta: 120 Tablet, Film Coated In 1 Bottle (0074-0576-22)","250","RC","0074-0576-22","NDC","","","facility","both","1","EA","","233.79","233.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venclexta: 1 Blister Pack In 1 Carton (0074-0576-11)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0074-0576-11","NDC","","","facility","both","1","EA","","233.95","233.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venclexta: 1 Blister Pack In 1 Carton (0074-0566-11)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0074-0566-11","NDC","","","facility","both","1","EA","","116.66","116.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venclexta: 1 Blister Pack In 1 Carton (0074-0566-07)  / 7 Tablet, Film Coated In 1 Blister Pack","250","RC","0074-0566-07","NDC","","","facility","both","1","EA","","117.16","117.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venclexta: 1 Blister Pack In 1 Carton (0074-0561-14)  / 14 Tablet, Film Coated In 1 Blister Pack","250","RC","0074-0561-14","NDC","","","facility","both","1","EA","","23.42","23.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dilantin: 100 Capsule In 1 Bottle (0071-3740-66)","250","RC","0071-3740-66","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrostat: 4 Bottle In 1 Carton (0071-0418-13)  / 25 Tablet In 1 Bottle","250","RC","0071-0418-13","NDC","","","facility","both","1","EA","","2.69","2.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrostat: 1 Bottle In 1 Carton (0071-0417-24)  / 100 Tablet In 1 Bottle","250","RC","0071-0417-24","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dilantin: 100 Blister Pack In 1 Carton (0071-0369-40)  / 1 Capsule In 1 Blister Pack","250","RC","0071-0369-40","NDC","","","facility","both","1","EA","","3.09","3.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dilantin Infatabs: 100 Tablet, Chewable In 1 Bottle (0071-0007-24)","250","RC","0071-0007-24","NDC","","","facility","both","1","EA","","2.62","2.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-11)  / 50 Ml In 1 Bag","250","RC","0338-0049-11","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Bottle, Plastic In 1 Carton (0527-5137-62)  / 60 Ml In 1 Bottle, Plastic","250","RC","0527-5137-62","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (0527-4593-13)  / 10 Capsule In 1 Blister Pack","250","RC","0527-4593-13","NDC","","","facility","both","1","EA","","2.15","2.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (0527-4591-13)  / 10 Capsule In 1 Blister Pack","250","RC","0527-4591-13","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 TABLET, EXTENDED RELEASE in 1 BOTTLE (0527-3311-37) ","250","RC","0527-3311-37","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 TABLET, EXTENDED RELEASE in 1 BOTTLE (0527-3310-37) ","250","RC","0527-3310-37","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 120 Tablet, Delayed Release In 1 Bottle (0527-3012-48)","250","RC","0527-3012-48","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 100 Tablet, Coated In 1 Bottle (0527-2961-37)","250","RC","0527-2961-37","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cocaine Hydrochloride Nasal: 1 Bottle, Glass In 1 Carton (0527-1971-74)  / 4 Ml In 1 Bottle, Glass","250","RC","0527-1971-74","NDC","","","facility","both","1","EA","","358.78","358.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 1 Bottle, Plastic In 1 Carton (0527-1948-70)  / 480 Ml In 1 Bottle, Plastic","250","RC","0527-1948-70","NDC","","","facility","both","1","EA","","37.65","37.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 1 Bottle, Plastic In 1 Carton (0527-1948-68)  / 200 Ml In 1 Bottle, Plastic","250","RC","0527-1948-68","NDC","","","facility","both","1","EA","","85.25","85.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clarithromycin: 60 Tablet, Film Coated In 1 Bottle, Plastic (0527-1932-06)","250","RC","0527-1932-06","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0527-1790-01)","250","RC","0527-1790-01","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0527-1788-01)","250","RC","0527-1788-01","NDC","","","facility","both","1","EA","","2.44","2.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (0527-1500-37)","250","RC","0527-1500-37","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 60 Tablet, Delayed Release In 1 Bottle (0527-2133-35)","250","RC","0527-2133-35","NDC","","","facility","both","1","EA","","5.97","5.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loxapine: 100 Capsule In 1 Bottle, Plastic (0527-1395-01)","250","RC","0527-1395-01","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin: 1 Bottle, Plastic In 1 Carton (0536-1054-29)  / 100 Tablet, Film Coated In 1 Bottle, Plastic","250","RC","0536-1054-29","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Benzoyl Peroxide Acne Medication: 1 Tube In 1 Carton (0536-1055-56)  / 42.5 Ml In 1 Tube","250","RC","0536-1055-56","NDC","","","facility","both","1","EA","","2.91","2.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"First Aid Antiseptic: 1 Tube In 1 Box (0536-1271-80)  / 28.4 G In 1 Tube","250","RC","0536-1271-80","NDC","","","facility","both","1","EA","","2.36","2.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Anti-Itch: 212 G In 1 Bottle, Pump (0536-1268-12)","250","RC","0536-1268-12","NDC","","","facility","both","1","EA","","6.8","6.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chlorode Hypertonicity Ophthalmic Solution: 1 Bottle In 1 Carton (0536-1254-94)  / 15 Ml In 1 Bottle","250","RC","0536-1254-94","NDC","","","facility","both","1","EA","","5.81","5.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin Low Dose: 1 Bottle, Plastic In 1 Carton (0536-1234-41)  / 120 Tablet, Delayed Release In 1 Bottle, Plastic","250","RC","0536-1234-41","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Cherry Flavor: 177 Ml In 1 Bottle, Spray (0536-1228-58)","250","RC","0536-1228-58","NDC","","","facility","both","1","EA","","4.22","4.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hcl: 100 Tablet, Film Coated In 1 Bottle, Plastic (0536-1214-29)","250","RC","0536-1214-29","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dibucaine Topical Anesthetic 1% Hemorrhoidal: 1 Tube In 1 Box (0536-1211-95)  / 28 G In 1 Tube","250","RC","0536-1211-95","NDC","","","facility","both","1","EA","","6.12","6.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Carbonate 10 Gr (648 Mg) (Antacid): 1000 Tablet In 1 Bottle, Plastic (0536-1206-10)","250","RC","0536-1206-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Pain Relief Patches: 5 Patch In 1 Carton (0536-1202-15)  / 9 G In 1 Patch","250","RC","0536-1202-15","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Pain Relief Patches: 30 Patch In 1 Carton (0536-1202-07)  / 9 G In 1 Patch","250","RC","0536-1202-07","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Hemorrhoidal: 12 Blister Pack In 1 Carton (0536-1186-12)  / 1 Suppository In 1 Blister Pack","250","RC","0536-1186-12","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levonorgestrel: 1 Blister Pack In 1 Carton (0536-1142-63)  / 1 Tablet In 1 Blister Pack","250","RC","0536-1142-63","NDC","","","facility","both","1","EA","","9.15","9.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Benzoyl Peroxide Acne Medication: 1 Tube In 1 Carton (0536-1056-56)  / 42.5 Ml In 1 Tube","250","RC","0536-1056-56","NDC","","","facility","both","1","EA","","5.27","5.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Probenecid: 100 Tablet, Film Coated In 1 Bottle (0527-1367-01)","250","RC","0527-1367-01","NDC","","","facility","both","1","EA","","2.59","2.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"DIGOX: 100 TABLET in 1 BOTTLE (0527-1324-01) ","250","RC","0527-1324-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0517-6710-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0517-5602-25)  / 2 Ml In 1 Vial, Single-Dose (0517-5602-01)","250","RC","0517-5602-25","NDC","","","facility","both","1","EA","","9.56","9.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitroglycerin: 25 Vial, Single-Dose In 1 Tray (0517-4810-25)  / 10 Ml In 1 Vial, Single-Dose (0517-4810-01)","250","RC","0517-4810-25","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Multi-Dose In 1 Tray (0517-4620-25)  / 20 Ml In 1 Vial, Multi-Dose","250","RC","0517-4620-25","NDC","","","facility","both","1","EA","","1.69","1.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Multi-Dose In 1 Tray (0517-4605-25)  / 5 Ml In 1 Vial, Multi-Dose","250","RC","0517-4605-25","NDC","","","facility","both","1","EA","","7.2","7.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Multi-Dose In 1 Tray (0517-4605-25)  / 5 Ml In 1 Vial, Multi-Dose","250","RC","0517-4605-25","NDC","","","facility","both","1","EA","","7.2","7.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4602-25)  / 2 Ml In 1 Vial, Single-Dose","250","RC","0517-4602-25","NDC","","","facility","both","1","EA","","7.04","7.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Multi-Dose In 1 Tray (0517-4620-25)  / 20 Ml In 1 Vial, Multi-Dose","250","RC","0517-4620-25","NDC","","","facility","both","1","EA","","1.69","1.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Chloride: 10 Vial, Glass In 1 Box (0517-6710-10)  / 10 Ml In 1 Vial, Glass","250","RC","0517-6710-10","NDC","","","facility","both","1","EA","","14.91","14.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0517-7504-01","NDC","","","facility","both","1","EA","","12.22","12.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pilocarpine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0527-1313-01)","250","RC","0527-1313-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Primidone: 100 Tablet In 1 Bottle (0527-1301-01)","250","RC","0527-1301-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (0527-0760-37)","250","RC","0527-0760-37","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0521-2311-00","NDC","","","facility","both","1","EA","","3.18","3.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Droperidol: 25 Vial, Single-Dose In 1 Tray (0517-9702-25)  / 2 Ml In 1 Vial, Single-Dose","250","RC","0517-9702-25","NDC","","","facility","both","1","EA","","6.74","6.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0517-9702-01","NDC","","","facility","both","1","EA","","3.66","3.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0517-9120-01","NDC","","","facility","both","1","EA","","2.35","2.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 25 Vial, Glass In 1 Tray (0517-7604-25)  / 4 Ml In 1 Vial, Glass","250","RC","0517-7604-25","NDC","","","facility","both","1","EA","","5.94","5.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 25 Vial, Glass In 1 Tray (0517-7604-25)  / 4 Ml In 1 Vial, Glass","250","RC","0517-7604-25","NDC","","","facility","both","1","EA","","7.42","7.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0517-7604-01","NDC","","","facility","both","1","EA","","6.47","6.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0517-7604-01","NDC","","","facility","both","1","EA","","6.72","6.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 25 Vial, Glass In 1 Tray (0517-7504-25)  / 4 Ml In 1 Vial, Glass","250","RC","0517-7504-25","NDC","","","facility","both","1","EA","","9.47","9.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4602-25)  / 2 Ml In 1 Vial, Single-Dose","250","RC","0517-4602-25","NDC","","","facility","both","1","EA","","7.23","7.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stomach Relief Regular Strength: 237 Ml In 1 Bottle, Plastic (0536-1286-36)","250","RC","0536-1286-36","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infants: 1 Bottle, Dropper In 1 Carton (0536-1303-75)  / 30 Ml In 1 Bottle, Dropper","250","RC","0536-1303-75","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Proglycem: 1 Bottle, Dropper In 1 Box (0575-6200-30)  / 30 Ml In 1 Bottle, Dropper","250","RC","0575-6200-30","NDC","","","facility","both","1","EA","","19.7","19.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Compro: 12 Packet In 1 Carton (0574-7226-12)  / 1 Suppository In 1 Packet","250","RC","0574-7226-12","NDC","","","facility","both","1","EA","","11.57","11.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisacodyl: 50 Blister Pack In 1 Carton (0574-7050-50)  / 1 Suppository In 1 Blister Pack","250","RC","0574-7050-50","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisacodyl: 12 Blister Pack In 1 Carton (0574-7050-12)  / 1 Suppository In 1 Blister Pack","250","RC","0574-7050-12","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin: 12 Packet In 1 Carton (0574-7034-12)  / 1 Suppository In 1 Packet","250","RC","0574-7034-12","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin: 1 Tube In 1 Carton (0574-4024-35)  / 3.5 G In 1 Tube","250","RC","0574-4024-35","NDC","","","facility","both","1","EA","","24.86","24.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 500 TABLET in 1 BOTTLE, PLASTIC (0591-0240-05) ","250","RC","0591-0240-05","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0574-4024-11","NDC","","","facility","both","1","EA","","12.03","12.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Colocort: 7 BOTTLE, WITH APPLICATOR in 1 CARTON (0574-2020-07)  / 60 mL in 1 BOTTLE, WITH APPLICATOR","250","RC","0574-2020-07","NDC","","","facility","both","1","EA","","6.7","6.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 118 Ml In 1 Bottle (0574-1133-04)","250","RC","0574-1133-04","NDC","","","facility","both","1","EA","","4.8","4.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actidose Aqua: 240 Ml In 1 Tube (0574-0521-76)","250","RC","0574-0521-76","NDC","","","facility","both","1","EA","","22","22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amiloride Hydrochloride: 100 Tablet In 1 Bottle (0574-0292-01)","250","RC","0574-0292-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam Hydrochloride: 1 Bottle, Glass In 1 Carton (0574-0150-04)  / 118 Ml In 1 Bottle, Glass","250","RC","0574-0150-04","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine And Prilocaine: 1 Tube In 1 Carton (0574-2042-30)  / 30 G In 1 Tube","250","RC","0574-2042-30","NDC","","","facility","both","1","EA","","20.04","20.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clotrimazole: 70 Lozenge In 1 Bottle, Plastic (0574-0107-70)","250","RC","0574-0107-70","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamterene And Hydrochlorothiazide: 100 Tablet In 1 Bottle, Plastic (0591-0348-01)","250","RC","0591-0348-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valproic: 100 Capsule, Liquid Filled In 1 Bottle (0591-4012-01)","250","RC","0591-4012-01","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride Sr: 60 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (0591-3541-60)","250","RC","0591-3541-60","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 100 Tablet In 1 Bottle (0591-2998-01)","250","RC","0591-2998-01","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valganciclovir Hydrochloride For Oral: 100 Ml In 1 Bottle, Glass (0591-2579-20)","250","RC","0591-2579-20","NDC","","","facility","both","1","EA","","141.27","141.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dalfampridine: 60 Tablet, Film Coated, Extended Release In 1 Bottle (0591-2533-60)","250","RC","0591-2533-60","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide: 30 Tablet, Film Coated, Extended Release In 1 Bottle (0591-2510-30)","250","RC","0591-2510-30","NDC","","","facility","both","1","EA","","85.71","85.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ambrisentan: 30 Tablet, Film Coated In 1 Bottle (0591-2406-30)","250","RC","0591-2406-30","NDC","","","facility","both","1","EA","","166.01","166.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glipizide: 100 Tablet In 1 Bottle, Plastic (0591-0461-01)","250","RC","0591-0461-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glipizide: 100 Tablet In 1 Bottle, Plastic (0591-0460-01)","250","RC","0591-0460-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guanfacine: 100 Tablet In 1 Bottle, Plastic (0591-0444-01)","250","RC","0591-0444-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-0404-01)","250","RC","0591-0404-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loxapine: 100 Capsule In 1 Bottle, Plastic (0591-0372-01)","250","RC","0591-0372-01","NDC","","","facility","both","1","EA","","2.42","2.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loxapine: 100 Capsule In 1 Bottle, Plastic (0591-0369-01)","250","RC","0591-0369-01","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicyclomine Hydrochloride: 100 Capsule In 1 Bottle, Plastic (0591-0794-01)","250","RC","0591-0794-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clotrimazole: 140 Lozenge In 1 Bottle, Plastic (0574-0107-14)","250","RC","0574-0107-14","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bromocriptine Mesylate: 100 Tablet In 1 Bottle, Plastic (0574-0106-01)","250","RC","0574-0106-01","NDC","","","facility","both","1","EA","","2.95","2.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine: 14 Pouch In 1 Carton (0536-5895-88)  / 1 H In 1 Pouch","250","RC","0536-5895-88","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine: 14 Pouch In 1 Carton (0536-5894-88)  / 1 H In 1 Pouch","250","RC","0536-5894-88","NDC","","","facility","both","1","EA","","2.28","2.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fiber Lax: 90 Tablet, Film Coated In 1 Bottle (0536-4306-11)","250","RC","0536-4306-11","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0536-3030-25","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0536-3029-25","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Nicotine Polacrilex Gum, Original Flavor: 11 Blister Pack In 1 Carton (0536-3029-23)  / 10 Gum, Chewing In 1 Blister Pack","250","RC","0536-3029-23","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Capsaicin: 1 Tube In 1 Carton (0536-2525-25)  / 60 G In 1 Tube","250","RC","0536-2525-25","NDC","","","facility","both","1","EA","","9.29","9.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine: 14 Pouch In 1 Carton (0536-5896-88)  / 1 H In 1 Pouch","250","RC","0536-5896-88","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Anti-Dandruff: 207 Ml In 1 Bottle, Plastic (0536-1995-53)","250","RC","0536-1995-53","NDC","","","facility","both","1","EA","","3.73","3.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Polyvinyl Alcohol 1.4% Lubricating Eye Drops: 1 Bottle, Dropper In 1 Box (0536-1408-94)  / 15 Ml In 1 Bottle, Dropper","250","RC","0536-1408-94","NDC","","","facility","both","1","EA","","5.12","5.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Hemorrhoidal: 12 SUPPOSITORY in 1 CARTON (0536-1389-12) ","250","RC","0536-1389-12","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Nicotine Polacrilex Gum, Mint Flavor: 11 Blister Pack In 1 Carton (0536-1362-23)  / 10 Gum, Chewing In 1 Blister Pack","250","RC","0536-1362-23","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Muscle Rub Cream: 1 Tube In 1 Carton (0536-1349-57)  / 85 G In 1 Tube","250","RC","0536-1349-57","NDC","","","facility","both","1","EA","","4.14","4.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine: 1 Bottle, Plastic In 1 Box (0536-1337-35)  / 24 Lozenge In 1 Bottle, Plastic","250","RC","0536-1337-35","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chest Congestion Relief: 473 Ml In 1 Bottle (0536-1314-85)","250","RC","0536-1314-85","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docusate Sodium Liquid: 473 Ml In 1 Bottle (0536-1304-85)","250","RC","0536-1304-85","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 1 Vial, Single-Dose In 1 Carton (0548-5400-00)  / 1 Ml In 1 Vial, Single-Dose","250","RC","0548-5400-00","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Estradiol: 100 Tablet In 1 Bottle (0555-0886-02)","250","RC","0555-0886-02","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 100 Tablet In 1 Bottle (0555-0872-02)","250","RC","0555-0872-02","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 100 Tablet In 1 Bottle (0555-0779-02)","250","RC","0555-0779-02","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Megestrol Acetate: 100 Tablet In 1 Bottle (0555-0606-02)","250","RC","0555-0606-02","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 100 Tablet In 1 Bottle (0555-0484-02)","250","RC","0555-0484-02","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norethindrone Acetate: 50 Tablet In 1 Bottle (0555-0211-10)","250","RC","0555-0211-10","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0159-02)","250","RC","0555-0159-02","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0158-02)","250","RC","0555-0158-02","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isoniazid: 100 Tablet In 1 Bottle (0555-0066-02)","250","RC","0555-0066-02","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isoproterenol Hydrochloride: 10 Vial In 1 Carton (0548-9502-00)  / 5 Ml In 1 Vial","250","RC","0548-9502-00","NDC","","","facility","both","1","EA","","331.29","331.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cortrosyn: 10 Vial In 1 Carton (0548-5900-00)  / 1 Ml In 1 Vial","250","RC","0548-5900-00","NDC","","","facility","both","1","EA","","29.14","29.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 1 Vial In 1 Carton (0548-5608-00)  / 3 Ml In 1 Vial","250","RC","0548-5608-00","NDC","","","facility","both","1","EA","","3.67","3.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (0548-5602-00)  / .4 Ml In 1 Syringe","250","RC","0548-5602-00","NDC","","","facility","both","1","EA","","2.47","2.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hemorrhoidal: 1 Tube In 1 Box (0536-1288-06)  / 57 G In 1 Tube","250","RC","0536-1288-06","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cresemba: 2 Blister Pack In 1 Carton (0469-0520-02)  / 7 Capsule In 1 Blister Pack","250","RC","0469-0520-02","NDC","","","facility","both","1","EA","","152.91","152.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cresemba: 1 Vial, Single-Dose In 1 Carton (0469-0420-01)  / 5 Ml In 1 Vial, Single-Dose","250","RC","0469-0420-01","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avycaz: 10 Vial, Single-Dose In 1 Carton (0456-2700-10)  / 1 Powder, For Solution In 1 Vial, Single-Dose (0456-2700-01)","250","RC","0456-2700-10","NDC","","","facility","both","1","EA","","197.6","197.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0456-2700-01","NDC","","","facility","both","1","EA","","151.51","151.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0456-2700-01","NDC","","","facility","both","1","EA","","163.7","163.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fetzima: 30 Capsule, Extended Release In 1 Bottle, Plastic (0456-2220-30)","250","RC","0456-2220-30","NDC","","","facility","both","1","EA","","29.11","29.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Savella: 60 Tablet, Film Coated In 1 Bottle (0456-1550-60)","250","RC","0456-1550-60","NDC","","","facility","both","1","EA","","14.16","14.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Savella: 60 Tablet, Film Coated In 1 Bottle (0456-1510-60)","250","RC","0456-1510-60","NDC","","","facility","both","1","EA","","14.16","14.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linzess: 1 Bottle In 1 Carton (0456-1203-30)  / 30 Capsule, Gelatin Coated In 1 Bottle","250","RC","0456-1203-30","NDC","","","facility","both","1","EA","","31.15","31.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linzess: 1 Bottle In 1 Carton (0456-1202-30)  / 30 Capsule, Gelatin Coated In 1 Bottle","250","RC","0456-1202-30","NDC","","","facility","both","1","EA","","31.23","31.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linzess: 1 Bottle In 1 Carton (0456-1201-30)  / 30 Capsule, Gelatin Coated In 1 Bottle","250","RC","0456-1201-30","NDC","","","facility","both","1","EA","","31.29","31.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0456-2402-06","NDC","","","facility","both","1","EA","","33.49","33.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cresemba: 4 Carton In 1 Carton (0469-0520-14)  / 14 Blister Pack In 1 Carton (0469-0520-02)  / 1 Capsule In 1 Blister Pack","250","RC","0469-0520-14","NDC","","","facility","both","1","EA","","168.04","168.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prograf: 1 Bottle In 1 Carton (0469-0657-73)  / 100 Capsule, Gelatin Coated In 1 Bottle","250","RC","0469-0657-73","NDC","","","facility","both","1","EA","","3.94","3.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 1 TUBE in 1 CARTON (0472-0343-56)  / 28 g in 1 TUBE","250","RC","0472-0343-56","NDC","","","facility","both","1","EA","","15.56","15.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Permethrin: 1 Tube In 1 Carton (0472-0242-60)  / 60 G In 1 Tube","250","RC","0472-0242-60","NDC","","","facility","both","1","EA","","35.21","35.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 1 Tube In 1 Carton (0472-0166-30)  / 30 G In 1 Tube","250","RC","0472-0166-30","NDC","","","facility","both","1","EA","","34.83","34.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tretinoin: 1 Tube In 1 Carton (0472-0117-20)  / 20 G In 1 Tube","250","RC","0472-0117-20","NDC","","","facility","both","1","EA","","138.89","138.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myrbetriq: 1 Bottle In 1 Carton (0469-5020-99)  / 100 Ml In 1 Bottle","250","RC","0469-5020-99","NDC","","","facility","both","1","EA","","10.41","10.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyloy: 1 Vial In 1 Box (0469-3425-10)  / 5 Ml In 1 Vial","250","RC","0469-3425-10","NDC","","","facility","both","1","EA","","2442.11","2442.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ambisome: 12.5 Ml In 1 Vial, Single-Dose (0469-3051-30)","250","RC","0469-3051-30","NDC","","","facility","both","1","EA","","30.93","30.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prograf: 10 Ampule In 1 Box (0469-3016-01)  / 1 Ml In 1 Ampule","250","RC","0469-3016-01","NDC","","","facility","both","1","EA","","89.35","89.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myrbetriq: 1 Bottle In 1 Carton (0469-2602-90)  / 90 Tablet, Film Coated, Extended Release In 1 Bottle","250","RC","0469-2602-90","NDC","","","facility","both","1","EA","","25.47","25.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myrbetriq: 1 Bottle In 1 Carton (0469-2602-30)  / 30 Tablet, Film Coated, Extended Release In 1 Bottle","250","RC","0469-2602-30","NDC","","","facility","both","1","EA","","25.47","25.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myrbetriq: 1 Bottle In 1 Carton (0469-2601-30)  / 30 Tablet, Film Coated, Extended Release In 1 Bottle","250","RC","0469-2601-30","NDC","","","facility","both","1","EA","","25.47","25.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xospata: 1 Bottle In 1 Carton (0469-1425-90)  / 90 Tablet In 1 Bottle","250","RC","0469-1425-90","NDC","","","facility","both","1","EA","","577.17","577.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xtandi: 1 Bottle In 1 Carton (0469-0725-60)  / 60 Tablet In 1 Bottle","250","RC","0469-0725-60","NDC","","","facility","both","1","EA","","436","436","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Viibryd: 30 Tablet In 1 Bottle (0456-1140-30)","250","RC","0456-1140-30","NDC","","","facility","both","1","EA","","20.18","20.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Viibryd: 30 Tablet In 1 Bottle (0456-1120-30)","250","RC","0456-1120-30","NDC","","","facility","both","1","EA","","20.18","20.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-25)  / 5 Ml In 1 Vial, Single-Dose (0409-9094-18)","250","RC","0409-9094-25","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-22)  / 2 Ml In 1 Vial, Single-Dose (0409-9094-12)","250","RC","0409-9094-22","NDC","","","facility","both","1","EA","","3.5","3.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-9094-18","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-9094-16","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-9094-16","NDC","","","facility","both","1","EA","","8.58","8.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-9094-12","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 10 Ampule In 1 Cello Pack (0409-9093-32)  / 2 Ml In 1 Ampule (0409-9093-37)","250","RC","0409-9093-32","NDC","","","facility","both","1","EA","","1.72","1.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride And Epinephrine: 25 Vial, Single-Dose In 1 Tray (0409-9045-17)  / 30 Ml In 1 Vial, Single-Dose (0409-9045-16)","250","RC","0409-9045-17","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride And Epinephrine: 25 Vial, Single-Dose In 1 Tray (0409-9045-17)  / 30 Ml In 1 Vial, Single-Dose (0409-9045-16)","250","RC","0409-9045-17","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-8183-11","NDC","","","facility","both","1","EA","","3.43","3.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Acetate: 25 Vial, Single-Dose In 1 Tray (0409-8183-01)  / 20 Ml In 1 Vial, Single-Dose (0409-8183-11)","250","RC","0409-8183-01","NDC","","","facility","both","1","EA","","2.92","2.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride in Dextrose and Sodium Chloride: 12 POUCH in 1 CASE (0409-7993-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","250","RC","0409-7993-09","NDC","","","facility","both","1","EA","","12.6","12.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 12 POUCH in 1 CASE (0409-7990-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","250","RC","0409-7990-09","NDC","","","facility","both","1","EA","","2.01","2.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 POUCH in 1 CASE (0409-7985-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","250","RC","0409-7985-09","NDC","","","facility","both","1","EA","","9","9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-9094-41","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Viibryd: 30 Tablet In 1 Bottle (0456-1110-30)","250","RC","0456-1110-30","NDC","","","facility","both","1","EA","","20.13","20.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0456-0600-01","NDC","","","facility","both","1","EA","","5.59","5.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dakins Full: 473 Ml In 1 Bottle (0436-0946-16)","250","RC","0436-0946-16","NDC","","","facility","both","1","EA","","24.84","24.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dakins Half: 473 Ml In 1 Bottle (0436-0936-16)","250","RC","0436-0936-16","NDC","","","facility","both","1","EA","","25.18","25.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dakins Quarter: 473 Ml In 1 Bottle (0436-0672-16)","250","RC","0436-0672-16","NDC","","","facility","both","1","EA","","25.55","25.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-9566-01","NDC","","","facility","both","1","EA","","2.84","2.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Box (0409-9558-10)  / 10 Ml In 1 Vial, Multi-Dose (0409-9558-31)","250","RC","0409-9558-10","NDC","","","facility","both","1","EA","","9.65","9.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Box (0409-9558-05)  / 5 Ml In 1 Vial, Multi-Dose (0409-9558-11)","250","RC","0409-9558-05","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-9303-11","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-9158-31","NDC","","","facility","both","1","EA","","4.23","4.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 25 Carton In 1 Tray (0409-9094-61)  / 1 Vial, Single-Dose In 1 Carton / 50 Ml In 1 Vial, Single-Dose (0409-9094-41)","250","RC","0409-9094-61","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 25 Carton In 1 Tray (0409-9094-61)  / 1 Vial, Single-Dose In 1 Carton / 50 Ml In 1 Vial, Single-Dose (0409-9094-41)","250","RC","0409-9094-61","NDC","","","facility","both","1","EA","","5.49","5.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 1 TUBE in 1 CARTON (0472-0345-56)  / 28 g in 1 TUBE","250","RC","0472-0345-56","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 25 Vial, Glass In 1 Tray (0517-1001-25)  / 1 Ml In 1 Vial, Glass (0517-1001-01)","250","RC","0517-1001-25","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0517-0901-01","NDC","","","facility","both","1","EA","","10.13","10.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylergonovine Maleate: 20 Vial, Single-Dose In 1 Carton (0517-0740-20)  / 1 Ml In 1 Vial, Single-Dose (0517-0740-01)","250","RC","0517-0740-20","NDC","","","facility","both","1","EA","","33.42","33.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0517-0740-01","NDC","","","facility","both","1","EA","","36.28","36.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Betamethasone Sodium Phosphate And Betamethasone Acetate: 1 Vial, Multi-Dose In 1 Carton (0517-0720-01)  / 5 Ml In 1 Vial, Multi-Dose","250","RC","0517-0720-01","NDC","","","facility","both","1","EA","","8.25","8.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0517-0374-01","NDC","","","facility","both","1","EA","","3.31","3.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0517-0374-01","NDC","","","facility","both","1","EA","","3.33","3.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0517-1020-01","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4601-25)  / 1 Ml In 1 Vial, Single-Dose","250","RC","0517-4601-25","NDC","","","facility","both","1","EA","","8.91","8.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4601-25)  / 1 Ml In 1 Vial, Single-Dose","250","RC","0517-4601-25","NDC","","","facility","both","1","EA","","9.79","9.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4601-25)  / 1 Ml In 1 Vial, Single-Dose","250","RC","0517-4601-25","NDC","","","facility","both","1","EA","","10.64","10.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0517-4002-01","NDC","","","facility","both","1","EA","","40.22","40.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venofer: 10 Vial, Single-Dose In 1 Box (0517-2340-10)  / 5 Ml In 1 Vial, Single-Dose","250","RC","0517-2340-10","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venofer: 1 Vial, Single-Dose In 1 Box (0517-2340-01)  / 5 Ml In 1 Vial, Single-Dose","250","RC","0517-2340-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide Sodium: 1 Vial In 1 Carton (0517-1820-01)  / 18 Ml In 1 Vial","250","RC","0517-1820-01","NDC","","","facility","both","1","EA","","93.26","93.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide Sodium: 1 Vial In 1 Carton (0517-1820-01)  / 18 Ml In 1 Vial","250","RC","0517-1820-01","NDC","","","facility","both","1","EA","","118.52","118.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","05047-4636-97","NDC","","","facility","both","1","EA","","124.26","124.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lmx4: 15 G In 1 Tube (0496-0882-15)","250","RC","0496-0882-15","NDC","","","facility","both","1","EA","","31.38","31.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lmx4: 5 G In 1 Tube (0496-0882-05)","250","RC","0496-0882-05","NDC","","","facility","both","1","EA","","4.92","4.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (0480-3567-01)","250","RC","0480-3567-01","NDC","","","facility","both","1","EA","","5.48","5.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (0480-3565-01)","250","RC","0480-3565-01","NDC","","","facility","both","1","EA","","5.79","5.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (0480-3564-01)","250","RC","0480-3564-01","NDC","","","facility","both","1","EA","","5.48","5.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Teriflunomide: 30 Tablet, Film Coated In 1 Bottle (0480-3156-56)","250","RC","0480-3156-56","NDC","","","facility","both","1","EA","","22.79","22.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fidaxomicin: 20 Tablet, Film Coated In 1 Bottle (0480-2596-34)","250","RC","0480-2596-34","NDC","","","facility","both","1","EA","","301.33","301.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Perampanel: 30 Tablet, Film Coated In 1 Bottle (0480-7063-56)","250","RC","0480-7063-56","NDC","","","facility","both","1","EA","","58.35","58.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Icosapent Ethyl: 120 Capsule, Liquid Filled In 1 Bottle (0480-0127-89)","250","RC","0480-0127-89","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0472-1915-01","NDC","","","facility","both","1","EA","","7.33","7.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miconazole 7: 7 SUPPOSITORY in 1 BOX (0472-1736-07) ","250","RC","0472-1736-07","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuterol Sulfate: 25 Pouch In 1 Carton (0487-9904-25)  / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose","250","RC","0487-9904-25","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuterol Sulfate: 30 Pouch In 1 Carton (0487-9904-01)  / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose","250","RC","0487-9904-01","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuterol Sulfate: 30 Pouch In 1 Carton (0487-9901-30)  / 1 Vial, Single-Dose In 1 Pouch / .5 Ml In 1 Vial, Single-Dose","250","RC","0487-9901-30","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide: 30 Pouch In 1 Carton (0487-9801-01)  / 1 Vial, Single-Dose In 1 Pouch / 2.5 Ml In 1 Vial, Single-Dose","250","RC","0487-9801-01","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide: 6 Pouch In 1 Carton (0487-9701-01)  / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule","250","RC","0487-9701-01","NDC","","","facility","both","1","EA","","15.45","15.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide: 6 Pouch In 1 Carton (0487-9701-01)  / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule","250","RC","0487-9701-01","NDC","","","facility","both","1","EA","","16.37","16.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide: 6 Pouch In 1 Carton (0487-9601-01)  / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule","250","RC","0487-9601-01","NDC","","","facility","both","1","EA","","7.22","7.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuterol Sulfate: 30 Pouch In 1 Carton (0487-9501-01)  / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose","250","RC","0487-9501-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"S2: 30 Pouch In 1 Carton (0487-5901-99)  / 1 Vial, Single-Use In 1 Pouch / .5 Ml In 1 Vial, Single-Use","250","RC","0487-5901-99","NDC","","","facility","both","1","EA","","2.99","2.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Asthmanefrin: 30 Pouch In 1 Carton (0487-2784-01)  / 1 Vial, Single-Use In 1 Pouch / .5 Ml In 1 Vial, Single-Use","250","RC","0487-2784-01","NDC","","","facility","both","1","EA","","3.35","3.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (0487-0201-01)  / 1 Vial, Single-Use In 1 Pouch / 3 Ml In 1 Vial, Single-Use","250","RC","0487-0201-01","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"K-Phos No. 2: 100 Tablet, Coated In 1 Bottle (0486-1134-01)","250","RC","0486-1134-01","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lmx4: 5 Tube In 1 Carton (0496-0882-06)  / 5 G In 1 Tube (0496-0882-05)","250","RC","0496-0882-06","NDC","","","facility","both","1","EA","","5.57","5.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sildenafil: 1 Bottle In 1 Carton (0591-4050-94)  / 112 Ml In 1 Bottle","250","RC","0591-4050-94","NDC","","","facility","both","1","EA","","4.44","4.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alprazolam: 100 Tablet In 1 Bottle (0781-1077-01)","250","RC","0781-1077-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alprazolam: 100 Tablet In 1 Bottle (0781-1061-01)","250","RC","0781-1061-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Griseofulvin: 118 Ml In 1 Bottle, Plastic (0713-0850-04)","250","RC","0713-0850-04","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gentamicin Sulfate: 1 Tube In 1 Carton (0713-0683-15)  / 15 G In 1 Tube","250","RC","0713-0683-15","NDC","","","facility","both","1","EA","","65.56","65.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (0713-0655-40)  / 5 G In 1 Tube","250","RC","0713-0655-40","NDC","","","facility","both","1","EA","","54.24","54.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 1 Tube In 1 Carton (0713-0637-37)  / 45 G In 1 Tube","250","RC","0713-0637-37","NDC","","","facility","both","1","EA","","73","73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mometasone Furoate: 1 Tube In 1 Carton (0713-0635-15)  / 15 G In 1 Tube","250","RC","0713-0635-15","NDC","","","facility","both","1","EA","","7.65","7.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketoconazole: 120 Ml In 1 Bottle, Plastic (0713-0592-04)","250","RC","0713-0592-04","NDC","","","facility","both","1","EA","","20.2","20.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 1 Tube In 1 Carton (0713-0574-60)  / 60 G In 1 Tube","250","RC","0713-0574-60","NDC","","","facility","both","1","EA","","162.65","162.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0713-0351-02","NDC","","","facility","both","1","EA","","3.99","3.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bacitracin: 28.4 G In 1 Tube (0713-0280-31)","250","RC","0713-0280-31","NDC","","","facility","both","1","EA","","2.88","2.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triple Antibiotic: 1 Tube In 1 Carton (0713-0268-31)  / 28.4 G In 1 Tube","250","RC","0713-0268-31","NDC","","","facility","both","1","EA","","4.6","4.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (0713-0228-31)  / 30 G In 1 Tube","250","RC","0713-0228-31","NDC","","","facility","both","1","EA","","6.7","6.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluocinolone Acetonide: 1 Tube In 1 Carton (0713-0223-15)  / 15 G In 1 Tube","250","RC","0713-0223-15","NDC","","","facility","both","1","EA","","31.22","31.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mometasone Furoate: 1 Tube In 1 Carton (0713-0634-15)  / 15 G In 1 Tube","250","RC","0713-0634-15","NDC","","","facility","both","1","EA","","19.42","19.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 1 Vial, Multi-Dose In 1 Carton (0703-9526-01)  / 30 Ml In 1 Vial, Multi-Dose","250","RC","0703-9526-01","NDC","","","facility","both","1","EA","","12.72","12.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alprazolam: 100 Tablet In 1 Bottle (0781-1079-01)","250","RC","0781-1079-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3059-72","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-2322-06","NDC","","","facility","both","1","EA","","14.27","14.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aprepitant: 1 Blister Pack In 1 Carton (0781-2321-06)  / 1 Capsule In 1 Blister Pack","250","RC","0781-2321-06","NDC","","","facility","both","1","EA","","15.4","15.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Omeprazole: 100 Capsule, Delayed Release In 1 Bottle (0781-2234-01)","250","RC","0781-2234-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefdinir: 60 Capsule In 1 Bottle (0781-2176-60)","250","RC","0781-2176-60","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pirfenidone: 270 Capsule In 1 Bottle, Plastic (0781-2158-32)","250","RC","0781-2158-32","NDC","","","facility","both","1","EA","","10.45","10.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Bottle (0781-2104-01)","250","RC","0781-2104-01","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin V Potasium: 100 TABLET in 1 BOTTLE (0781-1205-01) ","250","RC","0781-1205-01","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Bottle (0781-2103-01)","250","RC","0781-2103-01","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Bottle (0781-2102-01)","250","RC","0781-2102-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Acetate: 200 Capsule In 1 Bottle (0781-2081-02)","250","RC","0781-2081-02","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamterene And Hydrochlorothiazide: 100 Capsule In 1 Bottle (0781-2074-01)","250","RC","0781-2074-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 100 Capsule In 1 Bottle (0781-2067-01)","250","RC","0781-2067-01","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 28 Tablet, Multilayer, Extended Release In 1 Bottle (0781-1943-82)","250","RC","0781-1943-82","NDC","","","facility","both","1","EA","","9.41","9.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 40 Tablet, Multilayer, Extended Release In 1 Bottle (0781-1943-39)","250","RC","0781-1943-39","NDC","","","facility","both","1","EA","","8.76","8.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0703-9514-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0110-03)  / 1 Ml In 1 Vial (0703-0110-01)","250","RC","0703-0110-03","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0703-0110-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 1 Vial In 1 Carton (0703-0018-01)  / 50 Ml In 1 Vial","250","RC","0703-0018-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 1 Vial In 1 Carton (0703-0018-01)  / 50 Ml In 1 Vial","250","RC","0703-0018-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Topex: 1 Canister In 1 Carton (0699-3100-02)  / 57 G In 1 Canister","250","RC","0699-3100-02","NDC","","","facility","both","1","EA","","95.53","95.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Caffeine Citrate: 10 Vial In 1 Box (0641-6267-10)  / 3 Ml In 1 Vial (0641-6267-01)","250","RC","0641-6267-10","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Acetate: 1 Vial In 1 Carton (0641-6261-01)  / 20 Ml In 1 Vial","250","RC","0641-6261-01","NDC","","","facility","both","1","EA","","7.63","7.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6244-01","NDC","","","facility","both","1","EA","","7.57","7.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6236-01","NDC","","","facility","both","1","EA","","10.62","10.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (0641-6231-25)  / 20 Ml In 1 Vial, Single-Dose (0641-6231-01)","250","RC","0641-6231-25","NDC","","","facility","both","1","EA","","2.94","2.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6267-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0703-0113-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0703-8540-21","NDC","","","facility","both","1","EA","","2.95","2.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 VIAL, SINGLE-USE in 1 CARTON (0703-5140-01)  / 10 mL in 1 VIAL, SINGLE-USE","250","RC","0703-5140-01","NDC","","","facility","both","1","EA","","3.39","3.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0703-4502-01","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial, Single-Dose In 1 Carton (0703-3675-01)  / 10 Ml In 1 Vial, Single-Dose","250","RC","0703-3675-01","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Treprostinil: 1 Vial, Multi-Dose In 1 Carton (0703-0676-01)  / 20 Ml In 1 Vial, Multi-Dose","250","RC","0703-0676-01","NDC","","","facility","both","1","EA","","22.57","22.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3110-90","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3486-75","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3481-70","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fondaparinux Sodium: 10 Syringe In 1 Carton (0781-3476-95)  / .8 Ml In 1 Syringe (0781-3476-94)","250","RC","0781-3476-95","NDC","","","facility","both","1","EA","","1.73","1.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3465-94","NDC","","","facility","both","1","EA","","1.89","1.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3440-71","NDC","","","facility","both","1","EA","","48.74","48.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Vial, Single-Use In 1 Carton (0781-3416-94)  / 20 Ml In 1 Vial, Single-Use","250","RC","0781-3416-94","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3411-70","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial, Glass In 1 Package (0781-3408-95)  / 1 Injection, Powder, For Solution In 1 Vial, Glass (0781-3408-80)","250","RC","0781-3408-95","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3408-80","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0781-3491-94)","250","RC","0781-3491-94","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0781-3491-94)","250","RC","0781-3491-94","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norepinephrine Bitartrate: 10 Vial, Single-Dose In 1 Carton (0781-3755-95)  / 4 Ml In 1 Vial, Single-Dose (0781-3755-75)","250","RC","0781-3755-95","NDC","","","facility","both","1","EA","","5.56","5.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3755-75","NDC","","","facility","both","1","EA","","5.66","5.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (0781-3545-25)  / 1 Ml In 1 Vial, Multi-Dose (0781-3545-10)","250","RC","0781-3545-25","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3545-10","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (0781-3540-25)  / 10 Ml In 1 Vial, Multi-Dose (0781-3540-10)","250","RC","0781-3540-25","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3540-10","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmedetomidine Hydrochloride In 0.9% Sodium Chloride: 10 Vial In 1 Carton (0781-3493-95)  / 20 Ml In 1 Vial","250","RC","0781-3493-95","NDC","","","facility","both","1","EA","","2.54","2.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3493-80","NDC","","","facility","both","1","EA","","2.95","2.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial, Glass In 1 Package (0781-3407-95)  / 1 Injection, Powder, For Solution In 1 Vial, Glass (0781-3407-78)","250","RC","0781-3407-95","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6231-01","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3407-78","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3209-90","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone Sodium: 1 Vial, Single-Use In 1 Carton (0781-3208-85)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Use","250","RC","0781-3208-85","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 1 Vial, Pharmacy Bulk Package In 1 Carton (0781-3180-94)  / 250 Ml In 1 Vial, Pharmacy Bulk Package","250","RC","0781-3180-94","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 1 Vial In 1 Carton (0781-3159-72)  / 2 Ml In 1 Vial","250","RC","0781-3159-72","NDC","","","facility","both","1","EA","","1.6","1.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 10 Vial, Glass In 1 Carton (0781-3156-95)  / 100 Ml In 1 Vial, Glass (0781-3156-06)","250","RC","0781-3156-95","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3156-06","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ferumoxytol: 1 Vial, Single-Dose In 1 Carton (0781-3154-01)  / 17 Ml In 1 Vial, Single-Dose","250","RC","0781-3154-01","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisatracurium Besylate: 10 Vial, Multi-Dose In 1 Carton (0781-3152-95)  / 10 Ml In 1 Vial, Multi-Dose (0781-3152-70)","250","RC","0781-3152-95","NDC","","","facility","both","1","EA","","8.81","8.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3152-70","NDC","","","facility","both","1","EA","","8.74","8.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3150-75","NDC","","","facility","both","1","EA","","4.66","4.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3114-91","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial, Single-Use In 1 Carton (0781-3113-95)  / 15 Ml In 1 Vial, Single-Use (0781-3113-90)","250","RC","0781-3113-95","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3113-90","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3232-94","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 10 Vial In 1 Carton (0781-3232-95)  / 10 Ml In 1 Vial (0781-3232-94)","250","RC","0781-3232-95","NDC","","","facility","both","1","EA","","5.15","5.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial, Glass In 1 Package (0781-3404-95)  / 1 Injection, Powder, For Solution In 1 Vial, Glass (0781-3404-85)","250","RC","0781-3404-95","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3404-85","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3290-91","NDC","","","facility","both","1","EA","","4.77","4.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3289-91","NDC","","","facility","both","1","EA","","6.26","6.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin In 5 Percent Dextrose: 24 Bag In 1 Carton (0781-3289-09)  / 50 Ml In 1 Bag (0781-3289-91)","250","RC","0781-3289-09","NDC","","","facility","both","1","EA","","6.24","6.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ephedrine Sulfate: 10 Vial, Single-Dose In 1 Carton (0781-3269-95)  / 1 Ml In 1 Vial, Single-Dose (0781-3269-71)","250","RC","0781-3269-95","NDC","","","facility","both","1","EA","","1.95","1.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0781-3256-03","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3255-94)  / 100 Ml In 1 Vial, Single-Dose","250","RC","0781-3255-94","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3244-94)  / 50 Ml In 1 Vial, Single-Dose","250","RC","0781-3244-94","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3233-94)  / 25 Ml In 1 Vial, Single-Dose","250","RC","0781-3233-94","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6228-01","NDC","","","facility","both","1","EA","","1.27","1.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-1397-31","NDC","","","facility","both","1","EA","","45.55","45.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-0948-31","NDC","","","facility","both","1","EA","","1.72","1.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 25 Vial, Single-Dose In 1 Package (0641-0928-25)  / 1 Ml In 1 Vial, Single-Dose (0641-0928-21)","250","RC","0641-0928-25","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-0928-21","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-1398-31","NDC","","","facility","both","1","EA","","21.63","21.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-0477-21","NDC","","","facility","both","1","EA","","77.44","77.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-0476-21","NDC","","","facility","both","1","EA","","3.88","3.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-0400-37","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hydrochloride: 25 Vial In 1 Package (0641-0376-25)  / 1 Ml In 1 Vial (0641-0376-21)","250","RC","0641-0376-25","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital Sodium: 25 Vial In 1 Carton (0641-0477-25)  / 1 Ml In 1 Vial (0641-0477-21)","250","RC","0641-0477-25","NDC","","","facility","both","1","EA","","52.33","52.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-0376-21","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-1410-31","NDC","","","facility","both","1","EA","","2.55","2.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6008-01","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6008-01","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6008-01","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial In 1 Carton (0641-6007-10)  / 10 Ml In 1 Vial (0641-6007-01)","250","RC","0641-6007-10","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6007-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6007-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6001-01","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-1495-31","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-1410-31","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jardiance: 30 Tablet, Film Coated In 1 Bottle (0597-0153-30)","250","RC","0597-0153-30","NDC","","","facility","both","1","EA","","22.36","22.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jardiance: 30 Blister Pack In 1 Carton (0597-0152-37)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0597-0152-37","NDC","","","facility","both","1","EA","","21.98","21.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jardiance: 30 Tablet, Film Coated In 1 Bottle (0597-0152-30)","250","RC","0597-0152-30","NDC","","","facility","both","1","EA","","21.67","21.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ofev: 1 Bottle In 1 Carton (0597-0145-60)  / 60 Capsule In 1 Bottle","250","RC","0597-0145-60","NDC","","","facility","both","1","EA","","405.5","405.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pradaxa: 10 Blister Pack In 1 Carton (0597-0108-60)  / 6 Capsule In 1 Blister Pack","250","RC","0597-0108-60","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spiriva Respimat: 1 Cartridge In 1 Carton (0597-0100-51)  / 10 Spray, Metered In 1 Cartridge","250","RC","0597-0100-51","NDC","","","facility","both","1","EA","","62.24","62.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jardiance: 30 Blister Pack In 1 Carton (0597-0153-37)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","0597-0153-37","NDC","","","facility","both","1","EA","","22.1","22.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atrovent Hfa: 1 Canister In 1 Carton (0597-0087-17)  / 200 Aerosol, Metered In 1 Canister","250","RC","0597-0087-17","NDC","","","facility","both","1","EA","","509.25","509.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0597-0053-01","NDC","","","facility","both","1","EA","","214.2","214.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spevigo: 2 Vial, Glass In 1 Carton (0597-0035-10)  / 7.5 Ml In 1 Vial, Glass","250","RC","0597-0035-10","NDC","","","facility","both","1","EA","","30077.83","30077.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Minocycline Hydrochloride: 100 Capsule In 1 Bottle, Plastic (0591-5694-01)","250","RC","0591-5694-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0591-5557-01)","250","RC","0591-5557-01","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Probenecid: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-5347-01)","250","RC","0591-5347-01","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trihexyphenidyl Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0591-5337-01)","250","RC","0591-5337-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trihexyphenidyl Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0591-5335-01)","250","RC","0591-5335-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pradaxa: 60 Blister Pack In 1 Carton (0597-0355-56)  / 1 Capsule In 1 Blister Pack","250","RC","0597-0355-56","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-0367-21","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle, Plastic (0603-5336-21)","250","RC","0603-5336-21","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Tablet In 1 Bottle, Plastic (0603-5168-21)","250","RC","0603-5168-21","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Tablet In 1 Bottle, Plastic (0603-5167-21)","250","RC","0603-5167-21","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 100 TABLET in 1 BOTTLE, PLASTIC (0603-4975-21) ","250","RC","0603-4975-21","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 TABLET in 1 BOTTLE (0603-4209-21) ","250","RC","0603-4209-21","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 100 TABLET in 1 BOTTLE, PLASTIC (0603-3901-21) ","250","RC","0603-3901-21","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0603-1880-10","NDC","","","facility","both","1","EA","","4.44","4.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0603-1554-10","NDC","","","facility","both","1","EA","","5.35","5.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 473 Ml In 1 Bottle, Plastic (0603-1542-58)","250","RC","0603-1542-58","NDC","","","facility","both","1","EA","","19.54","19.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 473 mL in 1 BOTTLE, PLASTIC (0603-1508-58) ","250","RC","0603-1508-58","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicyclomine Hydrochloride: 473 Ml In 1 Bottle, Plastic (0603-1161-58)","250","RC","0603-1161-58","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pink Bismuth: 1 CELLO PACK in 1 CARTON (0603-0235-16)  / 30 TABLET, CHEWABLE in 1 CELLO PACK","250","RC","0603-0235-16","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Oxide: 120 Tablet In 1 Bottle (0603-0209-22)","250","RC","0603-0209-22","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pradaxa: 60 Blister Pack In 1 Carton (0597-0360-82)  / 1 Capsule In 1 Blister Pack","250","RC","0597-0360-82","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6013-01","NDC","","","facility","both","1","EA","","3.27","3.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6014-01","NDC","","","facility","both","1","EA","","3.05","3.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6015-01","NDC","","","facility","both","1","EA","","9.23","9.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6151-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neostigmine Methylsulfate: 10 Vial, Multi-Dose In 1 Carton (0641-6149-10)  / 10 Ml In 1 Vial, Multi-Dose (0641-6149-01)","250","RC","0641-6149-10","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6149-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6137-01","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6136-01","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 25 Vial, Single-Dose In 1 Package (0641-6127-25)  / 1 Ml In 1 Vial, Single-Dose (0641-6127-01)","250","RC","0641-6127-25","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6127-01","NDC","","","facility","both","1","EA","","2.14","2.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6125-01","NDC","","","facility","both","1","EA","","9.95","9.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6117-01","NDC","","","facility","both","1","EA","","4.26","4.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6116-01","NDC","","","facility","both","1","EA","","4.22","4.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6151-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6228-01","NDC","","","facility","both","1","EA","","2.84","2.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6205-01","NDC","","","facility","both","1","EA","","9.26","9.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenylephrine Hydrochloride: 10 Vial, Pharmacy Bulk Package In 1 Carton (0641-6188-10)  / 5 Ml In 1 Vial, Pharmacy Bulk Package (0641-6188-01)","250","RC","0641-6188-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6176-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6176-01","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6175-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6174-01","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6151-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiamine Hydrochloride: 25 Vial In 1 Carton (0641-6228-25)  / 2 Ml In 1 Vial (0641-6228-01)","250","RC","0641-6228-25","NDC","","","facility","both","1","EA","","3.16","3.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6103-01","NDC","","","facility","both","1","EA","","12.27","12.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6044-01","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infumorph 500: 20 Ml In 1 Ampule (0641-6040-01)","250","RC","0641-6040-01","NDC","","","facility","both","1","EA","","11.62","11.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infumorph 200: 20 Ml In 1 Ampule (0641-6039-01)","250","RC","0641-6039-01","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 20 Ml In 1 Vial (0641-6029-01)","250","RC","0641-6029-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6046-01","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6028-01","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6027-01","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6022-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6021-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6027-01","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6048-01","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6084-01","NDC","","","facility","both","1","EA","","2.66","2.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6082-01","NDC","","","facility","both","1","EA","","2.61","2.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 20 Ml In 1 Carton (0641-6079-01)","250","RC","0641-6079-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6078-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6061-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6061-01","NDC","","","facility","both","1","EA","","1.95","1.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam: 10 Vial In 1 Carton (0641-6060-10)  / 10 Ml In 1 Vial (0641-6060-01)","250","RC","0641-6060-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6060-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6059-01","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6057-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0641-6053-01","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 20 POUCH in 1 CASE (0409-7984-37)  / 4 BAG in 1 POUCH / 100 mL in 1 BAG","250","RC","0409-7984-37","NDC","","","facility","both","1","EA","","1.73","1.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Transdermal: 5 Pouch In 1 Carton (0406-9112-76)  / 1 Patch In 1 Pouch / 72 H In 1 Patch","250","RC","0406-9112-76","NDC","","","facility","both","1","EA","","26.96","26.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Transdermal: 5 Pouch In 1 Carton (0406-9100-76)  / 1 Patch In 1 Pouch / 72 H In 1 Patch","250","RC","0406-9100-76","NDC","","","facility","both","1","EA","","45.75","45.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 1 Bottle, Plastic In 1 Carton (0406-8557-30)  / 30 Ml In 1 Bottle, Plastic","250","RC","0406-8557-30","NDC","","","facility","both","1","EA","","2.9","2.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-8510-23)","250","RC","0406-8510-23","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8390-23)","250","RC","0406-8390-23","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8380-23)","250","RC","0406-8380-23","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8330-23)","250","RC","0406-8330-23","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Transdermal: 5 Pouch In 1 Carton (0406-9150-76)  / 1 Patch In 1 Pouch / 72 H In 1 Patch","250","RC","0406-9150-76","NDC","","","facility","both","1","EA","","21.03","21.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 6 Carton In 1 Case (0406-8003-30)  / 1 Bottle, Plastic In 1 Carton / 30 Ml In 1 Bottle, Plastic","250","RC","0406-8003-30","NDC","","","facility","both","1","EA","","2.92","2.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-5771-23)","250","RC","0406-5771-23","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-5755-23)","250","RC","0406-5755-23","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3244-01)","250","RC","0406-3244-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3243-01)","250","RC","0406-3243-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenoxylate Hydrochloride And Atropine Sulfate: 1000 Tablet In 1 Bottle (0406-1236-10)","250","RC","0406-1236-10","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8315-23)","250","RC","0406-8315-23","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Temazepam: 100 Capsule In 1 Bottle (0406-9961-01)","250","RC","0406-9961-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-0001-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0182-01)  / 52.6 Ml In 1 Vial, Single-Dose","250","RC","0409-0182-01","NDC","","","facility","both","1","EA","","8.41","8.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 24 Pouch In 1 Carton (0409-0152-24)  / 1 Bag In 1 Pouch (0409-0152-01)  / 100 Ml In 1 Bag","250","RC","0409-0152-24","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-0125-25)  / 20 Ml In 1 Vial, Multi-Dose (0409-0125-01)","250","RC","0409-0125-25","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-0125-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carboprost Tromethamine: 10 Vial In 1 Carton (0409-0064-10)  / 1 Ml In 1 Vial","250","RC","0409-0064-10","NDC","","","facility","both","1","EA","","98.62","98.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Epinephrine: 10 Vial, Multi-Dose In 1 Carton (0409-0007-10)  / 20 Ml In 1 Vial, Multi-Dose (0409-0007-01)","250","RC","0409-0007-10","NDC","","","facility","both","1","EA","","1.29","1.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-0007-01","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam: 25 Vial, Single-Dose In 1 Carton (0409-0001-25)  / 2 Ml In 1 Vial, Single-Dose (0409-0001-01)","250","RC","0409-0001-25","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-0152-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenoxylate Hydrochloride And Atropine Sulfate: 100 Tablet In 1 Bottle (0406-1236-01)","250","RC","0406-1236-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naltrexone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (0406-1170-03)","250","RC","0406-1170-03","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9124-16","NDC","","","facility","both","1","EA","","45.75","45.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl: 5 Pouch In 1 Carton (0378-9123-98)  / 1 Patch In 1 Pouch (0378-9123-16)  / 72 H In 1 Patch","250","RC","0378-9123-98","NDC","","","facility","both","1","EA","","26.59","26.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9123-16","NDC","","","facility","both","1","EA","","26.58","26.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9122-16","NDC","","","facility","both","1","EA","","16.82","16.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9121-16","NDC","","","facility","both","1","EA","","9.47","9.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9119-16","NDC","","","facility","both","1","EA","","19.98","19.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitroglycerin: 30 Pouch In 1 Carton (0378-9116-93)  / 1 Patch In 1 Pouch (0378-9116-16)  / 14 H In 1 Patch","250","RC","0378-9116-93","NDC","","","facility","both","1","EA","","1.27","1.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9116-16","NDC","","","facility","both","1","EA","","1.27","1.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9112-16","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9104-16","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9102-16","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9072-16","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rivastigmine: 30 Pouch In 1 Carton (0378-9071-93)  / 1 Patch In 1 Pouch (0378-9071-16)  / 24 H In 1 Patch","250","RC","0378-9071-93","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9071-16","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9070-16","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-8768-16","NDC","","","facility","both","1","EA","","10.59","10.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-8767-16","NDC","","","facility","both","1","EA","","5.45","5.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-9125-16","NDC","","","facility","both","1","EA","","67.02","67.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benzoin Compound Tincture: 59 Ml In 1 Bottle, Plastic (0395-0243-92)","250","RC","0395-0243-92","NDC","","","facility","both","1","EA","","9.71","9.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (0406-1142-01)","250","RC","0406-1142-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-0552-23)","250","RC","0406-0552-23","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadose: 1000 Ml In 1 Bottle, Plastic (0406-0527-10)","250","RC","0406-0527-10","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (0406-0154-01)","250","RC","0406-0154-01","NDC","","","facility","both","1","EA","","5.63","5.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (0406-0136-01)","250","RC","0406-0136-01","NDC","","","facility","both","1","EA","","5.49","5.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (0406-0127-01)","250","RC","0406-0127-01","NDC","","","facility","both","1","EA","","5.28","5.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","03953-92016","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Iodine And Potassium Iodide: 473 Ml In 1 Bottle, Plastic (0395-2775-16)","250","RC","0395-2775-16","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0395-1031-96","NDC","","","facility","both","1","EA","","7.23","7.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0395-1031-28","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0395-1031-16","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humco Gentian Violet 1%: 59 Ml In 1 Bottle, Plastic (0395-1003-92)","250","RC","0395-1003-92","NDC","","","facility","both","1","EA","","11.26","11.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0395-0605-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30)  / 1 Ml In 1 Cartridge (0409-1312-03)","250","RC","0409-1312-30","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30)  / 1 Ml In 1 Cartridge (0409-1312-03)","250","RC","0409-1312-30","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30)  / 1 Ml In 1 Cartridge (0409-1312-03)","250","RC","0409-1312-30","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1304-31)  / 1 Ml In 1 Cartridge (0409-1304-03)","250","RC","0409-1304-31","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0409-1319-01)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","250","RC","0409-1319-01","NDC","","","facility","both","1","EA","","1.95","1.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1304-03","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1273-03","NDC","","","facility","both","1","EA","","9.89","9.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1219-41","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1209-10","NDC","","","facility","both","1","EA","","4.22","4.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Epinephrine: 10 Ampule In 1 Tray (0409-1209-01)  / 5 Ml In 1 Ampule (0409-1209-10)","250","RC","0409-1209-01","NDC","","","facility","both","1","EA","","3.95","3.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1304-03","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Carton In 1 Container (0409-1323-05)  / 1 Syringe, Plastic In 1 Carton / 5 Ml In 1 Syringe, Plastic (0409-1323-15)","250","RC","0409-1323-05","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1323-15","NDC","","","facility","both","1","EA","","3.35","3.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 10 Carton In 1 Package (0409-1630-10)  / 1 Syringe, Plastic In 1 Carton / 10 Ml In 1 Syringe, Plastic (0409-1630-15)","250","RC","0409-1630-10","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 10 Carton In 1 Package (0409-1630-10)  / 1 Syringe, Plastic In 1 Carton / 10 Ml In 1 Syringe, Plastic (0409-1630-15)","250","RC","0409-1630-10","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1623-21","NDC","","","facility","both","1","EA","","5.28","5.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Butorphanol Tartrate: 10 Vial, Single-Dose In 1 Carton (0409-1623-01)  / 1 Ml In 1 Vial, Single-Dose (0409-1623-21)","250","RC","0409-1623-01","NDC","","","facility","both","1","EA","","3.68","3.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1463-71","NDC","","","facility","both","1","EA","","5.66","5.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1463-69","NDC","","","facility","both","1","EA","","4.95","4.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1391-21","NDC","","","facility","both","1","EA","","2.01","2.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1208-11","NDC","","","facility","both","1","EA","","25.42","25.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisatracurium Besylate: 10 Vial, Multi-Dose In 1 Carton (0409-1208-01)  / 10 Ml In 1 Vial, Multi-Dose (0409-1208-11)","250","RC","0409-1208-01","NDC","","","facility","both","1","EA","","25.42","25.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)","250","RC","0409-1159-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)","250","RC","0409-1159-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1144-65","NDC","","","facility","both","1","EA","","45.48","45.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 5 Vial In 1 Carton (0409-1144-02)  / 4 Ml In 1 Vial (0409-1144-62)","250","RC","0409-1144-02","NDC","","","facility","both","1","EA","","7.83","7.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1141-12","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-1135-02)  / 10 mL in 1 VIAL, SINGLE-DOSE","250","RC","0409-1135-02","NDC","","","facility","both","1","EA","","15.03","15.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Vial, Single-Dose In 1 Carton (0409-1134-03)  / 20 Ml In 1 Vial, Single-Dose","250","RC","0409-1134-03","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbocaine: 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-1041-30)  / 30 mL in 1 VIAL, SINGLE-DOSE","250","RC","0409-1041-30","NDC","","","facility","both","1","EA","","2.15","2.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-0830-11","NDC","","","facility","both","1","EA","","4.13","4.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Topotecan: 1 Vial, Single-Dose In 1 Carton (0409-0302-01)  / 4 Ml In 1 Vial, Single-Dose","250","RC","0409-0302-01","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1165-19","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1165-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1165-19)","250","RC","0409-1165-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1165-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1165-18)","250","RC","0409-1165-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1165-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1165-18)","250","RC","0409-1165-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1165-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1165-18)","250","RC","0409-1165-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1162-19)","250","RC","0409-1162-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1162-19)","250","RC","0409-1162-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1207-13","NDC","","","facility","both","1","EA","","4.39","4.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1630-15","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-8766-16","NDC","","","facility","both","1","EA","","5.27","5.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-8765-16","NDC","","","facility","both","1","EA","","2.96","2.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0671-04)","250","RC","0338-0671-04","NDC","","","facility","both","1","EA","","7.42","7.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0669-04)","250","RC","0338-0669-04","NDC","","","facility","both","1","EA","","6.33","6.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0663-04)","250","RC","0338-0663-04","NDC","","","facility","both","1","EA","","14.4","14.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetic Acid: 1000 Ml In 1 Bottle, Plastic (0338-0656-04)","250","RC","0338-0656-04","NDC","","","facility","both","1","EA","","11.52","11.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 100 Ml In 1 Bag (0338-0553-18)","250","RC","0338-0553-18","NDC","","","facility","both","1","EA","","5.72","5.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Intralipid: 1000 Ml In 1 Bag (0338-0519-14)","250","RC","0338-0519-14","NDC","","","facility","both","1","EA","","24.81","24.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0671-04)","250","RC","0338-0671-04","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Dextrose: 24 Bag In 1 Carton (0338-0411-02)  / 250 Ml In 1 Bag","250","RC","0338-0411-02","NDC","","","facility","both","1","EA","","10.46","10.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0338-0324-01","NDC","","","facility","both","1","EA","","103.89","103.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Recothrom: 1 Kit In 1 Kit (0338-0322-01)  *  5 Ml In 1 Vial (0338-0324-01)  *  5 Ml In 1 Syringe","250","RC","0338-0322-01","NDC","","","facility","both","1","EA","","112.98","112.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Plasma-Lyte A: 1000 Ml In 1 Bag (0338-0221-04)","250","RC","0338-0221-04","NDC","","","facility","both","1","EA","","5.23","5.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Plasma-Lyte A: 500 Ml In 1 Bag (0338-0221-03)","250","RC","0338-0221-03","NDC","","","facility","both","1","EA","","8.9","8.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myxredlin: 12 Container In 1 Carton (0338-0126-12)  / 100 Ml In 1 Container","250","RC","0338-0126-12","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Dextrose: 24 Bag In 1 Carton (0338-0411-02)  / 250 Ml In 1 Bag","250","RC","0338-0411-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers And Dextrose: 1000 Ml In 1 Bag (0338-0125-04)","250","RC","0338-0125-04","NDC","","","facility","both","1","EA","","7.18","7.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 24 Bag In 1 Carton (0338-1055-48)  / 100 Ml In 1 Bag","250","RC","0338-1055-48","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitroglycerin In Dextrose: 12 Bottle, Glass In 1 Box (0338-1051-02)  / 250 Ml In 1 Bottle, Glass","250","RC","0338-1051-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitroglycerin In Dextrose: 12 Bottle, Glass In 1 Box (0338-1051-02)  / 250 Ml In 1 Bottle, Glass","250","RC","0338-1051-02","NDC","","","facility","both","1","EA","","1.72","1.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dopamine Hydrochloride And Dextrose: 18 Bag In 1 Carton (0338-1009-02)  / 250 Ml In 1 Bag","250","RC","0338-1009-02","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dopamine Hydrochloride And Dextrose: 18 Bag In 1 Carton (0338-1007-02)  / 250 Ml In 1 Bag","250","RC","0338-1007-02","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0675-04)","250","RC","0338-0675-04","NDC","","","facility","both","1","EA","","9.26","9.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dopamine Hydrochloride And Dextrose: 18 Bag In 1 Carton (0338-1005-02)  / 250 Ml In 1 Bag","250","RC","0338-1005-02","NDC","","","facility","both","1","EA","","2.5","2.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 24 Bag In 1 Carton (0338-0709-48)  / 100 Ml In 1 Bag","250","RC","0338-0709-48","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 24 Bag In 1 Carton (0338-0705-48)  / 100 Ml In 1 Bag","250","RC","0338-0705-48","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Sodium Chloride: 14 Bag In 1 Carton (0338-0704-34)  / 1000 Ml In 1 Bag","250","RC","0338-0704-34","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 24 Bag In 1 Carton (0338-0703-48)  / 100 Ml In 1 Bag","250","RC","0338-0703-48","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Sodium Chloride: 14 Bag In 1 Carton (0338-0691-04)  / 1000 Ml In 1 Bag","250","RC","0338-0691-04","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0803-04)","250","RC","0338-0803-04","NDC","","","facility","both","1","EA","","6.17","6.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 1000 Ml In 1 Bag (0338-0117-04)","250","RC","0338-0117-04","NDC","","","facility","both","1","EA","","5.92","5.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Bag In 1 Carton (0338-0054-03)  / 500 Ml In 1 Bag","250","RC","0338-0054-03","NDC","","","facility","both","1","EA","","6.44","6.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1 Bag In 1 Package (0338-0049-48)  / 100 Ml In 1 Bag","250","RC","0338-0049-48","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1 Bag In 1 Package (0338-0049-48)  / 100 Ml In 1 Bag","250","RC","0338-0049-48","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1 Bag In 1 Package (0338-0049-41)  / 50 Ml In 1 Bag","250","RC","0338-0049-41","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1 Bag In 1 Package (0338-0049-41)  / 50 Ml In 1 Bag","250","RC","0338-0049-41","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 16 Bag In 1 Package (0338-0049-38)  / 100 Ml In 1 Bag","250","RC","0338-0049-38","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 16 Bag In 1 Package (0338-0049-31)  / 50 Ml In 1 Bag","250","RC","0338-0049-31","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 16 Bag In 1 Package (0338-0049-31)  / 50 Ml In 1 Bag","250","RC","0338-0049-31","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-18)  / 100 Ml In 1 Bag","250","RC","0338-0049-18","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-18)  / 100 Ml In 1 Bag","250","RC","0338-0049-18","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-11)  / 50 Ml In 1 Bag","250","RC","0338-0049-11","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 16 Bag In 1 Package (0338-0049-38)  / 100 Ml In 1 Bag","250","RC","0338-0049-38","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 500 Ml In 1 Bag (0338-0117-03)","250","RC","0338-0117-03","NDC","","","facility","both","1","EA","","5.17","5.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norepinephrine Bitartrate: 20 Container In 1 Carton (0338-0108-20)  / 250 Ml In 1 Container","250","RC","0338-0108-20","NDC","","","facility","both","1","EA","","48.15","48.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0089-04)  / 1000 Ml In 1 Bag","250","RC","0338-0089-04","NDC","","","facility","both","1","EA","","3.59","3.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0085-04)  / 1000 Ml In 1 Bag","250","RC","0338-0085-04","NDC","","","facility","both","1","EA","","7.17","7.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 24 Bag In 1 Carton (0338-0085-03)  / 500 Ml In 1 Bag","250","RC","0338-0085-03","NDC","","","facility","both","1","EA","","6.3","6.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0077-04)  / 1000 Ml In 1 Bag","250","RC","0338-0077-04","NDC","","","facility","both","1","EA","","9","9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (0338-0072-25)  / 1 Ml In 1 Vial","250","RC","0338-0072-25","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (0338-0072-25)  / 1 Ml In 1 Vial","250","RC","0338-0072-25","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 10 Bag In 1 Carton (0338-0070-10)  / 1000 Ml In 1 Bag","250","RC","0338-0070-10","NDC","","","facility","both","1","EA","","10.8","10.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 10 Vial In 1 Carton (0338-0069-10)  / 1 Ml In 1 Vial","250","RC","0338-0069-10","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 24 Bag In 1 Carton (0338-1055-48)  / 100 Ml In 1 Bag","250","RC","0338-1055-48","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 24 Bag In 1 Carton (0338-1055-48)  / 100 Ml In 1 Bag","250","RC","0338-1055-48","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-4644-16","NDC","","","facility","both","1","EA","","12.08","12.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-4643-16","NDC","","","facility","both","1","EA","","12.69","12.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-4642-16","NDC","","","facility","both","1","EA","","11.99","11.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-4641-16","NDC","","","facility","both","1","EA","","12.06","12.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-4640-16","NDC","","","facility","both","1","EA","","12.06","12.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 90 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (0378-4595-77)","250","RC","0378-4595-77","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Febuxostat: 30 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0378-3925-93) ","250","RC","0378-3925-93","NDC","","","facility","both","1","EA","","4.22","4.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mercaptopurine: 25 Tablet In 1 Bottle, Plastic (0378-3547-52)","250","RC","0378-3547-52","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Capecitabine: 120 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0378-2512-78) ","250","RC","0378-2512-78","NDC","","","facility","both","1","EA","","13.6","13.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1815-77)","250","RC","0378-1815-77","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicyclomine Hydrochloride: 100 CAPSULE in 1 BOTTLE, PLASTIC (0378-1610-01) ","250","RC","0378-1610-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle, Plastic (0378-1375-78)","250","RC","0378-1375-78","NDC","","","facility","both","1","EA","","6.1","6.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0378-1140-01)","250","RC","0378-1140-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxepin Hydrochloride: 100 Capsule In 1 Bottle, Plastic (0378-1049-01)","250","RC","0378-1049-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-0873-16","NDC","","","facility","both","1","EA","","44.44","44.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0378-1903-01)","250","RC","0378-1903-01","NDC","","","facility","both","1","EA","","5.39","5.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valsartan: 30 Tablet, Film Coated In 1 Bottle, Plastic (0378-5807-93)","250","RC","0378-5807-93","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Citalopram: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-6232-01)","250","RC","0378-6232-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tretinoin: 1 Tube In 1 Carton (0378-8083-20)  / 20 G In 1 Tube","250","RC","0378-8083-20","NDC","","","facility","both","1","EA","","155.83","155.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 1 BOTTLE, GLASS in 1 CARTON (0378-8043-21)  / 120 mL in 1 BOTTLE, GLASS","250","RC","0378-8043-21","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide: 30 Pouch In 1 Carton (0378-7970-55)  / 1 Ampule In 1 Pouch (0378-7970-31)  / 2.5 Ml In 1 Ampule","250","RC","0378-7970-55","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-7970-31","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norethindrone Acetate: 50 Tablet In 1 Bottle (0378-7291-89)","250","RC","0378-7291-89","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-7272-85","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-6986-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-6985-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lansoprazole: 2 Carton In 1 Box (0378-6981-88)  / 5 Blister Pack In 1 Carton (0378-6981-85)  / 10 Tablet, Orally Disintegrating, Delayed Release In 1 Blister Pack (0378-6981-32)","250","RC","0378-6981-88","NDC","","","facility","both","1","EA","","14.98","14.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abiraterone Acetate: 60 Tablet, Film Coated In 1 Bottle, Plastic (0378-6921-91)","250","RC","0378-6921-91","NDC","","","facility","both","1","EA","","259.89","259.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Scopolamine: 4 Pouch In 1 Carton (0378-6470-99)  / 1 Patch In 1 Pouch (0378-6470-16)  / 3 D In 1 Patch","250","RC","0378-6470-99","NDC","","","facility","both","1","EA","","26.82","26.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-6470-16","NDC","","","facility","both","1","EA","","30.51","30.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acamprosate Calcium: 180 Tablet, Delayed Release In 1 Bottle, Plastic (0378-6333-80)","250","RC","0378-6333-80","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Citalopram: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-6233-01)","250","RC","0378-6233-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-0872-16","NDC","","","facility","both","1","EA","","35.24","35.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0338-3814-50","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin Phosphate: 24 Bag In 1 Carton (0338-3814-24)  / 50 Ml In 1 Bag (0338-3814-50)","250","RC","0338-3814-24","NDC","","","facility","both","1","EA","","3.66","3.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0338-3612-50","NDC","","","facility","both","1","EA","","4.36","4.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 24 Bag In 1 Carton (0338-3503-41)  / 50 Ml In 1 Bag","250","RC","0338-3503-41","NDC","","","facility","both","1","EA","","2.8","2.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesnex: 1 Vial, Multi-Dose In 1 Box (0338-1305-01)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","0338-1305-01","NDC","","","facility","both","1","EA","","2.65","2.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesnex: 1 Vial, Multi-Dose In 1 Box (0338-1305-01)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","0338-1305-01","NDC","","","facility","both","1","EA","","3.23","3.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1077-02)  / 250 Ml In 1 Bag","250","RC","0338-1077-02","NDC","","","facility","both","1","EA","","11.12","11.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1075-02)  / 250 Ml In 1 Bag","250","RC","0338-1075-02","NDC","","","facility","both","1","EA","","19.18","19.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1075-02)  / 250 Ml In 1 Bag","250","RC","0338-1075-02","NDC","","","facility","both","1","EA","","22.18","22.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Dextrose: 40 Bag In 1 Case (0338-1709-40)  / 100 Ml In 1 Bag","250","RC","0338-1709-40","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 500 mL in 1 BAG (0338-6304-03) ","250","RC","0338-6304-03","NDC","","","facility","both","1","EA","","5.25","5.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 40 BAG in 1 CARTON (0338-6346-02)  / 250 mL in 1 BAG","250","RC","0338-6346-02","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"dalfampridine: 60 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC (0378-0509-91) ","250","RC","0378-0509-91","NDC","","","facility","both","1","EA","","64.46","64.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorthalidone: 100 Tablet In 1 Bottle, Plastic (0378-0222-01)","250","RC","0378-0222-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0378-0182-01)","250","RC","0378-0182-01","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 100 Tablet In 1 Bottle (0378-0137-01)","250","RC","0378-0137-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pindolol: 100 Tablet In 1 Bottle, Plastic (0378-0127-01)","250","RC","0378-0127-01","NDC","","","facility","both","1","EA","","1.2","1.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Tablet In 1 Bottle, Plastic (0378-0085-01)","250","RC","0378-0085-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Tablet In 1 Bottle, Plastic (0378-0078-01)","250","RC","0378-0078-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pindolol: 100 Tablet In 1 Bottle, Plastic (0378-0052-01)","250","RC","0378-0052-01","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0378-0045-01) ","250","RC","0378-0045-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-0018-01)","250","RC","0378-0018-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0363-0204-01","NDC","","","facility","both","1","EA","","2.45","2.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmedetomidine Hydrochloride: 12 Bag In 1 Carton (0338-9557-12)  / 100 Ml In 1 Bag","250","RC","0338-9557-12","NDC","","","facility","both","1","EA","","19.16","19.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1000 Ml In 1 Bag (0338-9543-06)","250","RC","0338-9543-06","NDC","","","facility","both","1","EA","","4.36","4.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 500 Ml In 1 Bag (0338-9543-04)","250","RC","0338-9543-04","NDC","","","facility","both","1","EA","","9.75","9.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 250 Ml In 1 Bag (0338-9543-02)","250","RC","0338-9543-02","NDC","","","facility","both","1","EA","","8.83","8.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 100 Ml In 1 Bag (0338-9159-30)","250","RC","0338-9159-30","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 40 BAG in 1 CARTON (0338-6346-02)  / 250 mL in 1 BAG","250","RC","0338-6346-02","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0378-0871-16","NDC","","","facility","both","1","EA","","17.89","17.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1630-15","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6102-19","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6102-18","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6102-18","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6102-18","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-10)  / 10 Ml In 1 Vial, Single-Dose (0409-6102-20)","250","RC","0409-6102-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-04)  / 4 Ml In 1 Vial, Single-Dose (0409-6102-18)","250","RC","0409-6102-04","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-02)  / 2 Ml In 1 Vial, Single-Dose (0409-6102-19)","250","RC","0409-6102-02","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-5921-16","NDC","","","facility","both","1","EA","","20.34","20.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-04)  / 4 Ml In 1 Vial, Single-Dose (0409-6102-18)","250","RC","0409-6102-04","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6625-22","NDC","","","facility","both","1","EA","","13.99","13.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial, Single-Dose In 1 Tray (0409-6534-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose (0409-6534-11)","250","RC","0409-6534-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial, Single-Dose In 1 Tray (0409-6534-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose (0409-6534-11)","250","RC","0409-6534-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial, Single-Dose In 1 Tray (0409-6534-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose (0409-6534-11)","250","RC","0409-6534-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6533-11","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6476-54","NDC","","","facility","both","1","EA","","17.49","17.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetic Acid: 12 BOTTLE, PLASTIC in 1 CASE (0409-6143-09)  / 1000 mL in 1 BOTTLE, PLASTIC","250","RC","0409-6143-09","NDC","","","facility","both","1","EA","","8.66","8.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 24 BOTTLE, PLASTIC in 1 CASE (0409-6139-03)  / 500 mL in 1 BOTTLE, PLASTIC","250","RC","0409-6139-03","NDC","","","facility","both","1","EA","","6.12","6.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 BOTTLE, PLASTIC in 1 CASE (0409-6138-03)  / 500 mL in 1 BOTTLE, PLASTIC","250","RC","0409-6138-03","NDC","","","facility","both","1","EA","","7.49","7.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6102-20","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6482-11","NDC","","","facility","both","1","EA","","48.8","48.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-5555-12","NDC","","","facility","both","1","EA","","2.25","2.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 25 Vial, Plastic In 1 Tray (0409-4887-10)  / 10 Ml In 1 Vial, Plastic (0409-4887-17)","250","RC","0409-4887-10","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4755-18","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 25 Vial, Single-Dose In 1 Tray (0409-4755-03)  / 2 Ml In 1 Vial, Single-Dose (0409-4755-18)","250","RC","0409-4755-03","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 800 Ampule In 1 Case (0409-4713-65)  / 5 Ml In 1 Ampule (0409-4713-75)","250","RC","0409-4713-65","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4887-23","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4699-54","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4688-22","NDC","","","facility","both","1","EA","","7.92","7.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium And Dextrose: 30 Pouch In 1 Case (0409-4520-30)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag (0409-4520-02)","250","RC","0409-4520-30","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4520-02","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4444-01","NDC","","","facility","both","1","EA","","1.98","1.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4346-16","NDC","","","facility","both","1","EA","","1.72","1.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4887-24","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4887-25","NDC","","","facility","both","1","EA","","6.56","6.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 25 Vial, Plastic In 1 Tray (0409-4887-50)  / 50 Ml In 1 Vial, Plastic (0409-4887-24)","250","RC","0409-4887-50","NDC","","","facility","both","1","EA","","2.63","2.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Bicarbonate: 10 Carton In 1 Package (0409-5534-14)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe (0409-5534-24)","250","RC","0409-5534-14","NDC","","","facility","both","1","EA","","28.57","28.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-5084-13","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-5082-11","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 10 Carton In 1 Package (0409-4933-01)  / 1 Syringe, Glass In 1 Carton / 10 Ml In 1 Syringe, Glass (0409-4933-11)","250","RC","0409-4933-01","NDC","","","facility","both","1","EA","","1.54","1.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 10 Carton In 1 Container (0409-4902-34)  / 1 Syringe In 1 Carton / 50 Ml In 1 Syringe (0409-4902-64)","250","RC","0409-4902-34","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 25 Vial, Single-Dose In 1 Tray (0409-4888-50)  / 50 Ml In 1 Vial, Single-Dose (0409-4888-06)","250","RC","0409-4888-50","NDC","","","facility","both","1","EA","","4.58","4.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 25 Vial, Single-Dose In 1 Tray (0409-4888-10)  / 10 Ml In 1 Vial, Single-Dose (0409-4888-02)","250","RC","0409-4888-10","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4888-06","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4888-06","NDC","","","facility","both","1","EA","","2.92","2.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4888-03","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4888-02","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4888-02","NDC","","","facility","both","1","EA","","3.14","3.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4888-01","NDC","","","facility","both","1","EA","","5.47","5.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4888-01","NDC","","","facility","both","1","EA","","6.22","6.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6635-18","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6637-24","NDC","","","facility","both","1","EA","","26.74","26.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 25 Vial, Single-Dose In 1 Tray (0409-6648-02)  / 50 Ml In 1 Vial, Single-Dose (0409-6648-16)","250","RC","0409-6648-02","NDC","","","facility","both","1","EA","","7.01","7.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 20 POUCH in 1 CASE (0409-7923-36)  / 4 BAG in 1 POUCH / 50 mL in 1 BAG","250","RC","0409-7923-36","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 60 BAG in 1 CASE (0409-7923-11)  / 100 mL in 1 BAG","250","RC","0409-7923-11","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 60 BAG in 1 CASE (0409-7923-06)  / 50 mL in 1 BAG","250","RC","0409-7923-06","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 POUCH in 1 CASE (0409-7922-53)  / 1 BAG in 1 POUCH / 250 mL in 1 BAG","250","RC","0409-7922-53","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 POUCH in 1 CASE (0409-7922-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","250","RC","0409-7922-09","NDC","","","facility","both","1","EA","","9","9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride in Dextrose and Sodium Chloride: 12 POUCH in 1 CASE (0409-7902-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","250","RC","0409-7902-09","NDC","","","facility","both","1","EA","","12.6","12.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 20 POUCH in 1 CASE (0409-7923-37)  / 4 BAG in 1 POUCH / 100 mL in 1 BAG","250","RC","0409-7923-37","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-7853-01","NDC","","","facility","both","1","EA","","23.59","23.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-7810-11","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dopamine Hydrochloride In Dextrose: 12 Bag In 1 Carton (0409-7809-22)  / 250 Ml In 1 Bag (0409-7809-11)","250","RC","0409-7809-22","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 24 Pouch In 1 Case (0409-7650-62)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag (0409-7650-52)","250","RC","0409-7650-62","NDC","","","facility","both","1","EA","","13.54","13.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-7650-52","NDC","","","facility","both","1","EA","","1.58","1.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-7620-13","NDC","","","facility","both","1","EA","","4.52","4.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose and Sodium Chloride: 24 POUCH in 1 CASE (0409-7926-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG","250","RC","0409-7926-03","NDC","","","facility","both","1","EA","","9.9","9.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 20 POUCH in 1 CASE (0409-7984-36)  / 4 BAG in 1 POUCH / 50 mL in 1 BAG","250","RC","0409-7984-36","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 BAG in 1 CASE (0409-7983-25)  / 250 mL in 1 BAG","250","RC","0409-7983-25","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 POUCH in 1 CASE (0409-7983-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","250","RC","0409-7983-09","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 POUCH in 1 CASE (0409-7983-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG","250","RC","0409-7983-03","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 POUCH in 1 CASE (0409-7983-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG","250","RC","0409-7983-03","NDC","","","facility","both","1","EA","","8.75","8.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 POUCH in 1 CASE (0409-7983-02)  / 1 BAG in 1 POUCH / 250 mL in 1 BAG","250","RC","0409-7983-02","NDC","","","facility","both","1","EA","","9","9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 12 BAG in 1 CASE (0409-7953-48)  / 1000 mL in 1 BAG","250","RC","0409-7953-48","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 24 POUCH in 1 CASE (0409-7953-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG","250","RC","0409-7953-03","NDC","","","facility","both","1","EA","","9.29","9.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose and Sodium Chloride: 12 POUCH in 1 CASE (0409-7941-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","250","RC","0409-7941-09","NDC","","","facility","both","1","EA","","4.52","4.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 POUCH in 1 CASE (0409-7930-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG","250","RC","0409-7930-03","NDC","","","facility","both","1","EA","","10.17","10.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 POUCH in 1 CASE (0409-7930-02)  / 1 BAG in 1 POUCH / 250 mL in 1 BAG","250","RC","0409-7930-02","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers and Dextrose: 12 POUCH in 1 CASE (0409-7929-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","250","RC","0409-7929-09","NDC","","","facility","both","1","EA","","8.96","8.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4332-11","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-7517-66","NDC","","","facility","both","1","EA","","19.58","19.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6778-11","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6729-41","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Pouch In 1 Case (0409-6729-24)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag (0409-6729-11)","250","RC","0409-6729-24","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Pouch In 1 Case (0409-6729-23)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag (0409-6729-41)","250","RC","0409-6729-23","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6729-11","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"24 POUCH in 1 CASE (0409-6729-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG (0409-6729-21) ","250","RC","0409-6729-03","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amidate: 10 Vial, Single-Dose In 1 Tray (0409-6695-02)  / 20 Ml In 1 Vial, Single-Dose (0409-6695-12)","250","RC","0409-6695-02","NDC","","","facility","both","1","EA","","7.92","7.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6653-18","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 25 Vial, Single-Dose In 1 Tray (0409-6653-05)  / 20 Ml In 1 Vial, Single-Dose (0409-6653-18)","250","RC","0409-6653-05","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 25 Vial, Single-Dose In 1 Tray (0409-6653-05)  / 20 Ml In 1 Vial, Single-Dose (0409-6653-18)","250","RC","0409-6653-05","NDC","","","facility","both","1","EA","","2.65","2.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-6648-16","NDC","","","facility","both","1","EA","","4.52","4.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride in Dextrose and Sodium Chloride: 12 POUCH in 1 CASE (0409-7107-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","250","RC","0409-7107-09","NDC","","","facility","both","1","EA","","12.6","12.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride in Sodium Chloride: 12 POUCH in 1 CASE (0409-7115-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","250","RC","0409-7115-09","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-7391-82","NDC","","","facility","both","1","EA","","15.24","15.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Phosphates: 25 Vial, Single-Dose In 1 Tray (0409-7391-72)  / 15 Ml In 1 Vial, Single-Dose (0409-7391-82)","250","RC","0409-7391-72","NDC","","","facility","both","1","EA","","13.57","13.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-7338-11","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-7335-13","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-7332-11","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone Sodium: 10 Vial, Single-Use In 1 Carton (0409-7332-01)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Use (0409-7332-11)","250","RC","0409-7332-01","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-7299-83","NDC","","","facility","both","1","EA","","5.84","5.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Acetate: 25 Vial, Single-Dose In 1 Tray (0409-7299-73)  / 20 Ml In 1 Vial, Single-Dose (0409-7299-83)","250","RC","0409-7299-73","NDC","","","facility","both","1","EA","","5","5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Phosphates: 25 Vial, Single-Dose In 1 Tray (0409-7295-01)  / 15 Ml In 1 Vial, Single-Dose (0409-7295-11)","250","RC","0409-7295-01","NDC","","","facility","both","1","EA","","19.2","19.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hetastarch In Sodium Chloride: 12 Container In 1 Case (0409-7248-03)  / 500 Ml In 1 Container (0409-7248-13)","250","RC","0409-7248-03","NDC","","","facility","both","1","EA","","32.16","32.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 BOTTLE, PLASTIC in 1 CASE (0409-7138-09)  / 1000 mL in 1 BOTTLE, PLASTIC","250","RC","0409-7138-09","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 BOTTLE, PLASTIC in 1 CASE (0409-7138-09)  / 1000 mL in 1 BOTTLE, PLASTIC","250","RC","0409-7138-09","NDC","","","facility","both","1","EA","","8.78","8.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial In 1 Tray (0409-4332-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (0409-4332-11)","250","RC","0409-4332-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2308-69","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2308-69","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2308-21","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2308-21","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2344-62","NDC","","","facility","both","1","EA","","8.03","8.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam: 25 Vial, Single-Dose In 1 Tray (0409-2305-17)  / 2 Ml In 1 Vial, Single-Dose (0409-2305-16)","250","RC","0409-2305-17","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2305-16","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam: 10 Vial, Single-Dose In 1 Carton (0409-2305-05)  / 5 Ml In 1 Vial, Single-Dose (0409-2305-04)","250","RC","0409-2305-05","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2305-04","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam: 10 Vial, Single-Dose In 1 Carton (0409-2308-01)  / 1 Ml In 1 Vial, Single-Dose (0409-2308-21)","250","RC","0409-2308-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2220-01","NDC","","","facility","both","1","EA","","1.86","1.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2347-31","NDC","","","facility","both","1","EA","","9.45","9.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 1 Vial, Single-Dose In 1 Box (0409-2634-50)  / 50 Ml In 1 Vial, Single-Dose","250","RC","0409-2634-50","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2634-25","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2634-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Box (0409-2634-01)  / 1 Ml In 1 Vial, Single-Dose (0409-2634-10)","250","RC","0409-2634-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Box (0409-2634-01)  / 1 Ml In 1 Vial, Single-Dose (0409-2634-10)","250","RC","0409-2634-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine In Dextrose: 12 Pouch In 1 Case (0409-2347-32)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag (0409-2347-31)","250","RC","0409-2347-32","NDC","","","facility","both","1","EA","","12.19","12.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine In Dextrose: 12 Pouch In 1 Case (0409-2347-32)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag (0409-2347-31)","250","RC","0409-2347-32","NDC","","","facility","both","1","EA","","15.21","15.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2347-31","NDC","","","facility","both","1","EA","","9.45","9.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0409-2066-05)  / 5 Ml In 1 Vial, Single-Dose (0409-2066-10)","250","RC","0409-2066-05","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2051-15","NDC","","","facility","both","1","EA","","12.96","12.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1746-71","NDC","","","facility","both","1","EA","","5.55","5.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1746-71","NDC","","","facility","both","1","EA","","5.56","5.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1746-71","NDC","","","facility","both","1","EA","","6.02","6.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1746-71","NDC","","","facility","both","1","EA","","7.52","7.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1746-70","NDC","","","facility","both","1","EA","","4.74","4.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Marcaine With Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-1746-10)  / 10 Ml In 1 Vial, Single-Dose (0409-1746-70)","250","RC","0409-1746-10","NDC","","","facility","both","1","EA","","5.15","5.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Marcaine With Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-1746-10)  / 10 Ml In 1 Vial, Single-Dose (0409-1746-70)","250","RC","0409-1746-10","NDC","","","facility","both","1","EA","","5.68","5.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1660-22","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1632-21","NDC","","","facility","both","1","EA","","5.37","5.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vecuronium Bromide: 10 Vial In 1 Carton (0409-1632-01)  / 10 Ml In 1 Vial (0409-1632-21)","250","RC","0409-1632-01","NDC","","","facility","both","1","EA","","9.99","9.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1631-40","NDC","","","facility","both","1","EA","","20.94","20.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Chloride: 10 Carton In 1 Container (0409-1631-10)  / 1 Syringe, Plastic In 1 Carton (0409-1631-40)  / 10 Ml In 1 Syringe, Plastic","250","RC","0409-1631-10","NDC","","","facility","both","1","EA","","6.24","6.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Chloride: 10 Carton In 1 Container (0409-1631-10)  / 1 Syringe, Plastic In 1 Carton (0409-1631-40)  / 10 Ml In 1 Syringe, Plastic","250","RC","0409-1631-10","NDC","","","facility","both","1","EA","","28.15","28.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Tartrate: 10 Vial, Single-Dose In 1 Carton (0409-1778-05)  / 5 Ml In 1 Vial, Single-Dose (0409-1778-15)","250","RC","0409-1778-05","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Tartrate: 10 Vial, Single-Dose In 1 Carton (0409-1778-05)  / 5 Ml In 1 Vial, Single-Dose (0409-1778-15)","250","RC","0409-1778-05","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketamine Hydrochloride: 10 Vial, Multi-Dose In 1 Box (0409-2051-05)  / 5 Ml In 1 Vial, Multi-Dose (0409-2051-15)","250","RC","0409-2051-05","NDC","","","facility","both","1","EA","","11.06","11.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2050-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2045-01","NDC","","","facility","both","1","EA","","6.53","6.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Vial, Single-Dose In 1 Carton (0409-2022-01)  / 50 Ml In 1 Vial, Single-Dose","250","RC","0409-2022-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procainamide Hydrochloride: 25 Carton In 1 Case (0409-1902-01)  / 1 Vial, Multi-Dose In 1 Carton (0409-1902-11)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","0409-1902-01","NDC","","","facility","both","1","EA","","93.51","93.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Vial, Single-Dose In 1 Carton (0409-1896-20)  / 20 Ml In 1 Vial, Single-Dose","250","RC","0409-1896-20","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1886-22","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 25 Vial, Single-Dose In 1 Carton (0409-1886-02)  / 5 Ml In 1 Vial, Single-Dose (0409-1886-22)","250","RC","0409-1886-02","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1866-01","NDC","","","facility","both","1","EA","","8.36","8.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1778-15","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-1778-15","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 1 Vial, Single-Dose In 1 Box (0409-2634-50)  / 50 Ml In 1 Vial, Single-Dose","250","RC","0409-2634-50","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Single-Dose In 1 Tray (0409-2720-01)  / 1 Ml In 1 Vial, Single-Dose (0409-2720-30)","250","RC","0409-2720-01","NDC","","","facility","both","1","EA","","2.3","2.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4031-16","NDC","","","facility","both","1","EA","","2.64","2.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 5 Vial, Glass In 1 Carton (0409-3815-12)  / 10 Ml In 1 Vial, Glass (0409-3815-11)","250","RC","0409-3815-12","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3795-19","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4092-11","NDC","","","facility","both","1","EA","","21.42","21.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3793-19","NDC","","","facility","both","1","EA","","4.79","4.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Spinal: 10 Ampule In 1 Carton (0409-3613-01)  / 2 Ml In 1 Ampule (0409-3613-11)","250","RC","0409-3613-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Spinal: 10 Ampule In 1 Carton (0409-3613-01)  / 2 Ml In 1 Ampule (0409-3613-11)","250","RC","0409-3613-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3435-01","NDC","","","facility","both","1","EA","","4.94","4.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4276-01)  / 20 Ml In 1 Vial, Multi-Dose (0409-4276-16)","250","RC","0409-4276-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial In 1 Tray (0409-4332-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (0409-4332-11)","250","RC","0409-4332-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4283-11","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 5 Cello Pack In 1 Package (0409-4283-01)  / 5 Ampule In 1 Cello Pack (0409-4283-25)  / 5 Ml In 1 Ampule (0409-4283-11)","250","RC","0409-4283-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 5 Cello Pack In 1 Package (0409-4283-01)  / 5 Ampule In 1 Cello Pack (0409-4283-25)  / 5 Ml In 1 Ampule (0409-4283-11)","250","RC","0409-4283-01","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4282-12","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4282-12","NDC","","","facility","both","1","EA","","3.7","3.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Ampule In 1 Carton (0409-4282-02)  / 10 Ml In 1 Ampule (0409-4282-12)","250","RC","0409-4282-02","NDC","","","facility","both","1","EA","","3.79","3.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4279-16","NDC","","","facility","both","1","EA","","2.19","2.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-4279-02)  / 30 Ml In 1 Vial, Single-Dose (0409-4279-16)","250","RC","0409-4279-02","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-4279-02)  / 30 Ml In 1 Vial, Single-Dose (0409-4279-16)","250","RC","0409-4279-02","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4277-17","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4277-02)  / 50 Ml In 1 Vial, Multi-Dose (0409-4277-17)","250","RC","0409-4277-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-4276-17","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4276-02)  / 50 Ml In 1 Vial, Multi-Dose (0409-4276-17)","250","RC","0409-4276-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3414-21","NDC","","","facility","both","1","EA","","1.76","1.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial In 1 Tray (0409-4332-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (0409-4332-11)","250","RC","0409-4332-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3414-18","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sufentanil Citrate: 10 Vial, Single-Dose In 1 Carton (0409-3382-21)  / 1 Ml In 1 Vial, Single-Dose (0409-3382-11)","250","RC","0409-3382-21","NDC","","","facility","both","1","EA","","15.27","15.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3299-16","NDC","","","facility","both","1","EA","","5.62","5.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3299-15","NDC","","","facility","both","1","EA","","9.04","9.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3189-05","NDC","","","facility","both","1","EA","","1.86","1.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Epinephrine: 25 Vial, Multi-Dose In 1 Tray (0409-3182-01)  / 20 Ml In 1 Vial, Multi-Dose (0409-3182-11)","250","RC","0409-3182-01","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3178-17","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Epinephrine: 25 Vial, Multi-Dose In 1 Tray (0409-3178-02)  / 30 Ml In 1 Vial, Multi-Dose (0409-3178-17)","250","RC","0409-3178-02","NDC","","","facility","both","1","EA","","4.78","4.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Epinephrine: 25 Vial, Multi-Dose In 1 Tray (0409-3178-01)  / 20 Ml In 1 Vial, Multi-Dose (0409-3178-16)","250","RC","0409-3178-01","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3300-01","NDC","","","facility","both","1","EA","","4.94","4.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milrinone Lactate: 10 BAG in 1 CASE (0409-2776-23)  / 100 mL in 1 BAG (0409-2776-43) ","250","RC","0409-2776-23","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2723-30","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Single-Dose In 1 Tray (0409-2723-01)  / 1 Ml In 1 Vial, Single-Dose (0409-2723-30)","250","RC","0409-2723-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-2720-30","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Tray (0409-2720-02)  / 10 Ml In 1 Vial, Multi-Dose (0409-2720-31)","250","RC","0409-2720-02","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (0409-3307-03)  / 30 Ml In 1 Vial (0409-3307-11)","250","RC","0409-3307-03","NDC","","","facility","both","1","EA","","3.1","3.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3365-11","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3365-11","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3365-11","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0409-3365-10)  / 1 Ml In 1 Vial, Single-Dose (0409-3365-11)","250","RC","0409-3365-10","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0409-3365-10)  / 1 Ml In 1 Vial, Single-Dose (0409-3365-11)","250","RC","0409-3365-10","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3330-01","NDC","","","facility","both","1","EA","","4.86","4.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3308-11","NDC","","","facility","both","1","EA","","1.89","1.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3308-11","NDC","","","facility","both","1","EA","","3.12","3.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3308-11","NDC","","","facility","both","1","EA","","3.44","3.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (0409-3308-03)  / 30 Ml In 1 Vial (0409-3308-11)","250","RC","0409-3308-03","NDC","","","facility","both","1","EA","","3.33","3.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (0409-3308-03)  / 30 Ml In 1 Vial (0409-3308-11)","250","RC","0409-3308-03","NDC","","","facility","both","1","EA","","4.58","4.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3307-11","NDC","","","facility","both","1","EA","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0409-3307-11","NDC","","","facility","both","1","EA","","2.91","2.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (0409-3307-03)  / 30 Ml In 1 Vial (0409-3307-11)","250","RC","0409-3307-03","NDC","","","facility","both","1","EA","","2.12","2.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isentress: 60 Tablet, Film Coated In 1 Bottle (0006-0227-61)","250","RC","0006-0227-61","NDC","","","facility","both","1","EA","","56.9","56.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-089-11","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 50 Blister Pack In 1 Box, Unit-Dose (50268-089-15)  / 1 Tablet In 1 Blister Pack (50268-089-11)","250","RC","50268-089-15","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68382-256-01)","250","RC","68382-256-01","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amiodarone Hydrochloride: 500 Tablet In 1 Bottle (68382-227-05)","250","RC","68382-227-05","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxychloroquine Sulfate: 100 Tablet, Film Coated In 1 Bottle (68382-096-01)","250","RC","68382-096-01","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (68382-095-01)","250","RC","68382-095-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (68382-094-01)","250","RC","68382-094-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (68382-092-01)","250","RC","68382-092-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amiodarone Hydrochloride: 30 Tablet In 1 Bottle (68382-297-06)","250","RC","68382-297-06","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 100 Tablet In 1 Bottle (68382-079-01)","250","RC","68382-079-01","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meloxicam: 100 Tablet In 1 Bottle (68382-051-01)","250","RC","68382-051-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meloxicam: 100 Tablet In 1 Bottle (68382-050-01)","250","RC","68382-050-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine: 100 Tablet In 1 Bottle (68382-020-01)","250","RC","68382-020-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine: 100 Tablet In 1 Bottle (68382-018-01)","250","RC","68382-018-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Topiramate: 60 Capsule, Coated Pellets In 1 Bottle (68382-005-14)","250","RC","68382-005-14","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Topiramate: 60 Capsule, Coated Pellets In 1 Bottle (68382-004-14)","250","RC","68382-004-14","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 50 Ml In 1 Bottle, Plastic (68382-444-05)","250","RC","68382-444-05","NDC","","","facility","both","1","EA","","2.59","2.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (68382-452-19)","250","RC","68382-452-19","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Tablet In 1 Bottle (68382-806-01)","250","RC","68382-806-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Tablet In 1 Bottle (68382-805-01)","250","RC","68382-805-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxazosin: 100 Tablet In 1 Bottle (68382-786-01)","250","RC","68382-786-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ezetimibe: 90 Tablet In 1 Bottle (68382-773-16)","250","RC","68382-773-16","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lansoprazole: 10 Blister Pack In 1 Carton (68382-772-77)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack (68382-772-30)","250","RC","68382-772-77","NDC","","","facility","both","1","EA","","8.25","8.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bosentan: 60 Tablet, Coated In 1 Bottle (68382-447-14)","250","RC","68382-447-14","NDC","","","facility","both","1","EA","","32.18","32.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68382-772-30","NDC","","","facility","both","1","EA","","7.86","7.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68382-771-30","NDC","","","facility","both","1","EA","","5.67","5.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Liothyronine Sodium: 100 Tablet In 1 Bottle (68382-583-01)","250","RC","68382-583-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 100 Tablet, Extended Release In 1 Bottle (68382-556-01)","250","RC","68382-556-01","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Citrate: 100 Tablet, Extended Release In 1 Bottle (68382-537-01)","250","RC","68382-537-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Citrate: 100 Tablet, Extended Release In 1 Bottle (68382-536-01)","250","RC","68382-536-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 10 BLISTER PACK in 1 CARTON (68308-505-47)  / 10 TABLET in 1 BLISTER PACK","250","RC","68308-505-47","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 30 G In 1 Bottle, Plastic (68308-152-30)","250","RC","68308-152-30","NDC","","","facility","both","1","EA","","23.22","23.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 15 G In 1 Bottle, Plastic (68308-152-15)","250","RC","68308-152-15","NDC","","","facility","both","1","EA","","11.61","11.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclosporine: 30 Vial, Single-Use In 1 Tray (68180-214-30)  / .4 Ml In 1 Vial, Single-Use","250","RC","68180-214-30","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68180-166-11","NDC","","","facility","both","1","EA","","4.16","4.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethacrynic Acid: 100 Tablet In 1 Bottle (68180-159-01)","250","RC","68180-159-01","NDC","","","facility","both","1","EA","","3.24","3.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirabegron: 90 Tablet, Film Coated, Extended Release In 1 Bottle (68180-151-09)","250","RC","68180-151-09","NDC","","","facility","both","1","EA","","14.68","14.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 50 Ml In 1 Bottle (68180-150-01)","250","RC","68180-150-01","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cephalexin: 100 Capsule In 1 Bottle (68180-122-01)","250","RC","68180-122-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naproxen: 500 mL in 1 BOTTLE, PLASTIC (68134-201-16) ","250","RC","68134-201-16","NDC","","","facility","both","1","EA","","29.17","29.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naltrexone Hydrochloride: 3 Blister Pack In 1 Carton (68094-853-62)  / 10 Tablet, Film Coated In 1 Blister Pack (68094-853-59)","250","RC","68094-853-62","NDC","","","facility","both","1","EA","","3.79","3.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-764-59","NDC","","","facility","both","1","EA","","8.35","8.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-763-59","NDC","","","facility","both","1","EA","","5.3","5.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethambutol Hydrochloride: 100 Tablet In 1 Bottle (68180-280-01)","250","RC","68180-280-01","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethambutol Hydrochloride: 100 Tablet In 1 Bottle (68180-281-01)","250","RC","68180-281-01","NDC","","","facility","both","1","EA","","2.07","2.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefixime: 50 Capsule In 1 Bottle (68180-423-08)","250","RC","68180-423-08","NDC","","","facility","both","1","EA","","15.86","15.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Tablet In 1 Bottle (68180-981-01)","250","RC","68180-981-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Tablet In 1 Bottle (68180-980-01)","250","RC","68180-980-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Tablet In 1 Bottle (68180-975-01)","250","RC","68180-975-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 1 Bottle In 1 Carton (68180-797-01)  / 460 Ml In 1 Bottle","250","RC","68180-797-01","NDC","","","facility","both","1","EA","","13.75","13.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefdinir: 100 Ml In 1 Bottle (68180-723-05)","250","RC","68180-723-05","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefdinir: 60 Capsule In 1 Bottle (68180-711-60)","250","RC","68180-711-60","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Bottle, Glass In 1 Carton (68180-678-01)  / 60 Ml In 1 Bottle, Glass","250","RC","68180-678-01","NDC","","","facility","both","1","EA","","7.14","7.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (68180-677-11)  / 10 Capsule In 1 Blister Pack","250","RC","68180-677-11","NDC","","","facility","both","1","EA","","4.22","4.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (68180-675-11)  / 10 Capsule In 1 Blister Pack","250","RC","68180-675-11","NDC","","","facility","both","1","EA","","4.32","4.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rifampin: 30 Capsule In 1 Bottle (68180-658-06)","250","RC","68180-658-06","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline: 60 Ml In 1 Bottle (68180-657-01)","250","RC","68180-657-01","NDC","","","facility","both","1","EA","","6.48","6.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"CEFTRIAXONE: 10 INJECTION, POWDER, FOR SOLUTION in 1 BOX (68180-633-10) ","250","RC","68180-633-10","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine Succinate: 30 Tablet, Film Coated, Extended Release In 1 Bottle (68180-604-06)","250","RC","68180-604-06","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cephalexin: 100 Ml In 1 Bottle (68180-441-01)","250","RC","68180-441-01","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 3 Tray In 1 Case (68094-750-62)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (68094-750-59)","250","RC","68094-750-62","NDC","","","facility","both","1","EA","","5.1","5.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68382-910-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-585-40","NDC","","","facility","both","1","EA","","10.69","10.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-584-40","NDC","","","facility","both","1","EA","","10.03","10.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aprepitant: 1 Blister Pack In 1 Carton (68462-583-40)  / 1 Capsule In 1 Blister Pack","250","RC","68462-583-40","NDC","","","facility","both","1","EA","","13.11","13.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 30 Tablet, Film Coated In 1 Bottle (68462-572-30)","250","RC","68462-572-30","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mupirocin: 15 G In 1 Tube (68462-564-17)","250","RC","68462-564-17","NDC","","","facility","both","1","EA","","234.72","234.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 25 Vial, Single-Dose In 1 Carton (68462-621-02)  / 2 Ml In 1 Vial, Single-Dose (68462-621-54)","250","RC","68462-621-02","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (68462-534-35)  / 30 G In 1 Tube","250","RC","68462-534-35","NDC","","","facility","both","1","EA","","132.47","132.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-469-40","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rizatriptan Benzoate: 18 Pouch In 1 Carton (68462-465-99)  / 1 Blister Pack In 1 Pouch / 1 Tablet In 1 Blister Pack","250","RC","68462-465-99","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acamprosate Calcium: 180 Tablet, Delayed Release In 1 Bottle (68462-435-18)","250","RC","68462-435-18","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atovaquone: 210 Ml In 1 Bottle (68462-421-21)","250","RC","68462-421-21","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-720-84","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Drospirenone And Ethinyl Estradiol: 3 Blister Pack In 1 Carton (68462-720-29)  / 1 Kit In 1 Blister Pack (68462-720-84)","250","RC","68462-720-29","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 120 Tablet, Film Coated In 1 Bottle (68462-714-08)","250","RC","68462-714-08","NDC","","","facility","both","1","EA","","4.13","4.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 120 Tablet, Film Coated In 1 Bottle (68462-713-08)","250","RC","68462-713-08","NDC","","","facility","both","1","EA","","1.82","1.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitroglycerin: 4 Bottle In 1 Carton (68462-639-45)  / 25 Tablet In 1 Bottle (68462-639-25)","250","RC","68462-639-45","NDC","","","facility","both","1","EA","","3.47","3.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitroglycerin: 1 Bottle In 1 Carton (68462-638-01)  / 100 Tablet In 1 Bottle","250","RC","68462-638-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 10 Vial, Single-Dose In 1 Carton (68462-622-64)  / 10 Ml In 1 Vial, Single-Dose (68462-622-10)","250","RC","68462-622-64","NDC","","","facility","both","1","EA","","2.12","2.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 10 Vial, Single-Dose In 1 Carton (68462-622-10)  / 10 Ml In 1 Vial, Single-Dose (68462-622-64)","250","RC","68462-622-10","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 25 Vial, Single-Dose In 1 Carton (68462-621-54)  / 2 Ml In 1 Vial, Single-Dose (68462-621-02)","250","RC","68462-621-54","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-639-25","NDC","","","facility","both","1","EA","","3.43","3.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propafenone Hydrochloride: 60 Capsule, Extended Release In 1 Bottle (68462-410-60)","250","RC","68462-410-60","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propafenone Hydrochloride: 60 Capsule, Extended Release In 1 Bottle (68462-408-60)","250","RC","68462-408-60","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle (68462-256-01)","250","RC","68462-256-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle (68462-254-01)","250","RC","68462-254-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Tablet, Chewable In 1 Bottle (68462-229-01)","250","RC","68462-229-01","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mometasone Furoate: 15 G In 1 Tube (68462-225-17)","250","RC","68462-225-17","NDC","","","facility","both","1","EA","","9.29","9.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium Carbonate Er: 100 Tablet In 1 Bottle (68462-224-01)","250","RC","68462-224-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium Carbonate: 100 Capsule In 1 Bottle (68462-222-01)","250","RC","68462-222-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mupirocin: 22 G In 1 Tube (68462-180-22)","250","RC","68462-180-22","NDC","","","facility","both","1","EA","","10.62","10.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 100 Tablet, Film Coated In 1 Bottle (68462-138-01)","250","RC","68462-138-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zonisamide: 100 Capsule In 1 Bottle (68462-129-01)","250","RC","68462-129-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zonisamide: 100 Capsule In 1 Bottle (68462-128-01)","250","RC","68462-128-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 30 Tablet In 1 Bottle (68462-104-30)","250","RC","68462-104-30","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68403-1100-6","NDC","","","facility","both","1","EA","","59090.63","59090.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 30 Tablet, Extended Release In 1 Bottle (68382-984-06)","250","RC","68382-984-06","NDC","","","facility","both","1","EA","","4","4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eletriptan Hydrobromide: 1 Blister Pack In 1 Carton (68382-923-86)  / 6 Tablet, Film Coated In 1 Blister Pack","250","RC","68382-923-86","NDC","","","facility","both","1","EA","","19.84","19.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-157-40","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle (68462-257-01)","250","RC","68462-257-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle (68462-258-01)","250","RC","68462-258-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indomethacin: 100 Capsule In 1 Bottle (68462-406-01)","250","RC","68462-406-01","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-404-44","NDC","","","facility","both","1","EA","","5.72","5.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-394-84","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (68462-338-01)","250","RC","68462-338-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (68462-337-01)","250","RC","68462-337-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-333-90)","250","RC","68462-333-90","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-332-90)","250","RC","68462-332-90","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-331-90)","250","RC","68462-331-90","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-330-90)","250","RC","68462-330-90","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norethindrone Acetate: 50 Tablet In 1 Bottle (68462-304-50)","250","RC","68462-304-50","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-303-84","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-292-01)","250","RC","68462-292-01","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (68462-269-30)","250","RC","68462-269-30","NDC","","","facility","both","1","EA","","2.89","2.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (68462-266-30)","250","RC","68462-266-30","NDC","","","facility","both","1","EA","","2.64","2.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-750-59","NDC","","","facility","both","1","EA","","3.03","3.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-598-11","NDC","","","facility","both","1","EA","","3.04","3.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-597-11","NDC","","","facility","both","1","EA","","1.88","1.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine: 100 Blister Pack In 1 Box, Unit-Dose (68084-597-01)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (68084-597-11)","250","RC","68084-597-01","NDC","","","facility","both","1","EA","","1.88","1.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-592-11","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Mononitrate: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-591-01)  / 1 TABLET, EXTENDED RELEASE in 1 BLISTER PACK (68084-591-11) ","250","RC","68084-591-01","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-603-11","NDC","","","facility","both","1","EA","","3.82","3.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-572-11","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-539-11","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-536-11","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-512-11","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simvastatin: 100 Blister Pack In 1 Box, Unit-Dose (68084-512-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-512-11)","250","RC","68084-512-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-590-95","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-511-11","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 30 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-604-21)  / 1 TABLET in 1 BLISTER PACK (68084-604-11) ","250","RC","68084-604-21","NDC","","","facility","both","1","EA","","3.57","3.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-610-11","NDC","","","facility","both","1","EA","","3.58","3.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-698-11","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (68084-698-01)  / 1 Capsule, Extended Release In 1 Blister Pack (68084-698-11)","250","RC","68084-698-01","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-697-11","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-683-11","NDC","","","facility","both","1","EA","","2.51","2.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-676-01)  / 1 TABLET in 1 BLISTER PACK (68084-676-11) ","250","RC","68084-676-01","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-655-11","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-654-11","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-645-11","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-643-11","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-640-11","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium Carbonate: 100 Blister Pack In 1 Box, Unit-Dose (68084-640-01)  / 1 Tablet, Extended Release In 1 Blister Pack (68084-640-11)","250","RC","68084-640-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-621-11","NDC","","","facility","both","1","EA","","14.3","14.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-617-11","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sotalol Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (68084-654-01)  / 1 Tablet In 1 Blister Pack (68084-654-11)","250","RC","68084-654-01","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meclizine Hydrochloride: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-491-01)  / 1 TABLET in 1 BLISTER PACK (68084-491-11) ","250","RC","68084-491-01","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-360-11","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-354-11","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-347-11","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-346-11","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Topiramate: 30 Blister Pack In 1 Box, Unit-Dose (68084-345-21)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-345-11)","250","RC","68084-345-21","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-345-11","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-344-11","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Topiramate: 100 Blister Pack In 1 Box, Unit-Dose (68084-344-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-344-11)","250","RC","68084-344-01","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-343-11","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-342-11","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-319-11","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Blister Pack In 1 Box, Unit-Dose (68084-319-01)  / 1 Tablet In 1 Blister Pack (68084-319-11)","250","RC","68084-319-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-318-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-376-11","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meclizine Hydrochloride: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-490-01)  / 1 TABLET in 1 BLISTER PACK (68084-490-11) ","250","RC","68084-490-01","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-482-11","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-479-11","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-451-11","NDC","","","facility","both","1","EA","","2.36","2.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-450-11","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-447-11","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (68084-447-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-447-11)","250","RC","68084-447-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-444-11","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-415-11","NDC","","","facility","both","1","EA","","2.15","2.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-389-11","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 100 Blister Pack In 1 Box, Unit-Dose (68084-389-01)  / 1 Tablet In 1 Blister Pack (68084-389-11)","250","RC","68084-389-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-388-11","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 100 Blister Pack In 1 Box, Unit-Dose (68084-388-01)  / 1 Tablet In 1 Blister Pack (68084-388-11)","250","RC","68084-388-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-381-11","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 100 Blister Pack In 1 Box, Unit-Dose (68084-381-01)  / 1 Tablet In 1 Blister Pack (68084-381-11)","250","RC","68084-381-01","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-708-95","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (68084-709-01)  / 1 Capsule, Extended Release In 1 Blister Pack (68084-709-11)","250","RC","68084-709-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-709-11","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-018-59","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-008-59","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-004-59","NDC","","","facility","both","1","EA","","4.16","4.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-997-11","NDC","","","facility","both","1","EA","","3.43","3.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-996-11","NDC","","","facility","both","1","EA","","1.98","1.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Carton (68094-018-61)  / 10 Tablet In 1 Blister Pack (68094-018-59)","250","RC","68094-018-61","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-988-33","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-964-95","NDC","","","facility","both","1","EA","","3.49","3.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (68084-950-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-950-11)","250","RC","68084-950-01","NDC","","","facility","both","1","EA","","22.3","22.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-928-95","NDC","","","facility","both","1","EA","","2.88","2.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-968-11","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-029-59","NDC","","","facility","both","1","EA","","3.63","3.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-030-59","NDC","","","facility","both","1","EA","","2.89","2.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-600-59","NDC","","","facility","both","1","EA","","1.49","1.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-599-59","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Ibuprofen: 3 Tray In 1 Case (68094-503-62)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose (68094-503-59)","250","RC","68094-503-62","NDC","","","facility","both","1","EA","","2.2","2.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-503-59","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-494-59","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-356-01","NDC","","","facility","both","1","EA","","6.16","6.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 3 Tray In 1 Case (68094-330-62)  / 10 Cup, Unit-Dose In 1 Tray / 10.15 Ml In 1 Cup, Unit-Dose (68094-330-59)","250","RC","68094-330-62","NDC","","","facility","both","1","EA","","1.73","1.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-330-59","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-231-59","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-129-59","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phentolamine Mesylate: 1 Vial In 1 Carton (68094-101-20)  / 1 Injection In 1 Vial","250","RC","68094-101-20","NDC","","","facility","both","1","EA","","529.47","529.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-043-59","NDC","","","facility","both","1","EA","","14.98","14.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68094-031-59","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-882-11","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-755-01","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-867-11","NDC","","","facility","both","1","EA","","2.24","2.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-782-11","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-776-11","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-775-95","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-753-95","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-752-95","NDC","","","facility","both","1","EA","","23.68","23.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-750-95","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-735-11","NDC","","","facility","both","1","EA","","3.35","3.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-729-11","NDC","","","facility","both","1","EA","","4.64","4.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-728-11","NDC","","","facility","both","1","EA","","1.69","1.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-722-11","NDC","","","facility","both","1","EA","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-713-11","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (68084-713-01)  / 1 Capsule, Extended Release In 1 Blister Pack (68084-713-11)","250","RC","68084-713-01","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-805-11","NDC","","","facility","both","1","EA","","3.12","3.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-808-11","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-862-11","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-859-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-856-11","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine: 100 Blister Pack In 1 Box, Unit-Dose (68084-856-01)  / 1 Tablet In 1 Blister Pack (68084-856-11)","250","RC","68084-856-01","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-854-11","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-853-11","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-847-11","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Pamoate: 100 Blister Pack In 1 Box, Unit-Dose (68084-847-01)  / 1 Capsule In 1 Blister Pack (68084-847-11)","250","RC","68084-847-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-845-11","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-844-11","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 30 Blister Pack In 1 Box, Unit-Dose (68084-823-21)  / 1 Tablet In 1 Blister Pack (68084-823-11)","250","RC","68084-823-21","NDC","","","facility","both","1","EA","","1.89","1.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-823-11","NDC","","","facility","both","1","EA","","2.12","2.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-818-95","NDC","","","facility","both","1","EA","","22.79","22.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-813-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-875-11","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fycompa: 30 Tablet In 1 Bottle (69616-272-30)","250","RC","69616-272-30","NDC","","","facility","both","1","EA","","34.36","34.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sotalol Hydrochloride: 100 Tablet In 1 Bottle (69584-842-10)","250","RC","69584-842-10","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imipramine Hydrochloride: 100 Tablet In 1 Bottle (69584-427-10)","250","RC","69584-427-10","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imipramine Hydrochloride: 100 Tablet In 1 Bottle (69584-426-10)","250","RC","69584-426-10","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imipramine Hydrochloride: 100 Tablet In 1 Bottle (69584-425-10)","250","RC","69584-425-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Tablet In 1 Bottle (69584-093-10)","250","RC","69584-093-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fycompa: 30 Tablet In 1 Bottle (69616-274-30)","250","RC","69616-274-30","NDC","","","facility","both","1","EA","","67.72","67.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Tablet In 1 Bottle (69584-091-10)","250","RC","69584-091-10","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 90 Tablet In 1 Bottle (69543-382-90)","250","RC","69543-382-90","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fycompa: 340 Ml In 1 Bottle (69616-290-38)","250","RC","69616-290-38","NDC","","","facility","both","1","EA","","7.74","7.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meclizine Hcl 12.5 Mg: 100 Tablet In 1 Bottle, Plastic (69618-027-01)","250","RC","69618-027-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 10 Ampule In 1 Carton (69918-899-10)  / 1 Ml In 1 Ampule","250","RC","69918-899-10","NDC","","","facility","both","1","EA","","8.92","8.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 30 Tablet In 1 Bottle (69918-301-30)","250","RC","69918-301-30","NDC","","","facility","both","1","EA","","3.3","3.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dojolvi: 1 Bottle, Glass In 1 Carton (69794-050-50)  / 500 Ml In 1 Bottle, Glass","250","RC","69794-050-50","NDC","","","facility","both","1","EA","","152.87","152.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Phenylacetate And Sodium Benzoate: 1 Vial, Single-Dose In 1 Carton (69784-810-01)  / 50 Ml In 1 Vial, Single-Dose","250","RC","69784-810-01","NDC","","","facility","both","1","EA","","6007.75","6007.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Acetate: 100 Ml In 1 Vial, Pharmacy Bulk Package (69784-231-10)","250","RC","69784-231-10","NDC","","","facility","both","1","EA","","8.74","8.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Acetate: 50 Ml In 1 Vial, Pharmacy Bulk Package (69784-230-20)","250","RC","69784-230-20","NDC","","","facility","both","1","EA","","27.2","27.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Acetate: 50 Ml In 1 Vial, Pharmacy Bulk Package (69784-230-10)","250","RC","69784-230-10","NDC","","","facility","both","1","EA","","9.61","9.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cromolyn Sodium: 12 Pouch In 1 Carton (69784-200-96)  / 8 Ampule In 1 Pouch / 5 Ml In 1 Ampule","250","RC","69784-200-96","NDC","","","facility","both","1","EA","","3.46","3.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69784-180-01","NDC","","","facility","both","1","EA","","4.24","4.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propafenone Hydrochloride: 60 Capsule, Extended Release In 1 Bottle, Plastic (69680-130-60)","250","RC","69680-130-60","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin 81 Mg: 120 Tablet, Coated In 1 Bottle, Plastic (69618-066-02)","250","RC","69618-066-02","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Senna: 100 Tablet In 1 Bottle (69618-064-01)","250","RC","69618-064-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infants Gas Relief Drops: 1 Bottle, Dropper In 1 Carton (69618-059-51)  / 30 Ml In 1 Bottle, Dropper","250","RC","69618-059-51","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (69452-390-98)","250","RC","69452-390-98","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dofetilide: 60 Capsule In 1 Bottle (69452-132-17)","250","RC","69452-132-17","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dofetilide: 60 Capsule In 1 Bottle (69452-131-17)","250","RC","69452-131-17","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 1 Bottle, Glass In 1 Carton (69452-125-50)  / 250 Ml In 1 Bottle, Glass","250","RC","69452-125-50","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetrabenazine: 112 Tablet In 1 Bottle (69452-117-21)","250","RC","69452-117-21","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69374-984-10","NDC","","","facility","both","1","EA","","99.31","99.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69374-980-05","NDC","","","facility","both","1","EA","","3.07","3.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69374-949-05","NDC","","","facility","both","1","EA","","5.15","5.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dofetilide: 60 Capsule In 1 Bottle (69452-133-17)","250","RC","69452-133-17","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69374-314-10","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69374-308-05","NDC","","","facility","both","1","EA","","4.32","4.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69374-308-05","NDC","","","facility","both","1","EA","","6.01","6.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (69367-612-01)","250","RC","69367-612-01","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Coated In 1 Bottle (69367-390-01)","250","RC","69367-390-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Coated In 1 Bottle (69367-388-01)","250","RC","69367-388-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indocin: 30 Suppository In 1 Box (69344-102-33)","250","RC","69344-102-33","NDC","","","facility","both","1","EA","","359.62","359.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69374-544-10","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valproic Acid: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-150-20)","250","RC","69452-150-20","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle, Plastic (69452-358-20)","250","RC","69452-358-20","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69452-350-60","NDC","","","facility","both","1","EA","","3.98","3.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naratriptan: 1 Blister Pack In 1 Carton (69452-341-72)  / 9 Tablet, Film Coated In 1 Blister Pack (69452-341-60)","250","RC","69452-341-72","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69452-341-60","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cevimeline: 100 Capsule In 1 Bottle (69452-316-20)","250","RC","69452-316-20","NDC","","","facility","both","1","EA","","2.04","2.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Maleate: 100 Tablet, Film Coated In 1 Bottle (69452-310-20)","250","RC","69452-310-20","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atovaquone: 1 Bottle In 1 Carton (69452-252-87)  / 210 Ml In 1 Bottle","250","RC","69452-252-87","NDC","","","facility","both","1","EA","","51.04","51.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Progesterone: 100 Capsule In 1 Bottle (69452-234-20)","250","RC","69452-234-20","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 1 Bottle In 1 Carton (69452-223-84)  / 460 Ml In 1 Bottle","250","RC","69452-223-84","NDC","","","facility","both","1","EA","","15.47","15.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxylamine Succinate And Pyridoxine Hydrochloride: 100 Tablet, Delayed Release In 1 Bottle (69452-206-20)","250","RC","69452-206-20","NDC","","","facility","both","1","EA","","2.61","2.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferasirox: 30 Tablet, For Suspension In 1 Bottle (69452-161-13)","250","RC","69452-161-13","NDC","","","facility","both","1","EA","","30.33","30.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69452-156-74","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethosuximide: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-152-20)","250","RC","69452-152-20","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 10 Vial In 1 Carton (70069-362-10)  / 10 Ml In 1 Vial (70069-362-01)","250","RC","70069-362-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-301-01","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Nitroprusside: 1 Vial In 1 Carton (70069-261-01)  / 2 Ml In 1 Vial","250","RC","70069-261-01","NDC","","","facility","both","1","EA","","20.82","20.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brimonidine Tartrate: 1 Bottle In 1 Carton (70069-231-01)  / 5 Ml In 1 Bottle","250","RC","70069-231-01","NDC","","","facility","both","1","EA","","7.62","7.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pilocarpine Hydrochloride: 1 Bottle In 1 Carton (70069-191-01)  / 15 Ml In 1 Bottle","250","RC","70069-191-01","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pilocarpine Hydrochloride: 1 Bottle In 1 Carton (70069-181-01)  / 15 Ml In 1 Bottle","250","RC","70069-181-01","NDC","","","facility","both","1","EA","","78.97","78.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisatracurium Besylate: 1 Vial In 1 Carton (70069-161-01)  / 10 Ml In 1 Vial","250","RC","70069-161-01","NDC","","","facility","both","1","EA","","12.66","12.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 1 Bottle In 1 Carton (70069-131-01)  / 5 Ml In 1 Bottle","250","RC","70069-131-01","NDC","","","facility","both","1","EA","","6.62","6.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tropicamide: 1 Bottle In 1 Carton (70069-121-01)  / 15 Ml In 1 Bottle","250","RC","70069-121-01","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-101-01","NDC","","","facility","both","1","EA","","6.81","6.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropivacaine Hydrochloride: 25 Vial In 1 Carton (70069-067-25)  / 20 Ml In 1 Vial (70069-067-01)","250","RC","70069-067-25","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-067-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-101-01","NDC","","","facility","both","1","EA","","4.97","4.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 1 Vial In 1 Carton (70069-363-01)  / 30 Ml In 1 Vial","250","RC","70069-363-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-371-01","NDC","","","facility","both","1","EA","","2.66","2.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-773-01","NDC","","","facility","both","1","EA","","8.45","8.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-747-01","NDC","","","facility","both","1","EA","","5.12","5.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-746-01","NDC","","","facility","both","1","EA","","18.59","18.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-671-01","NDC","","","facility","both","1","EA","","6.35","6.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-661-01","NDC","","","facility","both","1","EA","","3.43","3.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-617-01","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-617-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Proparacaine Hydrochloride: 1 Bottle In 1 Carton (70069-601-01)  / 15 Ml In 1 Bottle","250","RC","70069-601-01","NDC","","","facility","both","1","EA","","4.3","4.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-506-01","NDC","","","facility","both","1","EA","","15.93","15.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Latanoprost: 1 Bottle In 1 Carton (70069-421-01)  / 2.5 Ml In 1 Bottle","250","RC","70069-421-01","NDC","","","facility","both","1","EA","","7.55","7.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indocin: 1 Bottle, Glass In 1 Carton (69344-101-01)  / 237 Ml In 1 Bottle, Glass","250","RC","69344-101-01","NDC","","","facility","both","1","EA","","14.01","14.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropivacaine Hydrochloride: 1 Vial In 1 Carton (70069-064-01)  / 30 Ml In 1 Vial","250","RC","70069-064-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (70010-135-01)","250","RC","70010-135-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin Hydrochloride: 100 Tablet In 1 Bottle (70010-063-01)","250","RC","70010-063-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (70010-034-01)","250","RC","70010-034-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (70010-032-01)","250","RC","70010-032-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (70010-031-01)","250","RC","70010-031-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 500 Tablet In 1 Bottle (70010-161-05)","250","RC","70010-161-05","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (70010-030-01)","250","RC","70010-030-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (70010-029-01)","250","RC","70010-029-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (70010-011-01)","250","RC","70010-011-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (70010-009-01)","250","RC","70010-009-01","NDC","","","facility","both","1","EA","","3.53","3.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (70010-004-01)","250","RC","70010-004-01","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 1000 Tablet In 1 Bottle (70010-161-10)","250","RC","70010-161-10","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle In 1 Carton (70069-051-01)  / 10 Ml In 1 Bottle","250","RC","70069-051-01","NDC","","","facility","both","1","EA","","26.04","26.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine Hydrochloride: 5 Vial In 1 Carton (70069-027-05)  / 1 Ml In 1 Vial","250","RC","70069-027-05","NDC","","","facility","both","1","EA","","6.56","6.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-021-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-020-01","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-019-01","NDC","","","facility","both","1","EA","","5.88","5.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-019-01","NDC","","","facility","both","1","EA","","6.01","6.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-018-01","NDC","","","facility","both","1","EA","","10.92","10.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylergonovine Maleate: 12 Tablet In 1 Bottle (70010-786-12)","250","RC","70010-786-12","NDC","","","facility","both","1","EA","","23.28","23.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin: 100 Tablet, Extended Release In 1 Bottle (70010-491-01)","250","RC","70010-491-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cetirizine Hydrochloride: 90 Tablet, Coated In 1 Bottle (70010-163-09)","250","RC","70010-163-09","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 100 Tablet In 1 Bottle (70010-162-01)","250","RC","70010-162-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69339-174-02","NDC","","","facility","both","1","EA","","17.06","17.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetracaine Hydrochloride: 1 Bottle In 1 Carton (68682-920-64)  / 15 Ml In 1 Bottle","250","RC","68682-920-64","NDC","","","facility","both","1","EA","","138.61","138.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 2 Syringe, Plastic In 1 Package (68682-652-20)  / 2 Ml In 1 Syringe, Plastic","250","RC","68682-652-20","NDC","","","facility","both","1","EA","","306.87","306.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 2 Syringe, Plastic In 1 Package (68682-650-20)  / .5 Ml In 1 Syringe, Plastic","250","RC","68682-650-20","NDC","","","facility","both","1","EA","","216.42","216.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetrabenazine: 112 Tablet In 1 Bottle (68682-422-25)","250","RC","68682-422-25","NDC","","","facility","both","1","EA","","43.43","43.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide: 30 Tablet, Extended Release In 1 Bottle (68682-309-30)","250","RC","68682-309-30","NDC","","","facility","both","1","EA","","57.34","57.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xacduro: 1 Kit In 1 Carton (68547-111-10)  *  5 Ml In 1 Vial, Single-Dose (68547-211-20)  *  2.5 Ml In 1 Vial, Single-Dose (68547-311-30)","250","RC","68547-111-10","NDC","","","facility","both","1","EA","","566.5","566.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68516-5218-0","NDC","","","facility","both","1","EA","","15.64","15.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68516-5218-0","NDC","","","facility","both","1","EA","","16.61","16.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68516-5214-4","NDC","","","facility","both","1","EA","","14.24","14.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Austedo: 60 Tablet, Coated In 1 Bottle (68546-172-60)","250","RC","68546-172-60","NDC","","","facility","both","1","EA","","225.13","225.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68968-6610-1","NDC","","","facility","both","1","EA","","20.1","20.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myambutol: 10 Blister Pack In 1 Box, Unit-Dose (68850-012-02)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","68850-012-02","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68803-722-25","NDC","","","facility","both","1","EA","","225.46","225.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Visionblue: 10 Pouch In 1 Carton (68803-612-10)  / 1 Syringe, Glass In 1 Pouch / .5 Ml In 1 Syringe, Glass","250","RC","68803-612-10","NDC","","","facility","both","1","EA","","113.59","113.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rylaze: 3 Vial, Single-Dose In 1 Carton (68727-900-03)  / .5 Ml In 1 Vial, Single-Dose (68727-900-01)","250","RC","68727-900-03","NDC","","","facility","both","1","EA","","70.52","70.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68727-900-01","NDC","","","facility","both","1","EA","","81.16","81.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Defitelio: 25 Ml In 1 Carton (68727-800-02)","250","RC","68727-800-02","NDC","","","facility","both","1","EA","","2120.4","2120.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Defitelio: 2.5 Ml In 1 Vial (68727-800-01)","250","RC","68727-800-01","NDC","","","facility","both","1","EA","","2026.8","2026.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68516-5214-4","NDC","","","facility","both","1","EA","","18.34","18.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Octreotide Acetate: 10 Vial In 1 Carton (68462-897-10)  / 1 Ml In 1 Vial (68462-897-01)","250","RC","68462-897-10","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Octreotide Acetate: 10 Vial In 1 Carton (68462-897-10)  / 1 Ml In 1 Vial (68462-897-01)","250","RC","68462-897-10","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-897-01","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-897-01","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-896-01","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abiraterone Acetate: 60 Tablet In 1 Bottle (68462-882-60)","250","RC","68462-882-60","NDC","","","facility","both","1","EA","","22.13","22.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (68462-881-65)  / 60 G In 1 Tube","250","RC","68462-881-65","NDC","","","facility","both","1","EA","","122.91","122.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (68462-881-35)  / 30 G In 1 Tube","250","RC","68462-881-35","NDC","","","facility","both","1","EA","","61.44","61.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 1 Vial, Multi-Dose In 1 Carton (68462-760-10)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","68462-760-10","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-756-01","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-756-01","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-896-01","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 1 Vial In 1 Carton (68462-904-01)  / 16.7 Ml In 1 Vial","250","RC","68462-904-01","NDC","","","facility","both","1","EA","","137.67","137.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Latanoprost: 1 Bottle In 1 Carton (68462-944-03)  / 2.5 Ml In 1 Bottle","250","RC","68462-944-03","NDC","","","facility","both","1","EA","","6.66","6.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albutein: 1 Vial In 1 Carton (68516-5214-2)  / 500 Ml In 1 Vial (68516-5214-4)","250","RC","68516-5214-2","NDC","","","facility","both","1","EA","","14.32","14.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albutein: 1 Vial In 1 Carton (68516-5214-2)  / 500 Ml In 1 Vial (68516-5214-4)","250","RC","68516-5214-2","NDC","","","facility","both","1","EA","","14.96","14.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68462-946-30","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3010-1)  / 1 Bottle In 1 Pouch / 100 Tablet, Extended Release In 1 Bottle","250","RC","68992-3010-1","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylergonovine Maleate: 12 Tablet In 1 Bottle (69238-1605-2)","250","RC","69238-1605-2","NDC","","","facility","both","1","EA","","21.91","21.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 1 Bottle, Plastic In 1 Carton (69238-1595-2)  / 225 Ml In 1 Bottle, Plastic","250","RC","69238-1595-2","NDC","","","facility","both","1","EA","","4.44","4.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69238-1594-6","NDC","","","facility","both","1","EA","","15.46","15.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 100 Capsule In 1 Bottle (69238-1540-1)","250","RC","69238-1540-1","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 1 Bottle, Glass In 1 Carton (69238-1535-2)  / 120 Ml In 1 Bottle, Glass","250","RC","69238-1535-2","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69238-1617-1","NDC","","","facility","both","1","EA","","2.53","2.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (69238-1532-3)  / 30 G In 1 Tube","250","RC","69238-1532-3","NDC","","","facility","both","1","EA","","12.49","12.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 100 Tablet In 1 Bottle (69238-1491-1)","250","RC","69238-1491-1","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Difluprednate: 1 Bottle In 1 Carton (69238-1380-3)  / 5 Ml In 1 Bottle","250","RC","69238-1380-3","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 100 Tablet In 1 Bottle (69238-1306-1)","250","RC","69238-1306-1","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nadolol: 90 Tablet In 1 Bottle (69238-1124-9)","250","RC","69238-1124-9","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clomipramine Hcl: 90 Capsule In 1 Bottle (69238-1109-9)","250","RC","69238-1109-9","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (69238-1532-5)  / 15 G In 1 Tube","250","RC","69238-1532-5","NDC","","","facility","both","1","EA","","6.73","6.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 1 Bottle In 1 Carton (69238-1729-7)  / 150 Ml In 1 Bottle","250","RC","69238-1729-7","NDC","","","facility","both","1","EA","","2.14","2.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pilocarpine Hydrochloride: 1 Bottle In 1 Carton (69238-1745-8)  / 15 Ml In 1 Bottle","250","RC","69238-1745-8","NDC","","","facility","both","1","EA","","100.91","100.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pilocarpine Hydrochloride: 1 Bottle In 1 Carton (69238-1746-8)  / 15 Ml In 1 Bottle","250","RC","69238-1746-8","NDC","","","facility","both","1","EA","","8.26","8.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dash Chlorhexidine Gluconate 0.12% Oral Rinse: 15 Ml In 1 Cup, Unit-Dose (69339-138-15)","250","RC","69339-138-15","NDC","","","facility","both","1","EA","","3.01","3.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69339-137-01","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69339-136-03","NDC","","","facility","both","1","EA","","6.38","6.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenoxylate Hydrochloride And Atropine Sulfate: 100 Tablet In 1 Bottle (69315-910-01)","250","RC","69315-910-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 1000 Tablet In 1 Bottle (69315-905-10)","250","RC","69315-905-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 500 Tablet In 1 Bottle (69315-904-05)","250","RC","69315-904-05","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethacrynate Sodium: 1 Vial, Single-Dose In 1 Carton (69315-701-50)  / 50 Ml In 1 Vial, Single-Dose","250","RC","69315-701-50","NDC","","","facility","both","1","EA","","821.42","821.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 473 Ml In 1 Bottle (69315-504-47)","250","RC","69315-504-47","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 1 Bottle, Plastic In 1 Carton (69315-308-02)  / 2.5 Ml In 1 Bottle, Plastic","250","RC","69315-308-02","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 15 G In 1 Bottle, Plastic (69315-306-15)","250","RC","69315-306-15","NDC","","","facility","both","1","EA","","13.6","13.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flurbiprofen Sodium: 1 Bottle, Dropper In 1 Carton (69292-722-25)  / 2.5 Ml In 1 Bottle, Dropper","250","RC","69292-722-25","NDC","","","facility","both","1","EA","","10.78","10.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin: 1 Bottle, Glass In 1 Carton (69238-2512-9)  / 230 Ml In 1 Bottle, Glass","250","RC","69238-2512-9","NDC","","","facility","both","1","EA","","73.47","73.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 100 Tablet In 1 Bottle (69238-2081-1)","250","RC","69238-2081-1","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pilocarpine Hydrochloride: 1 Bottle In 1 Carton (69238-1747-8)  / 15 Ml In 1 Bottle","250","RC","69238-1747-8","NDC","","","facility","both","1","EA","","97.15","97.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate: 500 Capsule In 1 Bottle (69238-1100-5)","250","RC","69238-1100-5","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69339-153-01","NDC","","","facility","both","1","EA","","2.73","2.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 1 Bottle In 1 Carton (69230-326-60)  / 60 Tablet, Film Coated In 1 Bottle","250","RC","69230-326-60","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide Inhalation Suspension: 30 Pouch In 1 Carton (69097-319-53)  / 1 Ampule In 1 Pouch (69097-319-32)  / 2 Ml In 1 Ampule","250","RC","69097-319-53","NDC","","","facility","both","1","EA","","5.96","5.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69097-319-32","NDC","","","facility","both","1","EA","","5.51","5.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Exemestane: 30 Tablet In 1 Bottle (69097-316-02)","250","RC","69097-316-02","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Arformoterol Tartrate: 6 Pouch In 1 Carton (69097-168-87)  / 5 Vial, Single-Dose In 1 Pouch (69097-168-48)  / 2 Ml In 1 Vial, Single-Dose","250","RC","69097-168-87","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69097-168-48","NDC","","","facility","both","1","EA","","3.31","3.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide Inhalation Suspension: 30 Pouch In 1 Carton (69097-319-53)  / 1 Ampule In 1 Pouch (69097-319-32)  / 2 Ml In 1 Ampule","250","RC","69097-319-53","NDC","","","facility","both","1","EA","","5.51","5.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amlodipine Besylate: 90 Tablet In 1 Bottle (69097-128-05)","250","RC","69097-128-05","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69097-008-45","NDC","","","facility","both","1","EA","","132.84","132.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone Sodium Succinate: 1 Vial In 1 Carton (69097-004-67)  / 2 Ml In 1 Vial","250","RC","69097-004-67","NDC","","","facility","both","1","EA","","6.77","6.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Impavido: 2 Blister Pack In 1 Carton (69051-300-01)  / 14 Capsule In 1 Blister Pack","250","RC","69051-300-01","NDC","","","facility","both","1","EA","","1070.36","1070.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3075-3)  / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic","250","RC","68992-3075-3","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3040-1)  / 1 Bottle In 1 Pouch / 100 Tablet, Extended Release In 1 Bottle","250","RC","68992-3040-1","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (69097-098-08)","250","RC","69097-098-08","NDC","","","facility","both","1","EA","","2.72","2.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abacavir And Lamivudine: 30 Tablet, Film Coated In 1 Bottle (69097-362-02)","250","RC","69097-362-02","NDC","","","facility","both","1","EA","","2.42","2.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ambrisentan: 30 Tablet, Film Coated In 1 Bottle, Plastic (69097-387-02)","250","RC","69097-387-02","NDC","","","facility","both","1","EA","","69.13","69.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69194-976-01","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69194-0348-1","NDC","","","facility","both","1","EA","","5.11","5.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phytonadione: 100 Tablet In 1 Bottle (69097-999-07)","250","RC","69097-999-07","NDC","","","facility","both","1","EA","","10.32","10.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phytonadione: 30 Tablet In 1 Bottle (69097-999-02)","250","RC","69097-999-02","NDC","","","facility","both","1","EA","","10.15","10.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vigabatrin: 50 Packet In 1 Carton (69097-964-53)  / 10 Ml In 1 Packet","250","RC","69097-964-53","NDC","","","facility","both","1","EA","","29.27","29.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","69097-708-31","NDC","","","facility","both","1","EA","","2.51","2.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tenofovir Disoproxil Fumarate: 30 Tablet In 1 Bottle (69097-533-02)","250","RC","69097-533-02","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tadalafil: 60 Tablet, Film Coated In 1 Bottle (69097-526-03)","250","RC","69097-526-03","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 30 Tablet In 1 Bottle (69097-412-02)","250","RC","69097-412-02","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 30 Tablet In 1 Bottle (69097-411-02)","250","RC","69097-411-02","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 30 Tablet In 1 Bottle (69097-410-02)","250","RC","69097-410-02","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-313-11","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir Hydrochloride: 30 Blister Pack In 1 Box, Unit-Dose (68084-309-21)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-309-11)","250","RC","68084-309-21","NDC","","","facility","both","1","EA","","4.04","4.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-635-00","NDC","","","facility","both","1","EA","","2.14","2.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-572-01","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-570-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Carton (65219-564-20)  / 10 Ml In 1 Vial","250","RC","65219-564-20","NDC","","","facility","both","1","EA","","81.81","81.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-539-01","NDC","","","facility","both","1","EA","","24.22","24.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-535-01","NDC","","","facility","both","1","EA","","8.81","8.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-534-01","NDC","","","facility","both","1","EA","","10.44","10.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-533-01","NDC","","","facility","both","1","EA","","7.09","7.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Intralipid: 10 Bag In 1 Case (65219-531-10)  / 100 Ml In 1 Bag (65219-531-01)","250","RC","65219-531-10","NDC","","","facility","both","1","EA","","9.73","9.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-531-01","NDC","","","facility","both","1","EA","","9.76","9.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-510-02","NDC","","","facility","both","1","EA","","5.66","5.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 1 Vial, Multi-Dose In 1 Carton (65219-295-10)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","65219-295-10","NDC","","","facility","both","1","EA","","5.96","5.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-650-02","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xifaxan: 30 Tablet In 1 Bottle (65649-301-03)","250","RC","65649-301-03","NDC","","","facility","both","1","EA","","61.58","61.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azasan: 100 Tablet In 1 Bottle (65649-231-41)","250","RC","65649-231-41","NDC","","","facility","both","1","EA","","22.9","22.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lansoprazole: 1 Kit In 1 Container (65628-080-10)  *  300 Ml In 1 Bottle, Plastic *  .9 G In 1 Bottle, Plastic","250","RC","65628-080-10","NDC","","","facility","both","1","EA","","4.34","4.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lansoprazole: 1 Kit In 1 Container (65628-080-03)  *  .27 G In 1 Bottle, Plastic *  90 Ml In 1 Bottle, Plastic","250","RC","65628-080-03","NDC","","","facility","both","1","EA","","3.93","3.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vanflyta: 1 Bottle In 1 Carton (65597-504-04)  / 14 Tablet, Film Coated In 1 Bottle","250","RC","65597-504-04","NDC","","","facility","both","1","EA","","1034.78","1034.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Savaysa: 30 Tablet, Film Coated In 1 Bottle (65597-202-30)","250","RC","65597-202-30","NDC","","","facility","both","1","EA","","23.97","23.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Ampule In 1 Carton (65282-1605-1)  / 5 Ml In 1 Ampule","250","RC","65282-1605-1","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-658-01","NDC","","","facility","both","1","EA","","42.87","42.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam In Sodium Chloride: 10 Pouch In 1 Carton (65219-650-10)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","250","RC","65219-650-10","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-293-00","NDC","","","facility","both","1","EA","","6.12","6.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ad Prevent Original: 1 Tube In 1 Box (65197-401-01)  / 113 G In 1 Tube","250","RC","65197-401-01","NDC","","","facility","both","1","EA","","7.53","7.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65162-997-04","NDC","","","facility","both","1","EA","","12","12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65162-993-04","NDC","","","facility","both","1","EA","","11.06","11.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65162-992-04","NDC","","","facility","both","1","EA","","11.25","11.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65162-989-04","NDC","","","facility","both","1","EA","","11.66","11.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 30 Tablet, Film Coated, Extended Release In 1 Bottle (65162-986-03)","250","RC","65162-986-03","NDC","","","facility","both","1","EA","","3.26","3.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 75 Ml In 1 Bottle (65162-913-22)","250","RC","65162-913-22","NDC","","","facility","both","1","EA","","112.68","112.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 1 Bottle In 1 Carton (65162-893-74)  / 150 Ml In 1 Bottle","250","RC","65162-893-74","NDC","","","facility","both","1","EA","","21.76","21.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Coated In 1 Bottle (65162-879-03)","250","RC","65162-879-03","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rivastigmine: 30 Patch In 1 Carton (65162-825-34)  / 24 H In 1 Patch","250","RC","65162-825-34","NDC","","","facility","both","1","EA","","7.06","7.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65162-791-04","NDC","","","facility","both","1","EA","","4.07","4.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide: 100 Capsule, Delayed Release In 1 Bottle (65162-778-10)","250","RC","65162-778-10","NDC","","","facility","both","1","EA","","3.58","3.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 56 Ampule In 1 Carton (65162-914-46)  / 5 Ml In 1 Ampule","250","RC","65162-914-46","NDC","","","facility","both","1","EA","","22.53","22.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ad Treat Diaper Rash Cream With Dimethicone And Zinc Oxide: 1 Tube In 1 Box (65197-402-00)  / 113 G In 1 Tube","250","RC","65197-402-00","NDC","","","facility","both","1","EA","","7.53","7.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 1 Vial, Pharmacy Bulk Package In 1 Carton (65219-256-24)  / 180 Ml In 1 Vial, Pharmacy Bulk Package","250","RC","65219-256-24","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 1 Vial, Pharmacy Bulk Package In 1 Carton (65219-256-00)  / 180 Ml In 1 Vial, Pharmacy Bulk Package","250","RC","65219-256-00","NDC","","","facility","both","1","EA","","1.9","1.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-238-01","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketamine Hydrochloride: 10 Vial In 1 Tray (65219-188-10)  / 10 Ml In 1 Vial (65219-188-01)","250","RC","65219-188-10","NDC","","","facility","both","1","EA","","3.59","3.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-188-01","NDC","","","facility","both","1","EA","","7.11","7.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-187-01","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketamine Hydrochloride: 10 Vial In 1 Tray (65219-186-05)  / 5 Ml In 1 Vial (65219-186-01)","250","RC","65219-186-05","NDC","","","facility","both","1","EA","","5.65","5.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-186-01","NDC","","","facility","both","1","EA","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-184-01","NDC","","","facility","both","1","EA","","5.45","5.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-164-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-162-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-056-09","NDC","","","facility","both","1","EA","","10.96","10.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-054-09","NDC","","","facility","both","1","EA","","26.54","26.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65219-052-09","NDC","","","facility","both","1","EA","","16.06","16.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xifaxan: 60 Tablet In 1 Bottle (65649-303-02)","250","RC","65649-303-02","NDC","","","facility","both","1","EA","","93.54","93.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 30 Capsule, Extended Release In 1 Bottle (65862-528-30)","250","RC","65862-528-30","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 30 Capsule, Extended Release In 1 Bottle (65862-527-30)","250","RC","65862-527-30","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Tablet, Film Coated In 1 Bottle (65862-523-01)","250","RC","65862-523-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pioglitazone Hydrochloride: 30 Tablet In 1 Bottle (65862-513-30)","250","RC","65862-513-30","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 100 Tablet, Film Coated In 1 Bottle (65862-503-01)","250","RC","65862-503-01","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (65862-502-20)","250","RC","65862-502-20","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Efavirenz, Emtricitabine And Tenofovir Disoproxil Fumarate: 30 Tablet, Film Coated In 1 Bottle (65862-497-30)","250","RC","65862-497-30","NDC","","","facility","both","1","EA","","3.66","3.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 473 Ml In 1 Bottle (65862-496-47)","250","RC","65862-496-47","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle (65862-420-01)","250","RC","65862-420-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle (65862-419-01)","250","RC","65862-419-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 3 Blister Pack In 1 Carton (65862-391-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","65862-391-10","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 3 Blister Pack In 1 Carton (65862-390-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","65862-390-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Escitalopram: 100 Tablet, Film Coated In 1 Bottle (65862-373-01)","250","RC","65862-373-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 90 Tablet, Delayed Release In 1 Bottle (65862-559-90)","250","RC","65862-559-90","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Modafinil: 30 Tablet In 1 Bottle (65862-601-30)","250","RC","65862-601-30","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prasugrel: 30 Tablet, Film Coated In 1 Bottle (65862-830-30)","250","RC","65862-830-30","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esomeprazole Magnesium: 90 Capsule, Delayed Release In 1 Bottle (65862-784-90)","250","RC","65862-784-90","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methenamine Hippurate: 100 Tablet In 1 Bottle (65862-782-01)","250","RC","65862-782-01","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valganciclovir Hydrochloride: 60 Tablet In 1 Bottle (65862-753-60)","250","RC","65862-753-60","NDC","","","facility","both","1","EA","","5.28","5.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 150 Ml In 1 Bottle (65862-707-55)","250","RC","65862-707-55","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (65862-697-90)","250","RC","65862-697-90","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 30 Capsule, Extended Release In 1 Bottle (65862-697-30)","250","RC","65862-697-30","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ritonavir: 30 Tablet, Film Coated In 1 Bottle (65862-687-30)","250","RC","65862-687-30","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 1 Blister Pack In 1 Carton (65862-641-69)  / 6 Tablet, Film Coated In 1 Blister Pack","250","RC","65862-641-69","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 3 Blister Pack In 1 Carton (65862-641-63)  / 6 Tablet, Film Coated In 1 Blister Pack","250","RC","65862-641-63","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Tablet, Film Coated In 1 Bottle (65862-641-30)","250","RC","65862-641-30","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65862-626-03","NDC","","","facility","both","1","EA","","2.55","2.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Moxifloxacin Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (65862-603-30)","250","RC","65862-603-30","NDC","","","facility","both","1","EA","","3.88","3.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Emtricitabine And Tenofovir Disoproxil Fumarate: 30 Tablet, Film Coated In 1 Bottle (65862-354-30)","250","RC","65862-354-30","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Emtricitabine: 30 Capsule In 1 Bottle (65862-301-30)","250","RC","65862-301-30","NDC","","","facility","both","1","EA","","21.01","21.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle (65862-064-01)","250","RC","65862-064-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nevirapine: 240 Ml In 1 Bottle (65862-057-24)","250","RC","65862-057-24","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simvastatin: 90 Tablet, Film Coated In 1 Bottle (65862-050-90)","250","RC","65862-050-90","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zidovudine: 240 Ml In 1 Bottle (65862-048-24)","250","RC","65862-048-24","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 5 Blister Pack In 1 Carton (65862-022-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","65862-022-06","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 5 Blister Pack In 1 Carton (65862-021-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","65862-021-06","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cephalexin: 100 Capsule In 1 Bottle (65862-018-01)","250","RC","65862-018-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 500 Capsule In 1 Bottle (65862-017-05)","250","RC","65862-017-05","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Tablet, Film Coated In 1 Bottle (65862-014-01)","250","RC","65862-014-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Relistor: 7 Blister Pack In 1 Carton (65649-552-04)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","250","RC","65649-552-04","NDC","","","facility","both","1","EA","","271.55","271.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Relistor: 7 Blister Pack In 1 Carton (65649-551-03)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","250","RC","65649-551-03","NDC","","","facility","both","1","EA","","216.25","216.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Relistor: 1 Vial, Single-Dose In 1 Carton (65649-551-02)  / .6 Ml In 1 Vial, Single-Dose","250","RC","65649-551-02","NDC","","","facility","both","1","EA","","175.32","175.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Relistor: 1 Vial, Single-Dose In 1 Carton (65649-551-02)  / .6 Ml In 1 Vial, Single-Dose","250","RC","65649-551-02","NDC","","","facility","both","1","EA","","187.98","187.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diuril: 1 Bottle In 1 Carton (65649-311-12)  / 237 Ml In 1 Bottle","250","RC","65649-311-12","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Tablet, Film Coated In 1 Bottle (65862-015-01)","250","RC","65862-015-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Ml In 1 Bottle (65862-071-01)","250","RC","65862-071-01","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 75 Ml In 1 Bottle (65862-071-75)","250","RC","65862-071-75","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 30 Tablet, Film Coated In 1 Bottle (65862-296-30)","250","RC","65862-296-30","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (65862-295-90)","250","RC","65862-295-90","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (65862-294-90)","250","RC","65862-294-90","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ribavirin: 84 Capsule In 1 Bottle (65862-290-84)","250","RC","65862-290-84","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 120 Tablet, Film Coated In 1 Bottle (65862-247-08)","250","RC","65862-247-08","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 120 Tablet, Film Coated In 1 Bottle (65862-246-08)","250","RC","65862-246-08","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clarithromycin: 60 Tablet, Film Coated In 1 Bottle (65862-226-60)","250","RC","65862-226-60","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clarithromycin: 60 Tablet, Film Coated In 1 Bottle (65862-225-60)","250","RC","65862-225-60","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefdinir: 1 Bottle In 1 Carton (65862-218-60)  / 60 Ml In 1 Bottle","250","RC","65862-218-60","NDC","","","facility","both","1","EA","","3","3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (65862-201-90)","250","RC","65862-201-90","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclobenzaprine Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (65862-191-05)","250","RC","65862-191-05","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Finasteride: 30 Tablet, Film Coated In 1 Bottle (65862-149-30)","250","RC","65862-149-30","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 50 Tablet, Film Coated In 1 Bottle (65862-078-50)","250","RC","65862-078-50","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xifaxan: 6 Blister Pack In 1 Carton (65649-303-03)  / 10 Tablet In 1 Blister Pack","250","RC","65649-303-03","NDC","","","facility","both","1","EA","","91.31","91.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Colchicine: 90 Tablet In 1 Bottle (65162-710-09)","250","RC","65162-710-09","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Escitalopram Oxalate: 240 Ml In 1 Bottle (65162-705-88)","250","RC","65162-705-88","NDC","","","facility","both","1","EA","","7.84","7.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (64380-885-04)","250","RC","64380-885-04","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (64380-884-04)","250","RC","64380-884-04","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (64380-883-04)","250","RC","64380-883-04","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethosuximide: 100 Capsule In 1 Bottle (64380-878-06)","250","RC","64380-878-06","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 100 Tablet In 1 Bottle (64380-833-06)","250","RC","64380-833-06","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketoconazole: 100 Tablet In 1 Bottle (64380-827-06)","250","RC","64380-827-06","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 10 Capsule In 1 Blister Pack (64380-799-01)","250","RC","64380-799-01","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 35.44 G In 1 Tube (64380-789-32)","250","RC","64380-789-32","NDC","","","facility","both","1","EA","","16.85","16.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle, Plastic (64380-783-06)","250","RC","64380-783-06","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acarbose: 100 Tablet In 1 Bottle, Plastic (64380-759-06)","250","RC","64380-759-06","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Tablet In 1 Bottle (64380-741-06)","250","RC","64380-741-06","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vitamin D: 100 Capsule In 1 Bottle, Plastic (64380-737-06)","250","RC","64380-737-06","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 100 Capsule In 1 Bottle, Plastic (64380-726-06)","250","RC","64380-726-06","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 10 Capsule In 1 Blister Pack (64380-797-01)","250","RC","64380-797-01","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 100 Tablet In 1 Bottle (64380-918-06)","250","RC","64380-918-06","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 50 Tablet In 1 Bottle, Plastic (64380-970-25)","250","RC","64380-970-25","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose","250","RC","64764-300-20","NDC","","","facility","both","1","EA","","56.16","56.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 1 Vial, Pharmacy Bulk Package In 1 Carton (64679-679-01)  / 180 Ml In 1 Vial, Pharmacy Bulk Package (64679-679-02)","250","RC","64679-679-01","NDC","","","facility","both","1","EA","","1.98","1.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","64679-012-02","NDC","","","facility","both","1","EA","","2.29","2.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nuedexta: 60 Capsule, Gelatin Coated In 1 Bottle (64597-301-60)","250","RC","64597-301-60","NDC","","","facility","both","1","EA","","43.54","43.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spinraza: 1 Vial, Single-Use In 1 Box (64406-058-01)  / 5 Ml In 1 Vial, Single-Use","250","RC","64406-058-01","NDC","","","facility","both","1","EA","","1302.01","1302.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 500 Tablet, Film Coated In 1 Bottle, Plastic (64380-725-07)","250","RC","64380-725-07","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Container (64380-722-06)","250","RC","64380-722-06","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Uvadex: 12 Vial, Glass In 1 Carton (64067-216-01)  / 10 Ml In 1 Vial, Glass","250","RC","64067-216-01","NDC","","","facility","both","1","EA","","255.63","255.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Container (64380-721-06)","250","RC","64380-721-06","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Container (64380-720-06)","250","RC","64380-720-06","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamivudine: 60 Tablet, Film Coated In 1 Bottle (64380-710-03)","250","RC","64380-710-03","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranylcypromine Sulfate: 100 Tablet, Film Coated In 1 Bottle (64380-176-01)","250","RC","64380-176-01","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Megestrol Acetate: 240 Ml In 1 Bottle, Plastic (64380-160-01)","250","RC","64380-160-01","NDC","","","facility","both","1","EA","","2.43","2.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Megestrol Acetate: 100 Tablet In 1 Bottle (64380-158-01)","250","RC","64380-158-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","64281-110-05","NDC","","","facility","both","1","EA","","224.05","224.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","64253-900-30","NDC","","","facility","both","1","EA","","7.11","7.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naproxen: 100 Tablet In 1 Bottle (65162-188-10)","250","RC","65162-188-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Itraconazole: 150 Ml In 1 Bottle, Glass (65162-087-74)","250","RC","65162-087-74","NDC","","","facility","both","1","EA","","34.77","34.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevelamer Carbonate: 270 Tablet, Film Coated In 1 Bottle (65162-058-27)","250","RC","65162-058-27","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 90 Capsule In 1 Bottle (65162-028-09)","250","RC","65162-028-09","NDC","","","facility","both","1","EA","","5.63","5.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 90 Capsule In 1 Bottle (65162-025-09)","250","RC","65162-025-09","NDC","","","facility","both","1","EA","","4.52","4.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 90 Capsule In 1 Bottle (65162-024-09)","250","RC","65162-024-09","NDC","","","facility","both","1","EA","","4.27","4.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 90 Capsule In 1 Bottle (65162-023-09)","250","RC","65162-023-09","NDC","","","facility","both","1","EA","","4.06","4.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phytonadione: 2 Tray In 1 Carton (65145-151-10)  / 5 Vial, Single-Dose In 1 Tray (65145-151-05)  / 1 Ml In 1 Vial, Single-Dose (65145-151-01)","250","RC","65145-151-10","NDC","","","facility","both","1","EA","","2.4","2.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65145-151-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65145-131-01","NDC","","","facility","both","1","EA","","3.59","3.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65145-129-01","NDC","","","facility","both","1","EA","","4.94","4.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxepin Hydrochloride: 100 Capsule In 1 Bottle (64980-596-01)","250","RC","64980-596-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin: 1 Bottle In 1 Carton (64980-593-24)  / 230 Ml In 1 Bottle","250","RC","64980-593-24","NDC","","","facility","both","1","EA","","37.33","37.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactulose Solution: 473 Ml In 1 Bottle (64980-592-48)","250","RC","64980-592-48","NDC","","","facility","both","1","EA","","4.33","4.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dapsone: 100 Tablet In 1 Bottle (64980-566-01)","250","RC","64980-566-01","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 100 Tablet In 1 Bottle (64980-562-01)","250","RC","64980-562-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naproxen: 100 Tablet In 1 Bottle (65162-189-10)","250","RC","65162-189-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorthalidone: 90 Tablet In 1 Bottle (65162-250-09)","250","RC","65162-250-09","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 473 Ml In 1 Bottle (65162-698-90)","250","RC","65162-698-90","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 50 Ml In 1 Bottle (65162-691-79)","250","RC","65162-691-79","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 30 Ml In 1 Bottle, Dropper (65162-687-84)","250","RC","65162-687-84","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Felbamate: 237 Ml In 1 Bottle (65162-686-88)","250","RC","65162-686-88","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (65162-682-10)","250","RC","65162-682-10","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (65162-681-10)","250","RC","65162-681-10","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azelastine Hydrochloride: 1 Bottle, Spray In 1 Carton (65162-676-84)  / 30 Ml In 1 Bottle, Spray","250","RC","65162-676-84","NDC","","","facility","both","1","EA","","33.21","33.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 1 Bottle In 1 Carton (65162-649-78)  / 250 Ml In 1 Bottle","250","RC","65162-649-78","NDC","","","facility","both","1","EA","","11.43","11.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin And Extended-Release Dipyridamole: 60 Capsule In 1 Bottle (65162-596-06)","250","RC","65162-596-06","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bethanechol Chloride: 100 Tablet In 1 Bottle (65162-571-10)","250","RC","65162-571-10","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 500 Tablet In 1 Bottle (65162-465-50)","250","RC","65162-465-50","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 100 Tablet In 1 Bottle (65162-465-10)","250","RC","65162-465-10","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 100 Tablet In 1 Bottle (65162-464-10)","250","RC","65162-464-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sildenafil: 90 Tablet In 1 Bottle (65162-351-09)","250","RC","65162-351-09","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (65162-281-03)","250","RC","65162-281-03","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitazoxanide: 6 Tablet, Film Coated In 1 Bottle (64980-526-60)","250","RC","64980-526-60","NDC","","","facility","both","1","EA","","114.66","114.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Moxifloxacin: 1 Bottle In 1 Carton (65862-840-03)  / 3 Ml In 1 Bottle","250","RC","65862-840-03","NDC","","","facility","both","1","EA","","55.55","55.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Timolol Maleate: 1 Bottle In 1 Carton (64980-514-15)  / 15 Ml In 1 Bottle","250","RC","64980-514-15","NDC","","","facility","both","1","EA","","14.61","14.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Timolol Maleate: 1 Bottle In 1 Carton (64980-513-01)  / 10 Ml In 1 Bottle","250","RC","64980-513-01","NDC","","","facility","both","1","EA","","17.58","17.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","64875-001-01","NDC","","","facility","both","1","EA","","77.4","77.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isradipine: 100 Capsule In 1 Bottle (64850-910-01)","250","RC","64850-910-01","NDC","","","facility","both","1","EA","","4.46","4.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loxapine: 100 Capsule In 1 Bottle (64850-892-01)","250","RC","64850-892-01","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (64850-515-01)","250","RC","64850-515-01","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (64850-513-01)","250","RC","64850-513-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (64850-500-01)","250","RC","64850-500-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Livtencity: 1 Bottle In 1 Carton (64764-800-56)  / 56 Tablet, Coated In 1 Bottle","250","RC","64764-800-56","NDC","","","facility","both","1","EA","","396.39","396.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Livtencity: 1 Bottle In 1 Carton (64764-800-28)  / 28 Tablet, Coated In 1 Bottle","250","RC","64764-800-28","NDC","","","facility","both","1","EA","","391.06","391.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-750-30)","250","RC","64764-750-30","NDC","","","facility","both","1","EA","","28.16","28.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-730-30)","250","RC","64764-730-30","NDC","","","facility","both","1","EA","","28.08","28.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-720-30)","250","RC","64764-720-30","NDC","","","facility","both","1","EA","","28.12","28.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","64764-544-30","NDC","","","facility","both","1","EA","","22.97","22.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","64764-511-92","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ongentys: 30 Capsule In 1 Bottle (64896-403-01)","250","RC","64896-403-01","NDC","","","facility","both","1","EA","","37.09","37.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-661-01)","250","RC","64896-661-01","NDC","","","facility","both","1","EA","","6.9","6.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyproheptadine Hydrochloride: 473 Ml In 1 Bottle (64980-504-48)","250","RC","64980-504-48","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitriol: 1 Bottle, Glass In 1 Carton (64980-447-15)  / 15 Ml In 1 Bottle, Glass","250","RC","64980-447-15","NDC","","","facility","both","1","EA","","16.48","16.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefpodoxime Proxetil: 1 Bottle In 1 Carton (64980-403-50)  / 50 Ml In 1 Bottle","250","RC","64980-403-50","NDC","","","facility","both","1","EA","","8.74","8.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alendronate Sodium: 1 Blister Pack In 1 Carton (64980-342-14)  / 4 Tablet In 1 Blister Pack","250","RC","64980-342-14","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","64980-322-12","NDC","","","facility","both","1","EA","","4.48","4.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyridostigmine Bromide: 30 Tablet In 1 Bottle (64980-220-03)","250","RC","64980-220-03","NDC","","","facility","both","1","EA","","11.01","11.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium Carbonate: 100 Tablet, Extended Release In 1 Bottle (64980-205-01)","250","RC","64980-205-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chloroquine Phosphate: 25 Tablet In 1 Bottle, Plastic (64980-178-02)","250","RC","64980-178-02","NDC","","","facility","both","1","EA","","5.26","5.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","64950-354-05","NDC","","","facility","both","1","EA","","9.8","9.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isoniazid: 100 Tablet In 1 Bottle (64950-217-10)","250","RC","64950-217-10","NDC","","","facility","both","1","EA","","4.47","4.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isoniazid: 30 Tablet In 1 Bottle (64950-217-03)","250","RC","64950-217-03","NDC","","","facility","both","1","EA","","5.64","5.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-664-01)","250","RC","64896-664-01","NDC","","","facility","both","1","EA","","8.67","8.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-663-01)","250","RC","64896-663-01","NDC","","","facility","both","1","EA","","6.9","6.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-662-01)","250","RC","64896-662-01","NDC","","","facility","both","1","EA","","6.9","6.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Timolol Maleate: 1 Bottle In 1 Carton (64980-514-05)  / 5 Ml In 1 Bottle","250","RC","64980-514-05","NDC","","","facility","both","1","EA","","8.83","8.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clozapine: 100 Tablet In 1 Bottle (65862-844-01)","250","RC","65862-844-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65862-896-10","NDC","","","facility","both","1","EA","","9.5","9.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (67877-434-03)","250","RC","67877-434-03","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (67877-433-03)","250","RC","67877-433-03","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (67877-430-03)","250","RC","67877-430-03","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 3 Blister Pack In 1 Carton (67877-419-84)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","67877-419-84","NDC","","","facility","both","1","EA","","4.65","4.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 1 Blister Pack In 1 Carton (67877-419-33)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","67877-419-33","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 20 Tablet, Film Coated In 1 Bottle (67877-419-20)","250","RC","67877-419-20","NDC","","","facility","both","1","EA","","4.48","4.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67877-298-09","NDC","","","facility","both","1","EA","","1.6","1.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67877-261-06","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 80 G In 1 Tube (67877-251-80)","250","RC","67877-251-80","NDC","","","facility","both","1","EA","","14.55","14.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 454 G In 1 Jar (67877-251-45)","250","RC","67877-251-45","NDC","","","facility","both","1","EA","","26.97","26.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 1 Bottle, Plastic In 1 Carton (67877-230-22)  / 225 Ml In 1 Bottle, Plastic","250","RC","67877-230-22","NDC","","","facility","both","1","EA","","10.83","10.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 500 Capsule In 1 Bottle (67877-223-05)","250","RC","67877-223-05","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefuroxime Axetil: 60 Tablet, Film Coated In 1 Bottle (67877-216-60)","250","RC","67877-216-60","NDC","","","facility","both","1","EA","","2.25","2.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Riluzole: 60 Tablet In 1 Bottle (67877-286-60)","250","RC","67877-286-60","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dalfampridine: 60 Tablet, Film Coated, Extended Release In 1 Bottle (67877-444-60)","250","RC","67877-444-60","NDC","","","facility","both","1","EA","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (67877-717-12)","250","RC","67877-717-12","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67877-677-73","NDC","","","facility","both","1","EA","","106.78","106.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67877-676-72","NDC","","","facility","both","1","EA","","119.13","119.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 1 Bottle In 1 Carton (67877-658-61)  / 120 Ml In 1 Bottle","250","RC","67877-658-61","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (67877-639-30)","250","RC","67877-639-30","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 473 Ml In 1 Bottle (67877-457-47)","250","RC","67877-457-47","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (67877-638-30)","250","RC","67877-638-30","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (67877-592-01)","250","RC","67877-592-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (67877-590-01)","250","RC","67877-590-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Colchicine: 100 Tablet In 1 Bottle (67877-589-01)","250","RC","67877-589-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefdinir: 60 Capsule In 1 Bottle (67877-543-60)","250","RC","67877-543-60","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 90 Capsule In 1 Bottle (67877-462-90)","250","RC","67877-462-90","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefuroxime Axetil: 60 Tablet, Film Coated In 1 Bottle (67877-215-60)","250","RC","67877-215-60","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Temazepam: 100 Capsule In 1 Bottle (67877-146-01)","250","RC","67877-146-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esmolol Hydrochloride In Sodium Chloride: 1 Bag In 1 Pouch (67457-657-25)  / 250 Ml In 1 Bag","250","RC","67457-657-25","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Iron Sucrose: 10 Vial, Single-Dose In 1 Carton (67457-638-10)  / 5 Ml In 1 Vial, Single-Dose","250","RC","67457-638-10","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-638-00","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eptifibatide: 1 Vial In 1 Carton (67457-631-10)  / 100 Ml In 1 Vial","250","RC","67457-631-10","NDC","","","facility","both","1","EA","","8.61","8.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eptifibatide: 1 Vial In 1 Carton (67457-629-10)  / 10 Ml In 1 Vial","250","RC","67457-629-10","NDC","","","facility","both","1","EA","","7.08","7.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eptifibatide: 1 Vial In 1 Carton (67457-629-10)  / 10 Ml In 1 Vial","250","RC","67457-629-10","NDC","","","facility","both","1","EA","","10.62","10.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (67457-618-10)  / 52.6 Ml In 1 Vial, Single-Dose","250","RC","67457-618-10","NDC","","","facility","both","1","EA","","12.13","12.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial, Single-Dose In 1 Carton (67457-530-35)  / 17.5 Ml In 1 Vial, Single-Dose","250","RC","67457-530-35","NDC","","","facility","both","1","EA","","3.19","3.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 1 Vial, Multi-Dose In 1 Carton (67457-779-30)  / 30 Ml In 1 Vial, Multi-Dose","250","RC","67457-779-30","NDC","","","facility","both","1","EA","","13.23","13.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docetaxel: 1 Vial, Multi-Dose In 1 Carton (67457-781-08)  / 8 Ml In 1 Vial, Multi-Dose","250","RC","67457-781-08","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Silver Sulfadiazine: 25 G In 1 Tube (67877-124-25)","250","RC","67877-124-25","NDC","","","facility","both","1","EA","","14.76","14.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67850-150-00","NDC","","","facility","both","1","EA","","5.53","5.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bacitracin Zinc: 425.3 g in 1 JAR (67777-220-07) ","250","RC","67777-220-07","NDC","","","facility","both","1","EA","","30.88","30.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 24 Bag In 1 Carton (67457-940-10)  / 100 Ml In 1 Bag","250","RC","67457-940-10","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-887-00","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Granisetron Hydrochloride: 1 Vial In 1 Carton (67457-864-04)  / 1 Ml In 1 Vial","250","RC","67457-864-04","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Granisetron Hydrochloride: 1 Vial In 1 Carton (67457-863-01)  / 1 Ml In 1 Vial","250","RC","67457-863-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adenosine: 1 Vial In 1 Carton (67457-857-30)  / 30 Ml In 1 Vial","250","RC","67457-857-30","NDC","","","facility","both","1","EA","","3.61","3.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adenosine: 10 Vial, Single-Dose In 1 Carton (67457-855-02)  / 2 Ml In 1 Vial, Single-Dose (67457-855-00)","250","RC","67457-855-02","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-855-00","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 1 Vial In 1 Carton (67457-853-50)  / 5 Ml In 1 Vial","250","RC","67457-853-50","NDC","","","facility","both","1","EA","","52.51","52.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67877-721-33","NDC","","","facility","both","1","EA","","8.47","8.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide Oral Solution: 200 Ml In 1 Bottle (67877-732-95)","250","RC","67877-732-95","NDC","","","facility","both","1","EA","","3.13","3.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-252-11","NDC","","","facility","both","1","EA","","4.21","4.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-250-11","NDC","","","facility","both","1","EA","","7.74","7.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-249-11","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-248-11","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-229-11","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-221-11","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-220-11","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (68084-220-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-220-11)","250","RC","68084-220-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-214-11","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-205-11","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-204-11","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-203-11","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-269-11","NDC","","","facility","both","1","EA","","2.45","2.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Box, Unit-Dose (68084-270-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-270-11)","250","RC","68084-270-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-270-11","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-309-11","NDC","","","facility","both","1","EA","","4.11","4.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dantrolene Sodium: 30 Blister Pack In 1 Box, Unit-Dose (68084-300-21)  / 1 Capsule In 1 Blister Pack (68084-300-11)","250","RC","68084-300-21","NDC","","","facility","both","1","EA","","2.58","2.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-300-11","NDC","","","facility","both","1","EA","","2.71","2.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-299-11","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-291-11","NDC","","","facility","both","1","EA","","3.47","3.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-288-11","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-284-11","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-282-11","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-281-11","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Blister Pack In 1 Box, Unit-Dose (68084-281-01)  / 1 Tablet, Extended Release In 1 Blister Pack (68084-281-11)","250","RC","68084-281-01","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-280-11","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-272-11","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Box, Unit-Dose (68084-272-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-272-11)","250","RC","68084-272-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-475-00","NDC","","","facility","both","1","EA","","52.98","52.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Primidone: 100 Blister Pack In 1 Box, Unit-Dose (68084-202-01)  / 1 Tablet In 1 Blister Pack (68084-202-11)","250","RC","68084-202-01","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-070-11","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 100 Blister Pack In 1 Box, Unit-Dose (68084-070-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-070-11)","250","RC","68084-070-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-046-11","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (68084-046-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-046-11)","250","RC","68084-046-01","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-045-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-044-11","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-075-11","NDC","","","facility","both","1","EA","","31.63","31.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-041-11","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Warfarin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (68084-027-01)  / 1 Tablet In 1 Blister Pack (68084-027-11)","250","RC","68084-027-01","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zerbaxa: 10 Vial, Single-Dose In 1 Carton (67919-030-01)  / 10 Ml In 1 Vial, Single-Dose","250","RC","67919-030-01","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dronabinol: 60 Capsule In 1 Bottle (67877-754-60)","250","RC","67877-754-60","NDC","","","facility","both","1","EA","","2.86","2.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sirolimus: 100 Tablet, Film Coated In 1 Bottle (67877-748-01)","250","RC","67877-748-01","NDC","","","facility","both","1","EA","","6.62","6.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-027-11","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tretinoin: 3 Blister Pack In 1 Carton (68084-075-21)  / 10 Capsule In 1 Blister Pack (68084-075-11)","250","RC","68084-075-21","NDC","","","facility","both","1","EA","","31.1","31.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-082-11","NDC","","","facility","both","1","EA","","1.53","1.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-083-11","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-189-11","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-158-11","NDC","","","facility","both","1","EA","","2.34","2.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-157-11","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-155-11","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-149-11","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-120-11","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 100 Blister Pack In 1 Box, Unit-Dose (68084-120-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-120-11)","250","RC","68084-120-01","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-119-11","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-109-11","NDC","","","facility","both","1","EA","","1.2","1.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-104-11","NDC","","","facility","both","1","EA","","3.09","3.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-099-11","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-098-11","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-097-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-202-11","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","68084-310-11","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 10 Vial In 1 Carton (67457-457-20)  / 20 Ml In 1 Vial (67457-457-00)","250","RC","67457-457-20","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66689-401-01","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Digoxin: 1 Bottle, Glass In 1 Carton (66689-327-02)  / 60 Ml In 1 Bottle, Glass","250","RC","66689-327-02","NDC","","","facility","both","1","EA","","2.28","2.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin Hydrochloride: 1 Bottle In 1 Carton (66689-318-16)  / 473 Ml In 1 Bottle","250","RC","66689-318-16","NDC","","","facility","both","1","EA","","11.53","11.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 1 Bottle, Plastic In 1 Carton (66689-307-08)  / 250 Ml In 1 Bottle, Plastic","250","RC","66689-307-08","NDC","","","facility","both","1","EA","","4.24","4.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sucralfate: 1 Bottle, Plastic In 1 Carton (66689-305-16)  / 414 Ml In 1 Bottle, Plastic","250","RC","66689-305-16","NDC","","","facility","both","1","EA","","2.01","2.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Insta-Char Aqueous: 240 Ml In 1 Bottle, Plastic (66689-201-08)","250","RC","66689-201-08","NDC","","","facility","both","1","EA","","12.51","12.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66689-106-01","NDC","","","facility","both","1","EA","","1.9","1.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 500 Ml In 1 Bottle (66689-711-16)","250","RC","66689-711-16","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 1 Bottle, Plastic In 1 Carton (66689-058-04)  / 120 Ml In 1 Bottle, Plastic","250","RC","66689-058-04","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66689-053-01","NDC","","","facility","both","1","EA","","3.51","3.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66689-047-01","NDC","","","facility","both","1","EA","","7.54","7.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66689-038-01","NDC","","","facility","both","1","EA","","2.06","2.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66689-037-01","NDC","","","facility","both","1","EA","","1.6","1.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66689-036-01","NDC","","","facility","both","1","EA","","12.2","12.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 30 Ml In 1 Bottle (66689-025-30)","250","RC","66689-025-30","NDC","","","facility","both","1","EA","","3.34","3.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66689-062-01","NDC","","","facility","both","1","EA","","15.3","15.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamifant: 1 Vial, Single-Use In 1 Carton (66658-510-01)  / 20 Ml In 1 Vial, Single-Use","250","RC","66658-510-01","NDC","","","facility","both","1","EA","","443.16","443.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66794-228-02","NDC","","","facility","both","1","EA","","2.3","2.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66794-228-02","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66794-219-63","NDC","","","facility","both","1","EA","","4.27","4.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenytoin: 237 Ml In 1 Bottle (66689-775-08)","250","RC","66689-775-08","NDC","","","facility","both","1","EA","","4.74","4.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitigo: 1 Ml In 1 Vial, Single-Use (66794-162-02)","250","RC","66794-162-02","NDC","","","facility","both","1","EA","","10.63","10.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciloxan: 3.5 G In 1 Tube (66758-071-38)","250","RC","66758-071-38","NDC","","","facility","both","1","EA","","440.79","440.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cipro Hc: 1 Bottle In 1 Carton (66758-087-70)  / 10 Ml In 1 Bottle","250","RC","66758-087-70","NDC","","","facility","both","1","EA","","584.77","584.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kineret: 7 Syringe, Glass In 1 Carton (66658-234-07)  / .67 Ml In 1 Syringe, Glass","250","RC","66658-234-07","NDC","","","facility","both","1","EA","","362.7","362.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66658-234-01","NDC","","","facility","both","1","EA","","371.82","371.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Uptravi: 1 Bottle In 1 Carton (66215-604-06)  / 60 Tablet, Coated In 1 Bottle","250","RC","66215-604-06","NDC","","","facility","both","1","EA","","669.1","669.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Uptravi: 1 Bottle In 1 Carton (66215-602-06)  / 60 Tablet, Coated In 1 Bottle","250","RC","66215-602-06","NDC","","","facility","both","1","EA","","669.1","669.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opsumit: 1 Bottle In 1 Carton (66215-501-30)  / 30 Tablet, Film Coated In 1 Bottle","250","RC","66215-501-30","NDC","","","facility","both","1","EA","","758.34","758.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opsumit: 1 Blister Pack In 1 Carton (66215-501-15)  / 15 Tablet, Film Coated In 1 Blister Pack","250","RC","66215-501-15","NDC","","","facility","both","1","EA","","758.34","758.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle, Dropper In 1 Carton (65862-946-01)  / 10 Ml In 1 Bottle, Dropper","250","RC","65862-946-01","NDC","","","facility","both","1","EA","","33.2","33.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevelamer Carbonate: 90 Pouch In 1 Carton (65862-931-90)  / 1 Powder, For Suspension In 1 Pouch (65862-931-08)","250","RC","65862-931-90","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetadote: 4 Vial In 1 Carton (66220-207-30)  / 30 Ml In 1 Vial","250","RC","66220-207-30","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65862-931-08","NDC","","","facility","both","1","EA","","2.51","2.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","65862-930-08","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Finasteride: 90 Tablet, Film Coated In 1 Bottle (65862-927-90)","250","RC","65862-927-90","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Finasteride: 30 Tablet, Film Coated In 1 Bottle (65862-927-30)","250","RC","65862-927-30","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevelamer Carbonate: 270 Tablet, Film Coated In 1 Bottle (65862-921-27)","250","RC","65862-921-27","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 60 Capsule In 1 Bottle (65862-907-60)","250","RC","65862-907-60","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lansoprazole: 10 Blister Pack In 1 Carton (65862-896-78)  / 10 Tablet, Orally Disintegrating, Delayed Release In 1 Blister Pack (65862-896-10)","250","RC","65862-896-78","NDC","","","facility","both","1","EA","","10.29","10.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevelamer Carbonate: 90 Pouch In 1 Carton (65862-930-90)  / 1 Powder, For Suspension In 1 Pouch (65862-930-08)","250","RC","65862-930-90","NDC","","","facility","both","1","EA","","2.5","2.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sancuso: 168 H In 1 Pouch (66220-637-31)","250","RC","66220-637-31","NDC","","","facility","both","1","EA","","1132.79","1132.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Orfadin: 1 Bottle, Plastic In 1 Carton (66658-105-60)  / 60 Capsule In 1 Bottle, Plastic","250","RC","66658-105-60","NDC","","","facility","both","1","EA","","408.71","408.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66553-008-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66553-004-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66553-002-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66553-001-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66302-664-01","NDC","","","facility","both","1","EA","","432.58","432.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66302-648-01","NDC","","","facility","both","1","EA","","432.58","432.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66302-632-01","NDC","","","facility","both","1","EA","","432.58","432.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66302-616-01","NDC","","","facility","both","1","EA","","432.58","432.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tyvaso: 4 Ampule In 1 Box (66302-206-03)  / 2.9 Ml In 1 Ampule","250","RC","66302-206-03","NDC","","","facility","both","1","EA","","1537.43","1537.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Unituxin: 1 Vial, Single-Dose In 1 Box (66302-014-01)  / 5 Ml In 1 Vial, Single-Dose","250","RC","66302-014-01","NDC","","","facility","both","1","EA","","14947.39","14947.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 1 Injection, Powder, Lyophilized, For Solution In 1 Bag (66288-1300-1)","250","RC","66288-1300-1","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 1 Injection, Powder, Lyophilized, For Solution In 1 Bag (66288-1100-1)","250","RC","66288-1100-1","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66259-146-01","NDC","","","facility","both","1","EA","","96.64","96.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rocuronium: 10 Vial In 1 Carton (66794-229-41)  / 10 Ml In 1 Vial (66794-229-02)","250","RC","66794-229-41","NDC","","","facility","both","1","EA","","4.61","4.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66794-230-02","NDC","","","facility","both","1","EA","","3.45","3.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmedetomidine: 25 Vial, Glass In 1 Carton (66794-230-42)  / 2 Ml In 1 Vial, Glass (66794-230-02)","250","RC","66794-230-42","NDC","","","facility","both","1","EA","","3.72","3.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-423-00","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-422-00","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 10 Vial In 1 Carton (67457-420-10)  / 10 Ml In 1 Vial (67457-420-00)","250","RC","67457-420-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-420-00","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Vial In 1 Carton (67457-341-05)  / 100 Ml In 1 Vial","250","RC","67457-341-05","NDC","","","facility","both","1","EA","","7.59","7.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial In 1 Carton (67457-340-01)  / 20 Ml In 1 Vial (67457-340-00)","250","RC","67457-340-01","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-340-00","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Moxifloxacin Hydrochloride: 1 Bag In 1 Carton (67457-323-25)  / 250 Ml In 1 Bag","250","RC","67457-323-25","NDC","","","facility","both","1","EA","","18.32","18.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-299-00","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-426-00","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-457-00","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rifampin: 1 Vial In 1 Carton (67457-445-60)  / 10 Ml In 1 Vial","250","RC","67457-445-60","NDC","","","facility","both","1","EA","","127.52","127.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-438-00","NDC","","","facility","both","1","EA","","3.01","3.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-438-00","NDC","","","facility","both","1","EA","","26.82","26.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline: 10 Vial In 1 Carton (67457-437-10)  / 10 Ml In 1 Vial (67457-437-00)","250","RC","67457-437-10","NDC","","","facility","both","1","EA","","160.47","160.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial In 1 Carton (67457-436-50)  / 25 Ml In 1 Vial","250","RC","67457-436-50","NDC","","","facility","both","1","EA","","58.06","58.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 25 Vial In 1 Carton (67457-433-22)  / 2 Ml In 1 Vial (67457-433-00)","250","RC","67457-433-22","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 25 Vial In 1 Carton (67457-433-22)  / 2 Ml In 1 Vial (67457-433-00)","250","RC","67457-433-22","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-433-00","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pamidronate Disodium: 1 Vial In 1 Carton (67457-430-10)  / 10 Ml In 1 Vial","250","RC","67457-430-10","NDC","","","facility","both","1","EA","","8.58","8.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-428-00","NDC","","","facility","both","1","EA","","2.36","2.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-473-00","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 10 Bag In 1 Carton (67457-266-10)  / 100 Ml In 1 Bag (67457-266-00)","250","RC","67457-266-10","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-228-99","NDC","","","facility","both","1","EA","","11.16","11.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66993-730-51","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dapagliflozin: 30 Tablet, Film Coated In 1 Bottle, Plastic (66993-457-30)","250","RC","66993-457-30","NDC","","","facility","both","1","EA","","20.78","20.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dapagliflozin: 30 Tablet, Film Coated In 1 Bottle, Plastic (66993-456-30)","250","RC","66993-456-30","NDC","","","facility","both","1","EA","","20.94","20.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 1 Vial In 1 Carton (66993-370-83)  / 1 Ml In 1 Vial","250","RC","66993-370-83","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propafenone Hydrochloride: 60 CAPSULE, EXTENDED RELEASE in 1 BOTTLE (66993-114-60) ","250","RC","66993-114-60","NDC","","","facility","both","1","EA","","9.74","9.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluticasone Propionate Hfa: 1 Inhaler In 1 Carton (66993-079-96)  / 120 Aerosol, Metered In 1 Inhaler","250","RC","66993-079-96","NDC","","","facility","both","1","EA","","295.41","295.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluticasone Propionate Hfa: 1 Inhaler In 1 Carton (66993-078-96)  / 120 Aerosol, Metered In 1 Inhaler","250","RC","66993-078-96","NDC","","","facility","both","1","EA","","220.66","220.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atovaquone And Proguanil Hcl: 24 Tablet, Film Coated In 1 Dose Pack (66993-060-27)","250","RC","66993-060-27","NDC","","","facility","both","1","EA","","10.25","10.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66993-023-35","NDC","","","facility","both","1","EA","","4.65","4.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levalbuterol Hydrochloride: 2 POUCH in 1 CARTON (66993-023-27)  / 12 VIAL, SINGLE-DOSE in 1 POUCH (66993-023-35)  / 3 mL in 1 VIAL, SINGLE-DOSE","250","RC","66993-023-27","NDC","","","facility","both","1","EA","","4.65","4.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levalbuterol Hydrochloride: 2 POUCH in 1 CARTON (66993-022-27)  / 12 VIAL, SINGLE-DOSE in 1 POUCH (66993-022-35)  / 3 mL in 1 VIAL, SINGLE-DOSE","250","RC","66993-022-27","NDC","","","facility","both","1","EA","","4.65","4.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","66993-021-35","NDC","","","facility","both","1","EA","","4.63","4.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Estradiol Vaginal Cream: 1 Tube In 1 Carton (66993-002-10)  / 42.5 G In 1 Tube","250","RC","66993-002-10","NDC","","","facility","both","1","EA","","119.5","119.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesnex: 10 Blister Pack In 1 Carton (67108-3565-9)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","67108-3565-9","NDC","","","facility","both","1","EA","","79.23","79.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propylthiouracil: 100 Tablet In 1 Bottle (67253-651-10)","250","RC","67253-651-10","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Carton (67457-228-10)  / 10 Ml In 1 Vial, Multi-Dose (67457-228-99)","250","RC","67457-228-10","NDC","","","facility","both","1","EA","","9.3","9.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-220-00","NDC","","","facility","both","1","EA","","139.43","139.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-220-00","NDC","","","facility","both","1","EA","","174.33","174.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duraclon: 1 Vial In 1 Carton (67457-218-10)  / 10 Ml In 1 Vial","250","RC","67457-218-10","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (67457-217-20)  / 20 Ml In 1 Vial, Multi-Dose","250","RC","67457-217-20","NDC","","","facility","both","1","EA","","30.2","30.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","67457-196-00","NDC","","","facility","both","1","EA","","2.73","2.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sotradecol: 5 Vial, Multi-Dose In 1 Carton (67457-163-02)  / 2 Ml In 1 Vial, Multi-Dose (67457-163-00)","250","RC","67457-163-02","NDC","","","facility","both","1","EA","","118.87","118.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sotradecol: 5 Vial, Multi-Dose In 1 Carton (67457-162-02)  / 2 Ml In 1 Vial, Multi-Dose (67457-162-00)","250","RC","67457-162-02","NDC","","","facility","both","1","EA","","123.14","123.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amiodarone Hydrochloride: 1 Vial, Glass In 1 Carton (67457-153-18)  / 18 Ml In 1 Vial, Glass","250","RC","67457-153-18","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-788-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Insulin Aspart: 5 Syringe, Plastic In 1 Carton (73070-103-15)  / 3 Ml In 1 Syringe, Plastic (73070-103-10)","250","RC","73070-103-15","NDC","","","facility","both","1","EA","","4.44","4.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Insulin Aspart: 5 Syringe, Plastic In 1 Carton (73070-103-15)  / 3 Ml In 1 Syringe, Plastic (73070-103-10)","250","RC","73070-103-15","NDC","","","facility","both","1","EA","","30.74","30.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73070-103-10","NDC","","","facility","both","1","EA","","4.38","4.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73070-103-10","NDC","","","facility","both","1","EA","","30.48","30.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Insulin Aspart: 1 Vial, Glass In 1 Carton (73070-100-11)  / 10 Ml In 1 Vial, Glass","250","RC","73070-100-11","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Insulin Aspart: 1 Vial, Glass In 1 Carton (73070-100-11)  / 10 Ml In 1 Vial, Glass","250","RC","73070-100-11","NDC","","","facility","both","1","EA","","3.49","3.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73043-023-91","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (73043-010-03)","250","RC","73043-010-03","NDC","","","facility","both","1","EA","","3.34","3.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73043-005-03","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclosporine: 3 Pouch In 1 Carton (73043-005-01)  / 10 Vial, Single-Use In 1 Pouch / .4 Ml In 1 Vial, Single-Use","250","RC","73043-005-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Orgovyx: 30 Tablet, Film Coated In 1 Bottle, Plastic (72974-120-01)","250","RC","72974-120-01","NDC","","","facility","both","1","EA","","165.75","165.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-112-03","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-112-03","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-108-03","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-108-03","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-105-01","NDC","","","facility","both","1","EA","","3.19","3.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-102-25","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-101-06","NDC","","","facility","both","1","EA","","5.47","5.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibsrela: 60 Tablet In 1 Bottle (73154-050-60)","250","RC","73154-050-60","NDC","","","facility","both","1","EA","","49.44","49.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle (72888-084-01)","250","RC","72888-084-01","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle (72888-083-01)","250","RC","72888-083-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle (72888-082-01)","250","RC","72888-082-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 500 Tablet, Coated In 1 Bottle (72888-080-05)","250","RC","72888-080-05","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 1 Bottle In 1 Carton (72888-074-14)  / 250 Ml In 1 Bottle","250","RC","72888-074-14","NDC","","","facility","both","1","EA","","2.61","2.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rabeprazole Sodium: 30 Tablet, Delayed Release In 1 Bottle (72888-059-30)","250","RC","72888-059-30","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 1 Bottle In 1 Carton (72888-100-20)  / 150 Ml In 1 Bottle","250","RC","72888-100-20","NDC","","","facility","both","1","EA","","11.94","11.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 473 Ml In 1 Bottle, Plastic (72888-041-13)","250","RC","72888-041-13","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (72888-037-01)","250","RC","72888-037-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 50 Pouch In 1 Carton (72888-024-43)  / 1.58 G In 1 Pouch (72888-024-06)","250","RC","72888-024-43","NDC","","","facility","both","1","EA","","2.39","2.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 30 Pouch In 1 Carton (72888-024-07)  / 1.58 G In 1 Pouch (72888-024-06)","250","RC","72888-024-07","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72888-024-06","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 100 Tablet In 1 Bottle (72888-009-01)","250","RC","72888-009-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 100 Tablet In 1 Bottle (72888-113-01)","250","RC","72888-113-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 100 Tablet In 1 Bottle (72888-114-01)","250","RC","72888-114-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 30 Tablet In 1 Bottle (72888-178-30)","250","RC","72888-178-30","NDC","","","facility","both","1","EA","","2.47","2.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine: 30 Tablet, Extended Release In 1 Package (72888-175-30)","250","RC","72888-175-30","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium: 500 Ml In 1 Bottle (72888-172-46)","250","RC","72888-172-46","NDC","","","facility","both","1","EA","","5.1","5.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 473 Ml In 1 Bottle (72888-157-39)","250","RC","72888-157-39","NDC","","","facility","both","1","EA","","12.49","12.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 500 Tablet In 1 Bottle (72888-153-05)","250","RC","72888-153-05","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine: 90 Tablet, Extended Release In 1 Package (72888-143-90)","250","RC","72888-143-90","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 100 Ml In 1 Bottle (72888-125-26)","250","RC","72888-125-26","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-114-15","NDC","","","facility","both","1","EA","","432","432","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin: 30 Tablet, Film Coated In 1 Bottle (75834-242-30)","250","RC","75834-242-30","NDC","","","facility","both","1","EA","","7.39","7.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 100 Tablet In 1 Bottle (75834-221-01)","250","RC","75834-221-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nivagen Zinc Oxide: 56.7 G In 1 Tube (75834-170-02)","250","RC","75834-170-02","NDC","","","facility","both","1","EA","","8.45","8.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nivagen Zinc Oxide: 28.4 G In 1 Tube (75834-170-01)","250","RC","75834-170-01","NDC","","","facility","both","1","EA","","5.63","5.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet In 1 Bottle (75834-159-01)","250","RC","75834-159-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet In 1 Bottle (75834-158-01)","250","RC","75834-158-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorthalidone: 100 Tablet In 1 Bottle (75834-110-01)","250","RC","75834-110-01","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (75826-115-10)","250","RC","75826-115-10","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (75826-114-10)","250","RC","75826-114-10","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenoxylate Hydrochloride And Atropine Sulfate: 1000 Tablet In 1 Bottle, Plastic (75826-107-00)","250","RC","75826-107-00","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Tablet In 1 Bottle, Plastic (75826-142-10)","250","RC","75826-142-10","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin Ethylsuccinate: 100 Ml In 1 Bottle (75834-295-01)","250","RC","75834-295-01","NDC","","","facility","both","1","EA","","5.1","5.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ravicti: 1 Bottle In 1 Carton (75987-050-06)  / 25 Ml In 1 Bottle","250","RC","75987-050-06","NDC","","","facility","both","1","EA","","712.74","712.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenylephrine Hydrochloride: 1 Bottle, Dropper In 1 Carton (75907-130-23)  / 5 Ml In 1 Bottle, Dropper","250","RC","75907-130-23","NDC","","","facility","both","1","EA","","27.53","27.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Iodide: 30 Ml In 1 Bottle, With Applicator (75834-280-30)","250","RC","75834-280-30","NDC","","","facility","both","1","EA","","4.09","4.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle, Plastic (75907-071-01)","250","RC","75907-071-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle, Plastic (75907-070-01)","250","RC","75907-070-01","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle, Plastic (75907-069-01)","250","RC","75907-069-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet In 1 Bottle (75834-320-01)","250","RC","75834-320-01","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Niva Thyroid: 100 Tablet In 1 Bottle (75834-311-01)","250","RC","75834-311-01","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Niva Thyroid: 100 Tablet In 1 Bottle (75834-310-01)","250","RC","75834-310-01","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","74312-03880","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Proleukin: 1 Vial, Single-Dose In 1 Carton (73776-022-01)  / 1 Ml In 1 Vial, Single-Dose","250","RC","73776-022-01","NDC","","","facility","both","1","EA","","7139.95","7139.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemtesa: 30 Tablet, Film Coated In 1 Bottle (73336-075-30)","250","RC","73336-075-30","NDC","","","facility","both","1","EA","","24.67","24.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ella: 1 Blister Pack In 1 Carton (73302-456-01)  / 1 Tablet In 1 Blister Pack","250","RC","73302-456-01","NDC","","","facility","both","1","EA","","64.32","64.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73293-0001-1","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-163-33","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-163-33","NDC","","","facility","both","1","EA","","15","15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-161-43","NDC","","","facility","both","1","EA","","75.6","75.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-156-02","NDC","","","facility","both","1","EA","","10.2","10.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-149-02","NDC","","","facility","both","1","EA","","28.5","28.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-146-33","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-146-33","NDC","","","facility","both","1","EA","","17.63","17.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-120-02","NDC","","","facility","both","1","EA","","13.38","13.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-118-03","NDC","","","facility","both","1","EA","","7.33","7.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-116-03","NDC","","","facility","both","1","EA","","2.79","2.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-156-35","NDC","","","facility","both","1","EA","","6.3","6.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73776-001-11","NDC","","","facility","both","1","EA","","566500","566500","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Artesunate: 2 Kit In 1 Carton (73607-011-11)  / 1 Kit In 1 Kit *  1 Injection, Powder, For Solution In 1 Vial (73607-002-01)  *  1 Solution In 1 Vial (73607-003-02)","250","RC","73607-011-11","NDC","","","facility","both","1","EA","","6336.85","6336.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Artesunate: 1 Injection, Powder, For Solution In 1 Vial (73607-002-01)","250","RC","73607-002-01","NDC","","","facility","both","1","EA","","6182.83","6182.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Viokace: 1 Bottle In 1 Carton (73562-208-10)  / 100 Tablet In 1 Bottle","250","RC","73562-208-10","NDC","","","facility","both","1","EA","","14.56","14.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-116-01)","250","RC","73562-116-01","NDC","","","facility","both","1","EA","","17.78","17.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-115-01)","250","RC","73562-115-01","NDC","","","facility","both","1","EA","","3.61","3.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-114-01)","250","RC","73562-114-01","NDC","","","facility","both","1","EA","","28.28","28.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-112-01)","250","RC","73562-112-01","NDC","","","facility","both","1","EA","","14.31","14.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-111-01)","250","RC","73562-111-01","NDC","","","facility","both","1","EA","","10.61","10.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Viokace: 1 Bottle In 1 Carton (73562-104-10)  / 100 Tablet In 1 Bottle","250","RC","73562-104-10","NDC","","","facility","both","1","EA","","7.38","7.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tavneos: 1 Bottle, Plastic In 1 Carton (73556-168-01)  / 180 Capsule In 1 Bottle, Plastic","250","RC","73556-168-01","NDC","","","facility","both","1","EA","","174.61","174.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Revuforj: 30 Tablet, Film Coated In 1 Bottle, Plastic (73555-502-00)","250","RC","73555-502-00","NDC","","","facility","both","1","EA","","1185","1185","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","73177-116-02","NDC","","","facility","both","1","EA","","4.68","4.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 500 Tablet, Extended Release In 1 Bottle, Plastic (72789-365-82)","250","RC","72789-365-82","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyproheptadine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (72789-102-01)","250","RC","72789-102-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 1 Tube In 1 Carton (72578-129-08)  / 45 G In 1 Tube","250","RC","72578-129-08","NDC","","","facility","both","1","EA","","46.5","46.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 100 Capsule In 1 Bottle (72578-002-01)","250","RC","72578-002-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Tablet, Extended Release In 1 Bottle (72516-032-01)","250","RC","72516-032-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Repatha: 2 Syringe In 1 Carton (72511-760-02)  / 1 Ml In 1 Syringe (72511-760-01)","250","RC","72511-760-02","NDC","","","facility","both","1","EA","","490.19","490.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"AMOXICILLIN AND CLAVULANATE POTASSIUM: 150 mL in 1 BOTTLE (72508-204-15) ","250","RC","72508-204-15","NDC","","","facility","both","1","EA","","19.73","19.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin: 1 Tube In 1 Carton (72485-670-35)  / 3.5 G In 1 Tube","250","RC","72485-670-35","NDC","","","facility","both","1","EA","","14.85","14.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin: 50 Tube In 1 Carton (72485-670-31)  / 1 G In 1 Tube","250","RC","72485-670-31","NDC","","","facility","both","1","EA","","7.26","7.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Tablet In 1 Bottle (72578-166-01)","250","RC","72578-166-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72485-510-01","NDC","","","facility","both","1","EA","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiamine: 25 Vial, Multi-Dose In 1 Carton (72485-507-25)  / 2 Ml In 1 Vial, Multi-Dose (72485-507-01)","250","RC","72485-507-25","NDC","","","facility","both","1","EA","","2.28","2.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72485-507-01","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72485-507-01","NDC","","","facility","both","1","EA","","2.25","2.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72485-502-01","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 1 Injection, Powder, For Solution In 1 Carton (72485-423-10)","250","RC","72485-423-10","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (72603-152-01)  / 10 Ml In 1 Vial, Single-Dose","250","RC","72603-152-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-139-01","NDC","","","facility","both","1","EA","","2.62","2.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 100 Tablet In 1 Bottle (72603-134-01)","250","RC","72603-134-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-133-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Tablet In 1 Bottle (72578-170-01)","250","RC","72578-170-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-133-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Icosapent Ethyl: 120 Capsule In 1 Bottle (72603-129-01)","250","RC","72603-129-01","NDC","","","facility","both","1","EA","","2.43","2.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-128-01","NDC","","","facility","both","1","EA","","3.19","3.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Memantine: 60 Tablet In 1 Bottle (72603-119-01)","250","RC","72603-119-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (72603-107-01)  / 10 Ml In 1 Vial, Single-Dose","250","RC","72603-107-01","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brukinsa: 1 Bottle, Plastic In 1 Carton (72579-011-02)  / 120 Capsule In 1 Bottle, Plastic","250","RC","72579-011-02","NDC","","","facility","both","1","EA","","235.4","235.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-133-01","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72485-423-01","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (72485-201-01)","250","RC","72485-201-01","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicardipine Hydrochloride: 10 Vial In 1 Carton (72485-116-10)  / 10 Ml In 1 Vial (72485-116-01)","250","RC","72485-116-10","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72485-116-01","NDC","","","facility","both","1","EA","","14.92","14.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 10 Vial, Glass In 1 Carton (72485-107-10)  / 10 Ml In 1 Vial, Glass","250","RC","72485-107-10","NDC","","","facility","both","1","EA","","3.13","3.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 1 Vial, Glass In 1 Carton (72485-107-01)  / 10 Ml In 1 Vial, Glass","250","RC","72485-107-01","NDC","","","facility","both","1","EA","","5.82","5.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Nitroprusside: 1 Vial, Single-Dose In 1 Carton (72485-105-01)  / 2 Ml In 1 Vial, Single-Dose","250","RC","72485-105-01","NDC","","","facility","both","1","EA","","19.84","19.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vonjo: 40 Carton In 1 Box (72482-100-12)  / 1 Bottle In 1 Carton / 120 Capsule In 1 Bottle","250","RC","72482-100-12","NDC","","","facility","both","1","EA","","388.23","388.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Selegiline Hydrochloride: 60 Tablet In 1 Bottle (72319-006-02)","250","RC","72319-006-02","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sincalide: 5 Vial In 1 Package (72266-248-05)  / 5 Ml In 1 Vial (72266-248-01)","250","RC","72266-248-05","NDC","","","facility","both","1","EA","","24.24","24.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72266-248-01","NDC","","","facility","both","1","EA","","43.53","43.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline: 5 Vial In 1 Carton (72266-237-05)  / 10 Ml In 1 Vial (72266-237-01)","250","RC","72266-237-05","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72266-237-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Phenylacetate And Sodium Benzoate: 1 Vial, Single-Dose In 1 Carton (72266-236-01)  / 20 Ml In 1 Vial, Single-Dose","250","RC","72266-236-01","NDC","","","facility","both","1","EA","","2302.46","2302.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexrazoxane: 1 Vial In 1 Carton (72266-235-01)  / 25 Ml In 1 Vial","250","RC","72266-235-01","NDC","","","facility","both","1","EA","","85.79","85.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (72266-234-25)  / 1 Ml In 1 Vial (72266-234-01)","250","RC","72266-234-25","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (72485-201-01)","250","RC","72485-201-01","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin Sodium: 10 Vial In 1 Carton (72485-422-10)  / 1 Injection, Powder, For Solution In 1 Vial (72485-422-01)","250","RC","72485-422-10","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72485-422-01","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin Sodium And Sulbactam Sodium: 1 Bottle In 1 Carton (72485-418-15)  / 15 G In 1 Bottle","250","RC","72485-418-15","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72485-418-01","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72485-416-01","NDC","","","facility","both","1","EA","","3.24","3.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 4 Vial In 1 Carton (72485-415-04)  / 20 Ml In 1 Vial","250","RC","72485-415-04","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72485-415-01","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meropenem: 1 Vial In 1 Carton (72485-412-01)  / 20 Ml In 1 Vial","250","RC","72485-412-01","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72485-406-01","NDC","","","facility","both","1","EA","","7.02","7.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72485-404-01","NDC","","","facility","both","1","EA","","1.87","1.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-153-01","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-153-01","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-505-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-474-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-474-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-454-01","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (72603-558-01)","250","RC","72603-558-01","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nafcillin: 1 Vial In 1 Box (72603-453-01)  / 8 Ml In 1 Vial","250","RC","72603-453-01","NDC","","","facility","both","1","EA","","6.64","6.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 10 Bottle In 1 Carton (72603-444-01)  / 1 Injection, Powder, For Solution In 1 Bottle","250","RC","72603-444-01","NDC","","","facility","both","1","EA","","2.95","2.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-406-01","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 10 Vial, Single-Dose In 1 Carton (72603-387-10)  / 10 Ml In 1 Vial, Single-Dose (72603-387-01)","250","RC","72603-387-10","NDC","","","facility","both","1","EA","","3.29","3.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-387-01","NDC","","","facility","both","1","EA","","2.46","2.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial In 1 Carton (72603-350-25)  / 2 Ml In 1 Vial (72603-350-01)","250","RC","72603-350-25","NDC","","","facility","both","1","EA","","2.51","2.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oncaspar: 1 Vial, Single-Use In 1 Carton (72694-954-01)  / 5 Ml In 1 Vial, Single-Use","250","RC","72694-954-01","NDC","","","facility","both","1","EA","","33538.24","33538.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oncaspar: 1 Vial, Single-Use In 1 Carton (72694-954-01)  / 5 Ml In 1 Vial, Single-Use","250","RC","72694-954-01","NDC","","","facility","both","1","EA","","33538.24","33538.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tibsovo: 1 Bottle In 1 Carton (72694-617-60)  / 60 Tablet, Film Coated In 1 Bottle","250","RC","72694-617-60","NDC","","","facility","both","1","EA","","1002.77","1002.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Asparlas: 1 Vial, Single-Use In 1 Carton (72694-515-01)  / 5 Ml In 1 Vial, Single-Use","250","RC","72694-515-01","NDC","","","facility","both","1","EA","","90.53","90.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Asparlas: 1 Vial, Single-Use In 1 Carton (72694-515-01)  / 5 Ml In 1 Vial, Single-Use","250","RC","72694-515-01","NDC","","","facility","both","1","EA","","94.53","94.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sofosbuvir And Velpatasvir: 2 Blister Pack In 1 Carton (72626-2701-1)  / 14 Tablet, Film Coated In 1 Blister Pack","250","RC","72626-2701-1","NDC","","","facility","both","1","EA","","474.22","474.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nurtec Odt: 1 Blister Pack In 1 Carton (72618-3000-2)  / 8 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","72618-3000-2","NDC","","","facility","both","1","EA","","212.81","212.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72611-860-01","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72611-719-01","NDC","","","facility","both","1","EA","","1.7","1.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-800-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-350-01","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","76045-204-00","NDC","","","facility","both","1","EA","","3.39","3.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-219-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-218-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Bicarbonate: 25 Vial In 1 Carton (72603-209-25)  / 50 Ml In 1 Vial (72603-209-01)","250","RC","72603-209-25","NDC","","","facility","both","1","EA","","11.43","11.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-209-01","NDC","","","facility","both","1","EA","","11.57","11.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemfibrozil: 60 Tablet, Film Coated In 1 Bottle (72603-206-01)","250","RC","72603-206-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ofloxacin: 5 Ml In 1 Bottle, Dropper (72603-192-01)","250","RC","72603-192-01","NDC","","","facility","both","1","EA","","19.93","19.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-180-01","NDC","","","facility","both","1","EA","","5.54","5.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludrocortisone Acetate: 100 Tablet In 1 Bottle (72603-170-01)","250","RC","72603-170-01","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Maleate: 100 Tablet In 1 Bottle (72603-169-01)","250","RC","72603-169-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Maleate: 100 Tablet In 1 Bottle (72603-168-01)","250","RC","72603-168-01","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 30 Tablet, Film Coated In 1 Bottle (72603-159-01)","250","RC","72603-159-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 30 Tablet, Film Coated In 1 Bottle (72603-156-01)","250","RC","72603-156-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropivacaine Hydrochloride: 25 Vial In 1 Carton (72603-219-25)  / 20 Ml In 1 Vial (72603-219-01)","250","RC","72603-219-25","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 1 Injection, Powder, For Solution In 1 Vial, Single-Dose (72603-220-01)","250","RC","72603-220-01","NDC","","","facility","both","1","EA","","3.13","3.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 100 Tablet, Extended Release In 1 Bottle (72603-337-01)","250","RC","72603-337-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate Cream Usp, 0.05% Clobetasol Propionate Cream Usp, 0.05%: 30 G In 1 Tube (72603-323-02)","250","RC","72603-323-02","NDC","","","facility","both","1","EA","","9.48","9.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-314-01","NDC","","","facility","both","1","EA","","7.19","7.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-313-01","NDC","","","facility","both","1","EA","","5.14","5.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclobenzaprine Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (72603-312-02)","250","RC","72603-312-02","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 100 Tablet, Film Coated In 1 Bottle (72603-272-01)","250","RC","72603-272-01","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-267-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-266-01","NDC","","","facility","both","1","EA","","6.08","6.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyrimethamine: 30 Tablet In 1 Bottle (72603-262-01)","250","RC","72603-262-01","NDC","","","facility","both","1","EA","","375.03","375.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 1 Bottle In 1 Carton (72603-261-01)  / 460 Ml In 1 Bottle","250","RC","72603-261-01","NDC","","","facility","both","1","EA","","12.63","12.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 1 Bottle In 1 Carton (72603-240-01)  / 473 Ml In 1 Bottle","250","RC","72603-240-01","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferasirox: 30 Tablet, Film Coated In 1 Bottle (72603-233-01)","250","RC","72603-233-01","NDC","","","facility","both","1","EA","","7.1","7.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72603-221-01","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 100 Tablet, Extended Release In 1 Bottle (72603-338-01)","250","RC","72603-338-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 24 Syringe, Glass In 1 Carton (76045-204-20)  / 2 Ml In 1 Syringe, Glass (76045-204-00)","250","RC","76045-204-20","NDC","","","facility","both","1","EA","","6.97","6.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01)  / 30 Ml In 1 Vial, Single-Use","250","RC","76075-101-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-1017-69","NDC","","","facility","both","1","EA","","36","36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-1017-57","NDC","","","facility","both","1","EA","","45","45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-1017-12","NDC","","","facility","both","1","EA","","20.07","20.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-1015-38","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-1009-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8-98669-00201","NDC","","","facility","both","1","EA","","7.94","7.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","83634-600-41","NDC","","","facility","both","1","EA","","5.17","5.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Pouch In 1 Carton (83634-500-81)  / 1 Bag In 1 Pouch (83634-500-41)  / 50 Ml In 1 Bag","250","RC","83634-500-81","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","83634-500-41","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eptifibatide: 1 Vial, Single-Dose In 1 Carton (83634-301-51)  / 100 Ml In 1 Vial, Single-Dose","250","RC","83634-301-51","NDC","","","facility","both","1","EA","","5.6","5.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","88395-01545","NDC","","","facility","both","1","EA","","2.79","2.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-1019-54","NDC","","","facility","both","1","EA","","3.56","3.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-1234-56","NDC","","","facility","both","1","EA","","15.82","15.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6148-60","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6145-81","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6144-49","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6144-44","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6125-44","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6012-86","NDC","","","facility","both","1","EA","","3.11","3.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6001-39","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6000-56","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-1201-42","NDC","","","facility","both","1","EA","","2.21","2.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-5108-50","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-4094-01","NDC","","","facility","both","1","EA","","3.51","3.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-2685-02","NDC","","","facility","both","1","EA","","17.68","17.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-1700-25","NDC","","","facility","both","1","EA","","45","45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-1700-24","NDC","","","facility","both","1","EA","","45","45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-1700-23","NDC","","","facility","both","1","EA","","45","45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-1700-22","NDC","","","facility","both","1","EA","","45","45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epkinly: 1 Vial, Glass In 1 Carton (82705-002-01)  / .8 Ml In 1 Vial, Glass","250","RC","82705-002-01","NDC","","","facility","both","1","EA","","98.89","98.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Movantik: 30 Tablet, Film Coated In 1 Bottle (82625-8802-1)","250","RC","82625-8802-1","NDC","","","facility","both","1","EA","","23.98","23.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Movantik: 30 Tablet, Film Coated In 1 Bottle (82625-8801-1)","250","RC","82625-8801-1","NDC","","","facility","both","1","EA","","23.69","23.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","82619-111-03","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cosopt: 1 Bottle, Dropper In 1 Carton (82584-605-10)  / 10 Ml In 1 Bottle, Dropper","250","RC","82584-605-10","NDC","","","facility","both","1","EA","","402.06","402.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ogsiveo: 180 Tablet, Film Coated In 1 Bottle (82448-050-18)","250","RC","82448-050-18","NDC","","","facility","both","1","EA","","939.62","939.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abiraterone Acetate: 60 Tablet, Film Coated In 1 Bottle, Plastic (82293-002-10)","250","RC","82293-002-10","NDC","","","facility","both","1","EA","","22.13","22.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (81964-204-15)","250","RC","81964-204-15","NDC","","","facility","both","1","EA","","5.94","5.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cocaine Hydrochloride Nasal: 1 Bottle, Glass In 1 Carton (81665-301-02)  / 4 Ml In 1 Bottle, Glass","250","RC","81665-301-02","NDC","","","facility","both","1","EA","","595.86","595.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isoniazid: 100 Tablet In 1 Bottle, Plastic (81665-108-10)","250","RC","81665-108-10","NDC","","","facility","both","1","EA","","4.09","4.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isoniazid: 100 Tablet In 1 Bottle, Plastic (81665-107-10)","250","RC","81665-107-10","NDC","","","facility","both","1","EA","","2.1","2.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cromolyn Sodium: 12 Pouch In 1 Carton (81665-104-96)  / 8 Ampule In 1 Pouch / 5 Ml In 1 Ampule","250","RC","81665-104-96","NDC","","","facility","both","1","EA","","3.46","3.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Floxuridine: 1 Vial In 1 Box, Unit-Dose (81643-9270-1)  / 5 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","81643-9270-1","NDC","","","facility","both","1","EA","","3257.21","3257.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sucralfate: 420 Ml In 1 Bottle (82182-106-14)","250","RC","82182-106-14","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe","250","RC","83257-005-41","NDC","","","facility","both","1","EA","","231.67","231.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe","250","RC","83257-005-41","NDC","","","facility","both","1","EA","","231.67","231.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (83090-011-01)  / 10 Ml In 1 Vial, Single-Dose","250","RC","83090-011-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01)  / .8 Ml In 1 Vial, Glass","250","RC","82705-010-01","NDC","","","facility","both","1","EA","","79.47","79.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01)  / .8 Ml In 1 Vial, Glass","250","RC","82705-010-01","NDC","","","facility","both","1","EA","","81.6","81.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6148-62","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6148-88","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6149-73","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6150-14","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-4087-08","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6191-81","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6190-33","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6189-12","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6189-11","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6189-07","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6188-42","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6187-30","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6186-17","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6184-99","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6184-97","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6184-76","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6184-18","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6183-28","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6183-23","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6182-65","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6182-55","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6182-44","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6186-65","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-4707-09","NDC","","","facility","both","1","EA","","45","45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-4707-10","NDC","","","facility","both","1","EA","","45","45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-4707-11","NDC","","","facility","both","1","EA","","45","45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-6142-05","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-6141-96","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-6141-18","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-6141-17","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-6138-17","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-6134-95","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-6134-86","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-6129-75","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-6127-76","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-6127-75","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-6018-77","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-5102-27","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-4707-17","NDC","","","facility","both","1","EA","","45","45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-4707-12","NDC","","","facility","both","1","EA","","45","45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6182-42","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norepinephrine: 10 Pouch In 1 Box (81298-9655-3)  / 1 Bag In 1 Pouch (81298-9655-1)  / 250 Ml In 1 Bag","250","RC","81298-9655-3","NDC","","","facility","both","1","EA","","15.21","15.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6182-40","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6180-91","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6169-48","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6168-91","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6168-89","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6168-18","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6167-65","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6167-21","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6165-51","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6165-49","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6164-09","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6163-70","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6169-50","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6162-68","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6159-25","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6159-03","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6159-01","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6158-96","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6156-19","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6156-17","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6156-15","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6155-15","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6152-98","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6152-05","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6160-78","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6169-93","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6169-95","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6170-34","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6180-55","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6180-40","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6180-32","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6180-28","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6179-43","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6179-19","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6178-11","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6177-43","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6177-32","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6177-27","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6175-95","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6175-94","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6175-91","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6175-58","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6175-56","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6175-28","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6175-22","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6175-16","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6174-81","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6174-14","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6173-38","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6171-82","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6170-67","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9999-6181-16","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81298-9655-1","NDC","","","facility","both","1","EA","","40.96","40.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 1 Vial In 1 Carton (76329-9060-0)  / 30 Ml In 1 Vial","250","RC","76329-9060-0","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial In 1 Carton (76329-6300-5)  / 4 Ml In 1 Vial","250","RC","76329-6300-5","NDC","","","facility","both","1","EA","","46.31","46.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Syringe In 1 Package (76329-3390-1)  / 5 Ml In 1 Syringe","250","RC","76329-3390-1","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Bicarbonate: 1 Syringe In 1 Carton (76329-3352-1)  / 50 Ml In 1 Syringe","250","RC","76329-3352-1","NDC","","","facility","both","1","EA","","27.78","27.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 10 Carton In 1 Package (76329-3340-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe","250","RC","76329-3340-1","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Iron Sucrose: 10 Vial, Single-Dose In 1 Package (76329-9201-1)  / 5 Ml In 1 Vial, Single-Dose","250","RC","76329-9201-1","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 10 Carton In 1 Package (76329-3318-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe","250","RC","76329-3318-1","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Chloride: 10 Syringe In 1 Package (76329-3304-1)  / 10 Ml In 1 Syringe","250","RC","76329-3304-1","NDC","","","facility","both","1","EA","","15.14","15.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose Monohydrate: 1 Syringe In 1 Carton (76329-3302-1)  / 50 Ml In 1 Syringe","250","RC","76329-3302-1","NDC","","","facility","both","1","EA","","20.09","20.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Single-Use In 1 Box (76329-3015-5)  / 20 Ml In 1 Vial, Single-Use","250","RC","76329-3015-5","NDC","","","facility","both","1","EA","","14.66","14.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Single-Use In 1 Box (76329-3013-5)  / 10 Ml In 1 Vial, Single-Use","250","RC","76329-3013-5","NDC","","","facility","both","1","EA","","1.9","1.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 10 Carton In 1 Package (76329-3340-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe","250","RC","76329-3340-1","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phytonadione: 1 Syringe In 1 Carton (76329-1240-1)  / .5 Ml In 1 Syringe","250","RC","76329-1240-1","NDC","","","facility","both","1","EA","","38.99","38.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","77333-844-25","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","77333-827-25","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","77333-812-25","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simethicone 80Mg: 100 Blister Pack In 1 Box (77333-812-10)  / 1 Tablet, Chewable In 1 Blister Pack (77333-812-25)","250","RC","77333-812-10","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","77333-049-25","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","77333-031-25","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nadolol: 100 Tablet In 1 Bottle (76385-133-01)","250","RC","76385-133-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 100 Tablet, Film Coated In 1 Bottle (76385-124-01)","250","RC","76385-124-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 100 Tablet, Film Coated In 1 Bottle (76385-123-01)","250","RC","76385-123-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metopirone: 18 Capsule, Gelatin Coated In 1 Bottle (76336-455-18)","250","RC","76336-455-18","NDC","","","facility","both","1","EA","","72.47","72.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lysodren: 1 Bottle In 1 Carton (76336-080-60)  / 100 Tablet In 1 Bottle","250","RC","76336-080-60","NDC","","","facility","both","1","EA","","26.66","26.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nadolol: 100 Tablet In 1 Bottle (76385-134-01)","250","RC","76385-134-01","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foscavir: 10 Carton In 1 Carton (76310-024-25)  / 1 Bottle In 1 Carton (76310-024-15)  / 250 Ml In 1 Bottle","250","RC","76310-024-25","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","76310-024-15","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01)  / 15 Ml In 1 Vial, Single-Dose","250","RC","76075-102-01","NDC","","","facility","both","1","EA","","98.25","98.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01)  / 30 Ml In 1 Vial, Single-Use","250","RC","76075-101-01","NDC","","","facility","both","1","EA","","98.25","98.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01)  / 15 Ml In 1 Vial, Single-Dose","250","RC","76075-102-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","76310-024-15","NDC","","","facility","both","1","EA","","78.38","78.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 10 Capsule In 1 Blister Pack (76282-704-45)","250","RC","76282-704-45","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline: 90 Tablet, Film Coated In 1 Bottle (76282-212-90)","250","RC","76282-212-90","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","76204-900-11","NDC","","","facility","both","1","EA","","2.1","2.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levalbuterol: 30 Pouch In 1 Carton (76204-900-01)  / 1 Ampule In 1 Pouch (76204-900-11)  / 3 Ml In 1 Ampule","250","RC","76204-900-01","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","76204-800-11","NDC","","","facility","both","1","EA","","2.13","2.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levalbuterol: 30 Pouch In 1 Carton (76204-800-01)  / 1 Ampule In 1 Pouch (76204-800-11)  / 3 Ml In 1 Ampule","250","RC","76204-800-01","NDC","","","facility","both","1","EA","","2.13","2.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","76204-700-11","NDC","","","facility","both","1","EA","","2.12","2.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levalbuterol: 30 Pouch In 1 Carton (76204-700-01)  / 1 Ampule In 1 Pouch (76204-700-11)  / 3 Ml In 1 Ampule","250","RC","76204-700-01","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (76204-600-01)  / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule","250","RC","76204-600-01","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuterol Sulfate: 30 Pouch In 1 Carton (76204-200-01)  / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule","250","RC","76204-200-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide: 1 Pouch In 1 Carton (76204-100-30)  / 30 Ampule In 1 Pouch / 2.5 Ml In 1 Ampule","250","RC","76204-100-30","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide: 30 Pouch In 1 Carton (76204-100-01)  / 1 Ampule In 1 Pouch / 2.5 Ml In 1 Ampule","250","RC","76204-100-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cromolyn Sodium Oral Solution (Concentrate): 12 Pouch In 1 Carton (76204-025-96)  / 8 Ampule In 1 Pouch (76204-025-08)  / 5 Ml In 1 Ampule","250","RC","76204-025-96","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01)  / 10 Ml In 1 Vial, Single-Dose","250","RC","76075-103-01","NDC","","","facility","both","1","EA","","98.25","98.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nexplanon: 1 Blister Pack In 1 Carton (78206-145-01)  / 1 Implant In 1 Blister Pack","250","RC","78206-145-01","NDC","","","facility","both","1","EA","","2081.31","2081.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nexplanon: 1 Blister Pack In 1 Carton (78206-145-01)  / 1 Implant In 1 Blister Pack","250","RC","78206-145-01","NDC","","","facility","both","1","EA","","2081.31","2081.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Igalmi: 10 Pouch In 1 Carton (81092-1180-1)  / 1 Film In 1 Pouch (81092-1180-0)","250","RC","81092-1180-1","NDC","","","facility","both","1","EA","","94.5","94.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81092-1180-0","NDC","","","facility","both","1","EA","","125.18","125.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Igalmi: 10 Pouch In 1 Carton (81092-1120-1)  / 1 Film In 1 Pouch (81092-1120-0)","250","RC","81092-1120-1","NDC","","","facility","both","1","EA","","174.93","174.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytalux: 10 Carton In 1 Carton (81052-138-10)  / 1 Vial, Single-Dose In 1 Carton / 1.6 Ml In 1 Vial, Single-Dose (81052-138-01)","250","RC","81052-138-10","NDC","","","facility","both","1","EA","","5060.16","5060.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81033-512-15","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81033-412-15","NDC","","","facility","both","1","EA","","3.78","3.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81033-241-15","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81033-220-15","NDC","","","facility","both","1","EA","","3.81","3.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guaifenesin: 50 Cup, Unit-Dose In 1 Carton (81033-102-51)  / 5 Ml In 1 Cup, Unit-Dose (81033-102-05)","250","RC","81033-102-51","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81033-102-15","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81033-102-10","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81033-102-05","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81033-012-20","NDC","","","facility","both","1","EA","","18.13","18.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","80830-2365-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81033-104-05","NDC","","","facility","both","1","EA","","31.07","31.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81284-155-00","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 1 Vial, Pharmacy Bulk Package In 1 Carton (81284-155-01)  / 180 Ml In 1 Vial, Pharmacy Bulk Package (81284-155-00)","250","RC","81284-155-01","NDC","","","facility","both","1","EA","","1.86","1.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81298-8552-1","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (81298-8114-1)  / 100 Ml In 1 Vial, Single-Dose","250","RC","81298-8114-1","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Bicarbonate: 20 Vial In 1 Carton (81298-7620-3)  / 50 Ml In 1 Vial (81298-7620-1)","250","RC","81298-7620-3","NDC","","","facility","both","1","EA","","7.04","7.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81298-7620-1","NDC","","","facility","both","1","EA","","7.98","7.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81298-5010-1","NDC","","","facility","both","1","EA","","45.15","45.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81284-611-00","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81284-411-00","NDC","","","facility","both","1","EA","","60.38","60.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bludigo: 5 Ampule In 1 Carton (81284-315-05)  / 5 Ml In 1 Ampule (81284-315-00)","250","RC","81284-315-05","NDC","","","facility","both","1","EA","","14.11","14.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bludigo: 5 Ampule In 1 Carton (81284-315-05)  / 5 Ml In 1 Ampule (81284-315-00)","250","RC","81284-315-05","NDC","","","facility","both","1","EA","","14.11","14.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bludigo: 5 Ampule In 1 Carton (81284-315-05)  / 5 Ml In 1 Ampule (81284-315-00)","250","RC","81284-315-05","NDC","","","facility","both","1","EA","","495.36","495.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81284-315-00","NDC","","","facility","both","1","EA","","564.33","564.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","81298-8660-1","NDC","","","facility","both","1","EA","","44.82","44.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propofol: 20 Vial In 1 Carton (80830-2364-8)  / 50 Ml In 1 Vial (80830-2364-1)","250","RC","80830-2364-8","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","80830-2364-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enjaymo: 1 Vial, Single-Dose In 1 Carton (80203-347-01)  / 22 Ml In 1 Vial, Single-Dose","250","RC","80203-347-01","NDC","","","facility","both","1","EA","","28.1","28.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","80196-291-14","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rezurock: 1 Bottle In 1 Carton (79802-200-30)  / 30 Tablet In 1 Bottle","250","RC","79802-200-30","NDC","","","facility","both","1","EA","","1096.09","1096.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Syndros: 1 Bottle, Glass In 1 Carton (78613-201-30)  / 30 Ml In 1 Bottle, Glass","250","RC","78613-201-30","NDC","","","facility","both","1","EA","","90.48","90.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","78206-162-99","NDC","","","facility","both","1","EA","","66.02","66.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","78206-162-99","NDC","","","facility","both","1","EA","","66.02","66.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Renflexis: 1 Vial In 1 Carton (78206-162-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)","250","RC","78206-162-01","NDC","","","facility","both","1","EA","","67.63","67.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tabloid: 1 Bottle In 1 Carton (80725-630-25)  / 25 Tablet In 1 Bottle","250","RC","80725-630-25","NDC","","","facility","both","1","EA","","767.72","767.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","80777-113-09","NDC","","","facility","both","1","EA","","207.51","207.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate: 24 Pouch In 1 Carton (80830-2363-9)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","250","RC","80830-2363-9","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","80830-2363-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate: 24 Pouch In 1 Carton (80830-2362-9)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag","250","RC","80830-2362-9","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","80830-2362-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid In Sodium Chloride: 12 Pouch In 1 Carton (80830-2329-3)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","250","RC","80830-2329-3","NDC","","","facility","both","1","EA","","10.03","10.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","80830-2329-1","NDC","","","facility","both","1","EA","","10.54","10.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","80830-1693-1","NDC","","","facility","both","1","EA","","12.27","12.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","80830-1692-1","NDC","","","facility","both","1","EA","","7.4","7.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","80830-1691-1","NDC","","","facility","both","1","EA","","5.43","5.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","80830-1188-1","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72266-234-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phytonadione: 1 Bottle In 1 Carton (70710-1014-1)  / 100 Tablet In 1 Bottle","250","RC","70710-1014-1","NDC","","","facility","both","1","EA","","44.87","44.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70700-317-84","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferasirox: 30 Tablet In 1 Bottle, Plastic (70700-271-30)","250","RC","70700-271-30","NDC","","","facility","both","1","EA","","3.17","3.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferasirox: 30 Tablet In 1 Bottle, Plastic (70700-270-30)","250","RC","70700-270-30","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosfomycin Tromethamine: 1 Powder In 1 Packet (70700-268-99)","250","RC","70700-268-99","NDC","","","facility","both","1","EA","","133.31","133.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosfomycin Tromethamine: 1 Dose Pack In 1 Carton (70700-268-94)  / 1 Powder In 1 Dose Pack","250","RC","70700-268-94","NDC","","","facility","both","1","EA","","133.31","133.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70700-116-84","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Pain Reliever: 12 Blister Pack In 1 Carton (70677-1270-1)  / 1 Suppository In 1 Blister Pack","250","RC","70677-1270-1","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Childrens Allergy Relief: 1 Bottle In 1 Carton (70677-1268-1)  / 118 Ml In 1 Bottle","250","RC","70677-1268-1","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin: 30 Tablet, Film Coated In 1 Bottle (70710-1047-3)","250","RC","70710-1047-3","NDC","","","facility","both","1","EA","","7.67","7.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70710-1516-2","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ivabradine: 60 Tablet In 1 Bottle (70710-1471-6)","250","RC","70710-1471-6","NDC","","","facility","both","1","EA","","5.68","5.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70710-1461-1","NDC","","","facility","both","1","EA","","14.48","14.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Droxidopa: 90 Capsule In 1 Bottle (70710-1391-9)","250","RC","70710-1391-9","NDC","","","facility","both","1","EA","","7.13","7.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70710-1377-1","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyproheptadine Hydrochloride: 100 Tablet In 1 Bottle (70710-1110-1)","250","RC","70710-1110-1","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ambrisentan: 30 Tablet, Film Coated In 1 Bottle (70710-1180-3)","250","RC","70710-1180-3","NDC","","","facility","both","1","EA","","24.2","24.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ambrisentan: 30 Tablet, Film Coated In 1 Bottle (70710-1179-3)","250","RC","70710-1179-3","NDC","","","facility","both","1","EA","","25.4","25.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meclizine Hydrochloride: 100 Tablet In 1 Bottle (70710-1162-1)","250","RC","70710-1162-1","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirabegron: 90 Tablet, Extended Release In 1 Bottle (70710-1160-9)","250","RC","70710-1160-9","NDC","","","facility","both","1","EA","","17.05","17.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirabegron: 90 Tablet, Extended Release In 1 Bottle (70710-1159-9)","250","RC","70710-1159-9","NDC","","","facility","both","1","EA","","14.65","14.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 30 Tablet In 1 Bottle (70710-1140-3)","250","RC","70710-1140-3","NDC","","","facility","both","1","EA","","1.29","1.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70710-1359-1","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Childrens Allergy Relief: 1 Bottle In 1 Carton (70677-1268-1)  / 118 Ml In 1 Bottle","250","RC","70677-1268-1","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milk Of Magnesia: 355 Ml In 1 Bottle (70677-1073-1)","250","RC","70677-1073-1","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Nasal: 1 Bottle, Spray In 1 Carton (70677-1037-1)  / 30 Ml In 1 Bottle, Spray","250","RC","70677-1037-1","NDC","","","facility","both","1","EA","","2.12","2.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Childrens Allergy Relief: 1 Bottle In 1 Carton (70677-1012-1)  / 118 Ml In 1 Bottle","250","RC","70677-1012-1","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miconazole Nitrate: 1 Tube In 1 Carton (70677-1000-1)  / 30 G In 1 Tube","250","RC","70677-1000-1","NDC","","","facility","both","1","EA","","3.62","3.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Anti Diarrheal: 120 Ml In 1 Bottle (70677-0054-1)","250","RC","70677-0054-1","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stay Awake: 2 Blister Pack In 1 Carton (70677-0021-1)  / 8 Tablet In 1 Blister Pack","250","RC","70677-0021-1","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carboprost Tromethamine: 10 Vial In 1 Carton (70594-112-02)  / 1 Ml In 1 Vial (70594-112-01)","250","RC","70594-112-02","NDC","","","facility","both","1","EA","","66.31","66.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70594-112-01","NDC","","","facility","both","1","EA","","66.31","66.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70594-111-01","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70594-090-01","NDC","","","facility","both","1","EA","","3.97","3.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70594-089-01","NDC","","","facility","both","1","EA","","4.66","4.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Regular Strength Antacid: 150 Tablet, Chewable In 1 Bottle (70677-1075-1)","250","RC","70677-1075-1","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Infants Gas Relief: 1 Bottle, Dropper In 1 Carton (70677-1078-1)  / 30 Ml In 1 Bottle, Dropper","250","RC","70677-1078-1","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Stomach Relief: 1 Bottle In 1 Carton (70677-1082-1)  / 40 Tablet In 1 Bottle","250","RC","70677-1082-1","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Petroleum: 368 G In 1 Jar (70677-1235-2)","250","RC","70677-1235-2","NDC","","","facility","both","1","EA","","5.3","5.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epsom Salt: 454 G In 1 Pouch (70677-1210-1)","250","RC","70677-1210-1","NDC","","","facility","both","1","EA","","3.27","3.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Regular Strength Stomach Relief 527: 236 Ml In 1 Bottle (70677-1191-1)","250","RC","70677-1191-1","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Earwax Removal Drops: 1 Bottle In 1 Box (70677-1154-1)  / 15 Ml In 1 Bottle","250","RC","70677-1154-1","NDC","","","facility","both","1","EA","","3.7","3.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Earwax Removal Kit Ear Wax Drops: 1 Kit In 1 Kit (70677-1153-1)  *  1 Bottle In 1 Box (70677-1154-1)  / 15 Ml In 1 Bottle","250","RC","70677-1153-1","NDC","","","facility","both","1","EA","","4.89","4.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stay Awake: 2 Blister Pack In 1 Carton (70677-1126-1)  / 8 Tablet In 1 Blister Pack","250","RC","70677-1126-1","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (70677-1111-1)","250","RC","70677-1111-1","NDC","","","facility","both","1","EA","","2.93","2.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mineral Oil: 473 Ml In 1 Bottle, Plastic (70677-1110-1)","250","RC","70677-1110-1","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Anti-Diarrheal: 120 Ml In 1 Bottle (70677-1107-1)","250","RC","70677-1107-1","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Acid Reducer: 1 Bottle In 1 Carton (70677-1102-3)  / 90 Tablet, Film Coated In 1 Bottle","250","RC","70677-1102-3","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Ready To Use Mineral Oil Laxative: 1 Bottle In 1 Carton (70677-1090-1)  / 133 Ml In 1 Bottle","250","RC","70677-1090-1","NDC","","","facility","both","1","EA","","3.12","3.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Ready To Use Saline Laxative: 1 Bottle In 1 Carton (70677-1089-1)  / 133 Ml In 1 Bottle","250","RC","70677-1089-1","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenylephrine Hydrochloride: 1 Bottle, Dropper In 1 Carton (70756-649-35)  / 15 Ml In 1 Bottle, Dropper","250","RC","70756-649-35","NDC","","","facility","both","1","EA","","114.26","114.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenylephrine Hydrochloride: 1 Bottle, Dropper In 1 Carton (70756-629-25)  / 2 Ml In 1 Bottle, Dropper","250","RC","70756-629-25","NDC","","","facility","both","1","EA","","6.19","6.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol Decanoate: 1 Vial In 1 Carton (70756-615-81)  / 1 Ml In 1 Vial","250","RC","70756-615-81","NDC","","","facility","both","1","EA","","11.38","11.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70756-612-12","NDC","","","facility","both","1","EA","","3.3","3.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ofloxacin: 1 Bottle, Dropper In 1 Carton (70756-607-30)  / 5 Ml In 1 Bottle, Dropper","250","RC","70756-607-30","NDC","","","facility","both","1","EA","","19.92","19.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 14 Pouch In 1 Carton (70756-604-56)  / 4 Ampule In 1 Pouch (70756-604-44)  / 5 Ml In 1 Ampule","250","RC","70756-604-56","NDC","","","facility","both","1","EA","","7.55","7.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70756-604-44","NDC","","","facility","both","1","EA","","7.68","7.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (70756-404-11)","250","RC","70756-404-11","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 100 Tablet In 1 Bottle (70756-242-11)","250","RC","70756-242-11","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (70756-201-11)","250","RC","70756-201-11","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 473 Ml In 1 Bottle, Plastic (70752-138-12)","250","RC","70752-138-12","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70756-606-85","NDC","","","facility","both","1","EA","","5.25","5.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lansoprazole: 90 Capsule, Delayed Release In 1 Bottle (70756-807-90)","250","RC","70756-807-90","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cocaine Hydrochloride: 1 Bottle, Glass In 1 Carton (70839-362-04)  / 4 Ml In 1 Bottle, Glass","250","RC","70839-362-04","NDC","","","facility","both","1","EA","","458.32","458.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70860-778-41","NDC","","","facility","both","1","EA","","4.79","4.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 25 Vial, Single-Dose In 1 Carton (70860-776-02)  / 2 Ml In 1 Vial, Single-Dose (70860-776-41)","250","RC","70860-776-02","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70860-700-41","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70860-302-42","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70860-302-42","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70860-301-42","NDC","","","facility","both","1","EA","","1.72","1.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70860-301-41","NDC","","","facility","both","1","EA","","2.89","2.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 10 Vial In 1 Carton (70860-301-05)  / 5 Ml In 1 Vial (70860-301-41)","250","RC","70860-301-05","NDC","","","facility","both","1","EA","","3.24","3.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial In 1 Carton (70860-200-50)  / 50 Ml In 1 Vial","250","RC","70860-200-50","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 1 Bottle In 1 Carton (70860-118-99)  / 100 Ml In 1 Bottle","250","RC","70860-118-99","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70860-100-41","NDC","","","facility","both","1","EA","","4.84","4.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70842-160-01","NDC","","","facility","both","1","EA","","4.28","4.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycerol Phenylbutyrate: 1 Bottle In 1 Carton (70748-425-01)  / 25 Ml In 1 Bottle","250","RC","70748-425-01","NDC","","","facility","both","1","EA","","338.11","338.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylene Blue: 5 Vial In 1 Carton (70710-1838-5)  / 10 Ml In 1 Vial (70710-1838-1)","250","RC","70710-1838-5","NDC","","","facility","both","1","EA","","2.04","2.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylene Blue: 5 Vial In 1 Carton (70710-1838-5)  / 10 Ml In 1 Vial (70710-1838-1)","250","RC","70710-1838-5","NDC","","","facility","both","1","EA","","2.21","2.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70710-1838-1","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70710-1838-1","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 10 Vial In 1 Carton (70710-1725-6)  / 5 Ml In 1 Vial","250","RC","70710-1725-6","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial In 1 Carton (70710-1725-1)  / 5 Ml In 1 Vial","250","RC","70710-1725-1","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 10 Vial In 1 Carton (70710-1724-6)  / 5 Ml In 1 Vial","250","RC","70710-1724-6","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial In 1 Carton (70710-1724-1)  / 5 Ml In 1 Vial","250","RC","70710-1724-1","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 25 Carton In 1 Carton (70710-1643-7)  / 5 Vial In 1 Carton (70710-1643-5)  / 2 Ml In 1 Vial","250","RC","70710-1643-7","NDC","","","facility","both","1","EA","","2.8","2.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Icosapent Ethyl: 120 Capsule In 1 Bottle (70710-1592-7)","250","RC","70710-1592-7","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1530-1)  / 10 Ml In 1 Vial, Single-Dose","250","RC","70710-1530-1","NDC","","","facility","both","1","EA","","73.69","73.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70710-1852-6","NDC","","","facility","both","1","EA","","317.35","317.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prucalopride: 30 Tablet, Film Coated In 1 Bottle (70748-390-01)","250","RC","70748-390-01","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70748-323-02","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70748-323-02","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70748-323-02","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 60 Tablet, Delayed Release In 1 Bottle (70748-258-07)","250","RC","70748-258-07","NDC","","","facility","both","1","EA","","9.96","9.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leflunomide: 30 Tablet, Film Coated In 1 Bottle (70748-129-06)","250","RC","70748-129-06","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Phenylacetate And Sodium Benzoate: 1 Vial In 1 Carton (70710-1926-1)  / 20 Ml In 1 Vial","250","RC","70710-1926-1","NDC","","","facility","both","1","EA","","2244.03","2244.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indomethacin: 5 Blister Pack In 1 Carton (70710-1852-7)  / 6 Suppository In 1 Blister Pack (70710-1852-6)","250","RC","70710-1852-7","NDC","","","facility","both","1","EA","","316.02","316.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 1 Tube In 1 Carton (70752-113-03)  / 35.44 G In 1 Tube","250","RC","70752-113-03","NDC","","","facility","both","1","EA","","16.96","16.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitisinone: 1 Bottle, Plastic In 1 Carton (70505-205-60)  / 60 Capsule In 1 Bottle, Plastic","250","RC","70505-205-60","NDC","","","facility","both","1","EA","","138.32","138.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ic-Green: 6 Package In 1 Carton (70100-825-02)  / 1 Kit In 1 Package *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial (70100-725-01)  *  10 Ml In 1 Vial, Plastic (0409-4887-17)","250","RC","70100-825-02","NDC","","","facility","both","1","EA","","172.51","172.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70100-725-01","NDC","","","facility","both","1","EA","","97.74","97.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indocyanine Green: 6 Package In 1 Carton (70100-424-02)  / 1 Kit In 1 Package *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial *  10 Ml In 1 Vial, Plastic (0409-4887-17)","250","RC","70100-424-02","NDC","","","facility","both","1","EA","","90.72","90.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70100-424-01","NDC","","","facility","both","1","EA","","108.43","108.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70095-050-01","NDC","","","facility","both","1","EA","","14.83","14.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 1 Vial In 1 Carton (70095-031-01)  / 10 Ml In 1 Vial","250","RC","70095-031-01","NDC","","","facility","both","1","EA","","13.24","13.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70095-026-01","NDC","","","facility","both","1","EA","","21.78","21.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70095-025-01","NDC","","","facility","both","1","EA","","4.93","4.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-9599-07","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-9054-05","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-9053-05","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe","250","RC","70121-1568-1","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe","250","RC","70121-1568-1","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe","250","RC","70121-1568-1","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70121-1049-1","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loqtorzi: 1 Vial, Glass In 1 Carton (70114-340-01)  / 6 Ml In 1 Vial, Glass","250","RC","70114-340-01","NDC","","","facility","both","1","EA","","16730.79","16730.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1688-46","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1093-37","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1086-44","NDC","","","facility","both","1","EA","","7.41","7.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1068-07","NDC","","","facility","both","1","EA","","11.7","11.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1046-46","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1046-46","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1018-03","NDC","","","facility","both","1","EA","","4.23","4.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin: 1 Bottle, Glass In 1 Carton (70069-829-01)  / 230 Ml In 1 Bottle, Glass","250","RC","70069-829-01","NDC","","","facility","both","1","EA","","66.02","66.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esomeprazole Magnesium: 90 Capsule, Delayed Release In 1 Bottle (70069-815-90)","250","RC","70069-815-90","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valganciclovir Hydrochloride: 100 Ml In 1 Bottle (70069-810-01)","250","RC","70069-810-01","NDC","","","facility","both","1","EA","","47.89","47.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70069-808-01","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1094-36","NDC","","","facility","both","1","EA","","23.1","23.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1094-36","NDC","","","facility","both","1","EA","","3.13","3.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1105-37","NDC","","","facility","both","1","EA","","39.43","39.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1622-03","NDC","","","facility","both","1","EA","","6.03","6.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1617-46","NDC","","","facility","both","1","EA","","2.64","2.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1611-44","NDC","","","facility","both","1","EA","","23.03","23.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1552-07","NDC","","","facility","both","1","EA","","11.46","11.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1485-46","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1485-46","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1478-44","NDC","","","facility","both","1","EA","","14.74","14.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1475-50","NDC","","","facility","both","1","EA","","14.86","14.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1433-50","NDC","","","facility","both","1","EA","","54.78","54.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1315-74","NDC","","","facility","both","1","EA","","76.41","76.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1310-46","NDC","","","facility","both","1","EA","","13.96","13.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1269-37","NDC","","","facility","both","1","EA","","43.2","43.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1179-44","NDC","","","facility","both","1","EA","","17.34","17.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1175-46","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1175-46","NDC","","","facility","both","1","EA","","7.08","7.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1133-43","NDC","","","facility","both","1","EA","","2.15","2.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70092-1116-75","NDC","","","facility","both","1","EA","","52.78","52.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin: 1 Bottle, Glass In 1 Carton (70377-118-31)  / 230 Ml In 1 Bottle, Glass","250","RC","70377-118-31","NDC","","","facility","both","1","EA","","55.77","55.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 1 Bottle In 1 Carton (70377-117-11)  / 250 Ml In 1 Bottle","250","RC","70377-117-11","NDC","","","facility","both","1","EA","","3.22","3.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 50 Ml In 1 Bottle (70377-113-11)","250","RC","70377-113-11","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 10 Vial, Single-Dose In 1 Carton (70377-076-91)  / 10 Ml In 1 Vial, Single-Dose","250","RC","70377-076-91","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ingrezza: 30 Capsule In 1 Bottle (70370-2040-1)","250","RC","70370-2040-1","NDC","","","facility","both","1","EA","","466.2","466.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ingrezza: 30 Capsule In 1 Bottle (70370-1080-1)","250","RC","70370-1080-1","NDC","","","facility","both","1","EA","","512.1","512.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70257-563-20","NDC","","","facility","both","1","EA","","240.67","240.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hepagam B: 1 Vial, Glass In 1 Carton (70257-051-51)  / 5 Ml In 1 Vial, Glass (70257-051-05)","250","RC","70257-051-51","NDC","","","facility","both","1","EA","","86.23","86.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70255-025-04","NDC","","","facility","both","1","EA","","245.78","245.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70255-025-02","NDC","","","facility","both","1","EA","","163.85","163.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin: 240 Ml In 1 Bottle, Plastic (70408-239-32)","250","RC","70408-239-32","NDC","","","facility","both","1","EA","","178.83","178.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine: 90 Tablet, Extended Release In 1 Bottle, Plastic (70436-012-06)","250","RC","70436-012-06","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxylamine Succinate And Pyridoxine Hydrochloride: 100 Tablet, Delayed Release In 1 Bottle (70505-100-10)","250","RC","70505-100-10","NDC","","","facility","both","1","EA","","4.92","4.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Bottle In 1 Carton (70436-230-39)  / 75 Ml In 1 Bottle","250","RC","70436-230-39","NDC","","","facility","both","1","EA","","8.9","8.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Droxidopa: 90 Capsule In 1 Bottle (70436-141-06)","250","RC","70436-141-06","NDC","","","facility","both","1","EA","","3.69","3.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetrabenazine: 112 Tablet In 1 Bottle (70436-102-09)","250","RC","70436-102-09","NDC","","","facility","both","1","EA","","7.04","7.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetrabenazine: 112 Tablet In 1 Bottle (70436-101-09)","250","RC","70436-101-09","NDC","","","facility","both","1","EA","","3.52","3.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ganciclovir: 25 Vial In 1 Carton (70436-089-55)  / 10 Ml In 1 Vial","250","RC","70436-089-55","NDC","","","facility","both","1","EA","","20.86","20.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70436-032-35","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Injection, Powder, Lyophilized, For Solution In 1 Box (70436-029-80)","250","RC","70436-029-80","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Nitroprusside: 1 Vial In 1 Carton (70436-028-80)  / 2 Ml In 1 Vial","250","RC","70436-028-80","NDC","","","facility","both","1","EA","","18.27","18.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial In 1 Carton (70436-021-82)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","70436-021-82","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 10 Vial In 1 Box (70436-019-82)  / 5 Ml In 1 Vial","250","RC","70436-019-82","NDC","","","facility","both","1","EA","","3.57","3.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Braftovi: 2 Bottle In 1 Carton (70255-025-01)  / 90 Capsule In 1 Bottle (70255-025-02)","250","RC","70255-025-01","NDC","","","facility","both","1","EA","","163.85","163.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70512-812-01","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mektovi: 1 Bottle In 1 Carton (70255-010-02)  / 180 Tablet, Film Coated In 1 Bottle","250","RC","70255-010-02","NDC","","","facility","both","1","EA","","160.76","160.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epidiolex: 1 Bottle, Glass In 1 Carton (70127-100-10)  / 100 Ml In 1 Bottle, Glass (70127-100-01)","250","RC","70127-100-10","NDC","","","facility","both","1","EA","","153.9","153.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 1 Syringe, Glass In 1 Carton (70121-1706-1)  / 10 Ml In 1 Syringe, Glass","250","RC","70121-1706-1","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carboprost Tromethamine: 1 Vial In 1 Carton (70121-1680-1)  / 1 Ml In 1 Vial","250","RC","70121-1680-1","NDC","","","facility","both","1","EA","","83.15","83.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70121-1647-1","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe","250","RC","70121-1570-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe","250","RC","70121-1570-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 1 Syringe, Glass In 1 Carton (70121-1706-1)  / 10 Ml In 1 Syringe, Glass","250","RC","70121-1706-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70121-1712-1","NDC","","","facility","both","1","EA","","44.25","44.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmedetomidine Hydrochloride: 12 Pouch In 1 Carton (70121-1712-3)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","250","RC","70121-1712-3","NDC","","","facility","both","1","EA","","5.61","5.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70127-100-06","NDC","","","facility","both","1","EA","","108.73","108.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70127-100-01","NDC","","","facility","both","1","EA","","101.68","101.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lioresal (Baclofen): 2 Ampule In 1 Box (70121-2505-2)  / 1 Kit In 1 Ampule","250","RC","70121-2505-2","NDC","","","facility","both","1","EA","","261","261","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lioresal (Baclofen): 1 Ampule In 1 Box (70121-2503-1)  / 1 Kit In 1 Ampule","250","RC","70121-2503-1","NDC","","","facility","both","1","EA","","261","261","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lioresal (Baclofen): 1 Ampule In 1 Box (70121-2501-1)  / 1 Kit In 1 Ampule","250","RC","70121-2501-1","NDC","","","facility","both","1","EA","","261","261","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lioresal (Baclofen): 5 Ampule In 1 Box (70121-2496-5)  / 1 Ml In 1 Ampule","250","RC","70121-2496-5","NDC","","","facility","both","1","EA","","40.5","40.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70121-2495-1","NDC","","","facility","both","1","EA","","261","261","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70121-1722-1","NDC","","","facility","both","1","EA","","53.7","53.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70121-1719-1","NDC","","","facility","both","1","EA","","1.29","1.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","70121-1716-1","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aquasol A: 1 Vial, Single-Dose In 1 Carton (70199-026-11)  / 2 Ml In 1 Vial, Single-Dose","250","RC","70199-026-11","NDC","","","facility","both","1","EA","","567","567","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Delsym: 1 Bottle In 1 Carton (63824-175-65)  / 148 Ml In 1 Bottle","250","RC","63824-175-65","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sski: 1 Bottle, With Applicator In 1 Carton (71740-112-30)  / 30 Ml In 1 Bottle, With Applicator","250","RC","71740-112-30","NDC","","","facility","both","1","EA","","4.76","4.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xcopri: 30 Tablet, Film Coated In 1 Bottle (71699-200-30)","250","RC","71699-200-30","NDC","","","facility","both","1","EA","","66.6","66.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xcopri: 30 Tablet, Film Coated In 1 Bottle (71699-050-30)","250","RC","71699-050-30","NDC","","","facility","both","1","EA","","65.1","65.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium: 5 Tray In 1 Case (71656-072-50)  / 10 Cup In 1 Tray / 5 Ml In 1 Cup (71656-072-05)","250","RC","71656-072-50","NDC","","","facility","both","1","EA","","18.04","18.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71656-072-05","NDC","","","facility","both","1","EA","","17.62","17.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 1 Bottle In 1 Bottle (71656-061-16)  / 473 Ml In 1 Bottle","250","RC","71656-061-16","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71656-021-30","NDC","","","facility","both","1","EA","","21.59","21.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71506-028-59","NDC","","","facility","both","1","EA","","9.3","9.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71506-016-59","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71449-079-51","NDC","","","facility","both","1","EA","","919.17","919.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medpura Benzoyl Peroxide Aqueous Base, Acne Treatment Gel: 1 Tube In 1 Carton (71399-9478-5)  / 42.5 Ml In 1 Tube","250","RC","71399-9478-5","NDC","","","facility","both","1","EA","","4.52","4.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fexofenadine Hcl: 100 Tablet In 1 Bottle (71399-8042-1)","250","RC","71399-8042-1","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hcl: 100 Capsule In 1 Bottle (71399-8026-1)","250","RC","71399-8026-1","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Qdolo: 473 Ml In 1 Bottle (71511-301-16)","250","RC","71511-301-16","NDC","","","facility","both","1","EA","","11.75","11.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71399-4456-1","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 30 Ml In 1 Bottle (72162-2037-3)","250","RC","72162-2037-3","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride Extended-Release: 90 Tablet, Extended Release In 1 Bottle (72162-1786-9)","250","RC","72162-1786-9","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (72162-1676-1)","250","RC","72162-1676-1","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultiva: 10 Vial, Glass In 1 Carton (72078-035-02)  / 5 Ml In 1 Vial, Glass (72078-035-00)","250","RC","72078-035-02","NDC","","","facility","both","1","EA","","59.08","59.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72078-035-00","NDC","","","facility","both","1","EA","","82.41","82.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultiva: 10 Vial, Glass In 1 Carton (72078-034-01)  / 3 Ml In 1 Vial, Glass (72078-034-00)","250","RC","72078-034-01","NDC","","","facility","both","1","EA","","36.89","36.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72078-034-00","NDC","","","facility","both","1","EA","","12.38","12.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Caplyta: 30 Capsule In 1 Bottle (72060-142-40)","250","RC","72060-142-40","NDC","","","facility","both","1","EA","","93.88","93.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Natacyn: 1 Bottle, Glass In 1 Carton (71776-005-15)  / 15 Ml In 1 Bottle, Glass","250","RC","71776-005-15","NDC","","","facility","both","1","EA","","1278.58","1278.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Caplyta: 30 Capsule In 1 Bottle (72060-121-40)","250","RC","72060-121-40","NDC","","","facility","both","1","EA","","92.34","92.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71839-143-01","NDC","","","facility","both","1","EA","","4.1","4.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72060-142-01","NDC","","","facility","both","1","EA","","82.22","82.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Asperflex 24Hrs: 1 Patch In 1 Package (71399-3884-1)","250","RC","71399-3884-1","NDC","","","facility","both","1","EA","","1.53","1.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Succinylcholine Chloride: 25 Vial, Multi-Dose In 1 Carton (71288-719-11)  / 10 Ml In 1 Vial, Multi-Dose (71288-719-10)","250","RC","71288-719-11","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Carton (71288-718-11)  / 10 Ml In 1 Vial, Multi-Dose (71288-718-10)","250","RC","71288-718-11","NDC","","","facility","both","1","EA","","4.75","4.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-718-10","NDC","","","facility","both","1","EA","","4.23","4.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-716-11","NDC","","","facility","both","1","EA","","5.96","5.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Carton (71288-700-06)  / 5 Ml In 1 Vial, Multi-Dose (71288-700-05)","250","RC","71288-700-06","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Carton (71288-700-06)  / 5 Ml In 1 Vial, Multi-Dose (71288-700-05)","250","RC","71288-700-06","NDC","","","facility","both","1","EA","","3.88","3.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-700-05","NDC","","","facility","both","1","EA","","1.88","1.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-700-05","NDC","","","facility","both","1","EA","","2.66","2.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 10 Vial, Single-Dose In 1 Carton (71288-600-11)  / 10 Ml In 1 Vial, Single-Dose (71288-600-10)","250","RC","71288-600-11","NDC","","","facility","both","1","EA","","1.24","1.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-600-10","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-505-02","NDC","","","facility","both","1","EA","","7.43","7.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-438-93","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (71288-728-32)  / 30 Ml In 1 Vial, Single-Dose","250","RC","71288-728-32","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-803-20","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hcl: 100 Capsule In 1 Bottle (71399-1028-1)","250","RC","71399-1028-1","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 100 Pouch In 1 Package (71399-1025-3)  / 1 Tablet In 1 Pouch","250","RC","71399-1025-3","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medpura Vitamin A And D Vitamin A And D: 113 G In 1 Tube (71399-0122-4)","250","RC","71399-0122-4","NDC","","","facility","both","1","EA","","5.9","5.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medpura Vitamin A And D Vitamin A And D: 454 G In 1 Jar (71399-0122-1)","250","RC","71399-0122-1","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71390-011-00","NDC","","","facility","both","1","EA","","3.43","3.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doptelet: 2 Blister Pack In 1 Carton (71369-020-30)  / 15 Tablet, Film Coated In 1 Blister Pack (71369-020-16)","250","RC","71369-020-30","NDC","","","facility","both","1","EA","","751.78","751.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doptelet: 1 Blister Pack In 1 Carton (71369-020-15)  / 15 Tablet, Film Coated In 1 Blister Pack (71369-020-16)","250","RC","71369-020-15","NDC","","","facility","both","1","EA","","759.42","759.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71369-020-11","NDC","","","facility","both","1","EA","","759.42","759.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doptelet: 1 Blister Pack In 1 Carton (71369-020-10)  / 10 Tablet, Film Coated In 1 Blister Pack (71369-020-11)","250","RC","71369-020-10","NDC","","","facility","both","1","EA","","718.04","718.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71351-021-05","NDC","","","facility","both","1","EA","","2.34","2.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 4 Vial, Single-Dose In 1 Carton (71288-803-21)  / 20 Ml In 1 Vial, Single-Dose (71288-803-20)","250","RC","71288-803-21","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-803-20","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72196-0422-1","NDC","","","facility","both","1","EA","","85.5","85.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72196-6006-1","NDC","","","facility","both","1","EA","","12.05","12.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72196-6044-1","NDC","","","facility","both","1","EA","","7.5","7.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (72266-118-25)  / 1 Ml In 1 Vial (72266-118-01)","250","RC","72266-118-25","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (72266-118-25)  / 1 Ml In 1 Vial (72266-118-01)","250","RC","72266-118-25","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72266-118-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72266-118-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72266-118-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (72266-103-01)  / 40 Ml In 1 Vial, Multi-Dose","250","RC","72266-103-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (72266-102-01)  / 20 Ml In 1 Vial, Multi-Dose","250","RC","72266-102-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexrazoxane: 1 Vial In 1 Carton (72266-101-01)  / 50 Ml In 1 Vial","250","RC","72266-101-01","NDC","","","facility","both","1","EA","","104.44","104.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 30 Tablet, Film Coated, Extended Release In 1 Bottle (72241-031-22)","250","RC","72241-031-22","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 30 Tablet, Film Coated, Extended Release In 1 Bottle (72241-029-22)","250","RC","72241-029-22","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Capsule In 1 Bottle (72241-023-05)","250","RC","72241-023-05","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Raloxifene Hydrochloride: 30 Tablet, Coated In 1 Bottle (72241-010-22)","250","RC","72241-010-22","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (72266-118-25)  / 1 Ml In 1 Vial (72266-118-01)","250","RC","72266-118-25","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 1 Vial In 1 Carton (72266-124-01)  / 20 Ml In 1 Vial","250","RC","72266-124-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72266-234-01","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72266-234-01","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72266-204-01","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dorzolamide Hydrochloride: 1 Bottle In 1 Carton (72266-197-01)  / 10 Ml In 1 Bottle","250","RC","72266-197-01","NDC","","","facility","both","1","EA","","24.9","24.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Moxifloxacin Ophthalmic Solution: 1 Bottle In 1 Carton (72266-158-01)  / 3 Ml In 1 Bottle","250","RC","72266-158-01","NDC","","","facility","both","1","EA","","15.39","15.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Vial, Single-Dose In 1 Carton (72266-131-01)  / 20 Ml In 1 Vial, Single-Dose","250","RC","72266-131-01","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72266-127-01","NDC","","","facility","both","1","EA","","13.03","13.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Raloxifene Hydrochloride: 100 Tablet, Coated In 1 Bottle (72241-010-05)","250","RC","72241-010-05","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-437-91","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abiraterone: 60 Tablet, Film Coated In 1 Bottle (72205-285-60)","250","RC","72205-285-60","NDC","","","facility","both","1","EA","","11.07","11.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 60 Ml In 1 Bottle, Glass (72205-060-78)","250","RC","72205-060-78","NDC","","","facility","both","1","EA","","2.43","2.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albendazole: 2 Tablet In 1 Bottle (72205-051-08)","250","RC","72205-051-08","NDC","","","facility","both","1","EA","","39.58","39.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (72205-044-11)  / 10 Capsule In 1 Blister Pack","250","RC","72205-044-11","NDC","","","facility","both","1","EA","","3.07","3.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (72205-042-11)  / 10 Capsule In 1 Blister Pack","250","RC","72205-042-11","NDC","","","facility","both","1","EA","","2.73","2.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Use In 1 Carton (72205-031-01)  / 20 Ml In 1 Vial, Single-Use","250","RC","72205-031-01","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atorvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (72205-024-90)","250","RC","72205-024-90","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (72205-003-90)","250","RC","72205-003-90","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","72196-6074-1","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sirolimus: 1 Bottle, Glass In 1 Carton (72205-099-78)  / 60 Ml In 1 Bottle, Glass","250","RC","72205-099-78","NDC","","","facility","both","1","EA","","12.34","12.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sacubitril And Valsartan: 60 Tablet, Film Coated In 1 Bottle (72205-282-60)","250","RC","72205-282-60","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sacubitril And Valsartan: 60 Tablet, Film Coated In 1 Bottle (72205-281-60)","250","RC","72205-281-60","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sacubitril And Valsartan: 60 Tablet, Film Coated In 1 Bottle (72205-280-60)","250","RC","72205-280-60","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vilazodone Hydrochloride: 30 Tablet In 1 Bottle (72205-262-30)","250","RC","72205-262-30","NDC","","","facility","both","1","EA","","1.49","1.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vilazodone Hydrochloride: 30 Tablet In 1 Bottle (72205-261-30)","250","RC","72205-261-30","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vilazodone Hydrochloride: 30 Tablet In 1 Bottle (72205-260-30)","250","RC","72205-260-30","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (72205-211-30)","250","RC","72205-211-30","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (72205-210-30)","250","RC","72205-210-30","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (72205-207-30)","250","RC","72205-207-30","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darunavir: 30 Tablet, Film Coated In 1 Bottle, Plastic (72205-185-30)","250","RC","72205-185-30","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darunavir: 60 Tablet, Film Coated In 1 Bottle, Plastic (72205-184-60)","250","RC","72205-184-60","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 60 Tablet, Coated In 1 Bottle (72205-168-60)","250","RC","72205-168-60","NDC","","","facility","both","1","EA","","2.2","2.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ticagrelor: 100 Tablet In 1 Bottle (72205-368-91)","250","RC","72205-368-91","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (70954-059-10)","250","RC","70954-059-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71285-6060-1","NDC","","","facility","both","1","EA","","38.7","38.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71285-6044-1","NDC","","","facility","both","1","EA","","6.28","6.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71285-0422-1","NDC","","","facility","both","1","EA","","78.3","78.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71285-0204-1","NDC","","","facility","both","1","EA","","85.71","85.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71285-0203-1","NDC","","","facility","both","1","EA","","46.26","46.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71266-9227-1","NDC","","","facility","both","1","EA","","56.25","56.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71266-8006-1","NDC","","","facility","both","1","EA","","45.78","45.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71285-6064-1","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71266-6519-1","NDC","","","facility","both","1","EA","","125.03","125.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71266-5083-1","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71266-5082-1","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71266-5040-1","NDC","","","facility","both","1","EA","","41.24","41.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71266-6290-1","NDC","","","facility","both","1","EA","","14.84","14.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-019-10","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (71288-016-15)  / 10 Ml In 1 Vial, Single-Dose","250","RC","71288-016-15","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71285-6074-1","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71286-6006-1","NDC","","","facility","both","1","EA","","11.97","11.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71286-6003-2","NDC","","","facility","both","1","EA","","18.69","18.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71286-2082-2","NDC","","","facility","both","1","EA","","37.73","37.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71286-2071-5","NDC","","","facility","both","1","EA","","3.81","3.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71285-8093-1","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71285-6176-1","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Misoprostol: 100 Tablet In 1 Bottle (70954-444-20)","250","RC","70954-444-20","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 250 Ml In 1 Bottle (70954-319-10)","250","RC","70954-319-10","NDC","","","facility","both","1","EA","","39.03","39.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet In 1 Bottle (70954-276-10)","250","RC","70954-276-10","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet In 1 Bottle (70954-275-10)","250","RC","70954-275-10","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet In 1 Bottle (70954-273-10)","250","RC","70954-273-10","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicyclomine Hydrochloride: 473 Ml In 1 Bottle (70954-261-10)","250","RC","70954-261-10","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trihexyphenidyl Hydrochloride: 100 Tablet In 1 Bottle (70954-212-10)","250","RC","70954-212-10","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisoprolol Fumarate: 30 Tablet In 1 Bottle (70954-455-10)","250","RC","70954-455-10","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trihexyphenidyl Hydrochloride: 100 Tablet In 1 Bottle (70954-211-10)","250","RC","70954-211-10","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naproxen Oral Suspension: 500 Ml In 1 Bottle (70954-151-10)","250","RC","70954-151-10","NDC","","","facility","both","1","EA","","10.58","10.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyridostigmine: 473 Ml In 1 Bottle (70954-148-10)","250","RC","70954-148-10","NDC","","","facility","both","1","EA","","10.21","10.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levocarnitine: 118 Ml In 1 Bottle (70954-140-10)","250","RC","70954-140-10","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dapsone: 100 Tablet In 1 Bottle (70954-136-20)","250","RC","70954-136-20","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dapsone: 100 Tablet In 1 Bottle (70954-135-20)","250","RC","70954-135-20","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisoprolol Fumarate: 30 Tablet In 1 Bottle (70954-456-10)","250","RC","70954-456-10","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levocarnitine: 90 Blister Pack In 1 Carton (70954-492-10)  / 10 Tablet In 1 Blister Pack","250","RC","70954-492-10","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71019-029-03","NDC","","","facility","both","1","EA","","2.79","2.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71019-014-07","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71019-014-07","NDC","","","facility","both","1","EA","","5.4","5.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitazoxanide: 6 Tablet In 1 Bottle (70954-934-10)","250","RC","70954-934-10","NDC","","","facility","both","1","EA","","172.69","172.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 480 Ml In 1 Bottle (70954-852-30)","250","RC","70954-852-30","NDC","","","facility","both","1","EA","","22.77","22.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indomethacin: 1 Bottle In 1 Carton (70954-637-10)  / 237 Ml In 1 Bottle","250","RC","70954-637-10","NDC","","","facility","both","1","EA","","6.81","6.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine Hydrochloride: 120 Ml In 1 Bottle, Plastic (70954-600-10)","250","RC","70954-600-10","NDC","","","facility","both","1","EA","","2.95","2.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prucalopride: 30 Tablet In 1 Bottle (70954-597-10)","250","RC","70954-597-10","NDC","","","facility","both","1","EA","","25.77","25.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin: 230 Ml In 1 Bottle (70954-496-10)","250","RC","70954-496-10","NDC","","","facility","both","1","EA","","120.43","120.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Vial, Single-Dose In 1 Carton (71288-027-30)  / 20 Ml In 1 Vial, Single-Dose","250","RC","71288-027-30","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-403-01","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (71288-402-31)  / 30 Ml In 1 Vial, Multi-Dose (71288-402-30)","250","RC","71288-402-31","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (71288-402-11)  / 10 Ml In 1 Vial, Multi-Dose (71288-402-10)","250","RC","71288-402-11","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-402-10","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Single-Dose In 1 Carton (71288-400-03)  / 2 Ml In 1 Vial, Single-Dose (71288-400-02)","250","RC","71288-400-03","NDC","","","facility","both","1","EA","","1.76","1.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-400-02","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-303-01","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-203-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-203-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-203-02","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyanocobalamin: 25 Vial, Multi-Dose In 1 Carton (71288-303-02)  / 1 Ml In 1 Vial, Multi-Dose (71288-303-01)","250","RC","71288-303-02","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Single-Dose In 1 Carton (71288-403-02)  / 1 Ml In 1 Vial, Single-Dose (71288-403-01)","250","RC","71288-403-02","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-436-88","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (71288-435-87)  / .8 Ml In 1 Syringe (71288-435-86)","250","RC","71288-435-87","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-435-86","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (71288-434-85)  / .6 Ml In 1 Syringe (71288-434-84)","250","RC","71288-434-85","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-434-84","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (71288-433-83)  / .4 Ml In 1 Syringe (71288-433-82)","250","RC","71288-433-83","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-433-82","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (71288-432-81)  / .3 Ml In 1 Syringe (71288-432-80)","250","RC","71288-432-81","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-432-80","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-427-10","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 1 Vial, Multi-Dose In 1 Carton (71288-426-03)  / 3 Ml In 1 Vial, Multi-Dose","250","RC","71288-426-03","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (71288-436-89)  / 1 Ml In 1 Syringe (71288-436-88)","250","RC","71288-436-89","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-203-02","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-203-02","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Vial, Single-Dose In 1 Carton (71288-115-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","250","RC","71288-115-30","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Vial, Single-Dose In 1 Carton (71288-115-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","250","RC","71288-115-30","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial, Single-Dose In 1 Carton (71288-109-20)  / 20 Ml In 1 Vial, Single-Dose","250","RC","71288-109-20","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 1 Bottle In 1 Carton (71288-033-75)  / 1 Injection, Powder, For Solution In 1 Bottle","250","RC","71288-033-75","NDC","","","facility","both","1","EA","","3.55","3.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-032-20","NDC","","","facility","both","1","EA","","2.98","2.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-031-20","NDC","","","facility","both","1","EA","","3.62","3.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-029-10","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 10 Vial, Single-Dose In 1 Carton (71288-028-11)  / 5 Ml In 1 Vial, Single-Dose (71288-028-10)","250","RC","71288-028-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","71288-028-10","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Regadenoson: 1 Syringe, Plastic In 1 Carton (71288-201-85)  / 5 Ml In 1 Syringe, Plastic","250","RC","71288-201-85","NDC","","","facility","both","1","EA","","4.09","4.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50)  / 50 Ml In 1 Vial, Single-Dose","250","RC","71288-167-50","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial, Single-Dose In 1 Carton (71288-157-10)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","250","RC","71288-157-10","NDC","","","facility","both","1","EA","","9.13","9.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial, Single-Dose In 1 Carton (71288-137-20)  / 10 Ml In 1 Vial, Single-Dose","250","RC","71288-137-20","NDC","","","facility","both","1","EA","","248.98","248.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 10 Blister Pack In 1 Box, Unit-Dose (63739-995-10)  / 10 Capsule In 1 Blister Pack","250","RC","63739-995-10","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55513-126-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Otezla: 60 Tablet, Film Coated In 1 Bottle (55513-137-60)","250","RC","55513-137-60","NDC","","","facility","both","1","EA","","147.26","147.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Blincyto: 1 Kit In 1 Package (55513-160-01)  *  3.088 Ml In 1 Vial (55513-150-01)  *  10.6 Ml In 1 Vial (55513-155-01)","250","RC","55513-160-01","NDC","","","facility","both","1","EA","","279.56","279.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55513-150-01","NDC","","","facility","both","1","EA","","250.03","250.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55513-148-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sensipar: 30 Tablet, Coated In 1 Bottle, Plastic (55513-073-30)","250","RC","55513-073-30","NDC","","","facility","both","1","EA","","2.02","2.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55513-057-01","NDC","","","facility","both","1","EA","","6.89","6.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55566-6500-1","NDC","","","facility","both","1","EA","","23.64","23.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cervidil: 1 Pouch In 1 Carton (55566-2800-1)  / 10 Mg In 1 Pouch (55566-2800-0)","250","RC","55566-2800-1","NDC","","","facility","both","1","EA","","913.18","913.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55566-2800-0","NDC","","","facility","both","1","EA","","913.18","913.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Corlanor: 28 Ampule In 1 Carton (55513-813-28)  / 5 Ml In 1 Ampule (55513-813-01)","250","RC","55513-813-28","NDC","","","facility","both","1","EA","","3.84","3.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55513-813-01","NDC","","","facility","both","1","EA","","3.74","3.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (57664-046-88)","250","RC","57664-046-88","NDC","","","facility","both","1","EA","","8.76","8.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamivudine: 240 Ml In 1 Bottle (57237-274-24)","250","RC","57237-274-24","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (57237-184-90)","250","RC","57237-184-90","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Moxifloxacin Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (57237-156-30)","250","RC","57237-156-30","NDC","","","facility","both","1","EA","","9.54","9.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alfuzosin Hydrochloride: 90 Tablet, Film Coated, Extended Release In 1 Bottle (57237-114-90)","250","RC","57237-114-90","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 3 Blister Pack In 1 Carton (57237-077-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","57237-077-10","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Finasteride: 30 Tablet, Film Coated In 1 Bottle (57237-061-30)","250","RC","57237-061-30","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (57237-047-01)","250","RC","57237-047-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (57237-043-90)","250","RC","57237-043-90","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (57237-042-90)","250","RC","57237-042-90","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin V Potassium: 100 Tablet, Film Coated In 1 Bottle (57237-040-01)","250","RC","57237-040-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Tablet, Film Coated In 1 Bottle (57237-028-01)","250","RC","57237-028-01","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 12 Blister Pack In 1 Carton (57237-005-11)  / 1 Tablet In 1 Blister Pack","250","RC","57237-005-11","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (57237-075-30)","250","RC","57237-075-30","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Corlanor: 60 Tablet, Film Coated In 1 Bottle (55513-810-60)","250","RC","55513-810-60","NDC","","","facility","both","1","EA","","17.28","17.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Corlanor: 60 Tablet, Film Coated In 1 Bottle (55513-800-60)","250","RC","55513-800-60","NDC","","","facility","both","1","EA","","9.92","9.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nplate: 1 Vial, Single-Dose In 1 Carton (55513-223-01)  / .25 Ml In 1 Vial, Single-Dose","250","RC","55513-223-01","NDC","","","facility","both","1","EA","","19.82","19.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nplate: 1 Vial, Single-Dose In 1 Carton (55513-223-01)  / .25 Ml In 1 Vial, Single-Dose","250","RC","55513-223-01","NDC","","","facility","both","1","EA","","21.48","21.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nplate: 1 Vial In 1 Carton (55513-222-01)  / 1 Ml In 1 Vial","250","RC","55513-222-01","NDC","","","facility","both","1","EA","","19.82","19.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55513-267-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial","250","RC","55513-207-01","NDC","","","facility","both","1","EA","","83.36","83.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial","250","RC","55513-207-01","NDC","","","facility","both","1","EA","","83.36","83.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-206-01)  / 4 Ml In 1 Vial","250","RC","55513-206-01","NDC","","","facility","both","1","EA","","83.36","83.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amjevita: 1 Syringe In 1 Carton (55513-481-01)  / .8 Ml In 1 Syringe","250","RC","55513-481-01","NDC","","","facility","both","1","EA","","2406.14","2406.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01)  / 1.7 Ml In 1 Vial, Single-Use","250","RC","55513-730-01","NDC","","","facility","both","1","EA","","50.19","50.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avsola: 1 Vial, Single-Dose In 1 Carton (55513-670-01)  / 10 Ml In 1 Vial, Single-Dose","250","RC","55513-670-01","NDC","","","facility","both","1","EA","","78.17","78.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amjevita: 1 Syringe In 1 Carton (55513-482-01)  / .4 Ml In 1 Syringe","250","RC","55513-482-01","NDC","","","facility","both","1","EA","","1203.07","1203.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-169-10)  / 10 Ml In 1 Vial, Single-Dose","250","RC","55150-169-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-169-10)  / 10 Ml In 1 Vial, Single-Dose","250","RC","55150-169-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-168-30)  / 30 Ml In 1 Vial, Single-Dose","250","RC","55150-168-30","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-171-10)  / 10 Ml In 1 Vial, Single-Dose","250","RC","55150-171-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sildenafil: 1 Vial, Single-Dose In 1 Carton (55150-166-13)  / 12.5 Ml In 1 Vial, Single-Dose","250","RC","55150-166-13","NDC","","","facility","both","1","EA","","137.68","137.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-165-05)  / 5 Ml In 1 Vial, Single-Dose","250","RC","55150-165-05","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-165-05)  / 5 Ml In 1 Vial, Single-Dose","250","RC","55150-165-05","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (55150-163-30)  / 30 Ml In 1 Vial, Single-Dose","250","RC","55150-163-30","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (55150-163-30)  / 30 Ml In 1 Vial, Single-Dose","250","RC","55150-163-30","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-168-30)  / 30 Ml In 1 Vial, Single-Dose","250","RC","55150-168-30","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 10 Vial, Single-Dose In 1 Carton (55150-202-10)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose (55150-202-00)","250","RC","55150-202-10","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-202-00","NDC","","","facility","both","1","EA","","2.21","2.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-201-20)  / 20 Ml In 1 Vial, Single-Dose","250","RC","55150-201-20","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esmolol Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-194-10)  / 10 Ml In 1 Vial, Single-Dose","250","RC","55150-194-10","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-171-10)  / 10 Ml In 1 Vial, Single-Dose","250","RC","55150-171-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 10 Vial, Single-Dose In 1 Carton (55150-188-10)  / 10 Ml In 1 Vial, Single-Dose","250","RC","55150-188-10","NDC","","","facility","both","1","EA","","2.95","2.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-183-01","NDC","","","facility","both","1","EA","","17.76","17.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 10 Vial, Single-Dose In 1 Carton (55150-177-05)  / 5 Ml In 1 Vial, Single-Dose","250","RC","55150-177-05","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 10 Vial, Single-Dose In 1 Carton (55150-174-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","250","RC","55150-174-10","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sumatriptan: 5 Vial, Single-Dose In 1 Carton (55150-173-01)  / .5 Ml In 1 Vial, Single-Dose","250","RC","55150-173-01","NDC","","","facility","both","1","EA","","5.87","5.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-172-30)  / 30 Ml In 1 Vial, Single-Dose","250","RC","55150-172-30","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicardipine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-183-10)  / 10 Ml In 1 Vial, Single-Dose (55150-183-01)","250","RC","55150-183-10","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-162-05)  / 5 Ml In 1 Vial, Single-Dose","250","RC","55150-162-05","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-162-05)  / 5 Ml In 1 Vial, Single-Dose","250","RC","55150-162-05","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-162-05)  / 5 Ml In 1 Vial, Single-Dose","250","RC","55150-162-05","NDC","","","facility","both","1","EA","","1.58","1.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55111-681-11","NDC","","","facility","both","1","EA","","4.51","4.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fondaparinux Sodium: 10 Syringe In 1 Carton (55111-680-10)  / .6 Ml In 1 Syringe (55111-680-11)","250","RC","55111-680-10","NDC","","","facility","both","1","EA","","5.95","5.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55111-678-11","NDC","","","facility","both","1","EA","","2.64","2.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fondaparinux Sodium: 10 Syringe In 1 Carton (55111-678-10)  / .5 Ml In 1 Syringe (55111-678-11)","250","RC","55111-678-10","NDC","","","facility","both","1","EA","","2.64","2.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55111-671-06","NDC","","","facility","both","1","EA","","34.32","34.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fondaparinux Sodium: 10 Syringe In 1 Carton (55111-681-10)  / .8 Ml In 1 Syringe (55111-681-11)","250","RC","55111-681-10","NDC","","","facility","both","1","EA","","4.59","4.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial In 1 Box (55150-114-20)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","55150-114-20","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-161-02)  / 2 Ml In 1 Vial, Single-Dose","250","RC","55150-161-02","NDC","","","facility","both","1","EA","","2.4","2.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Ampule In 1 Carton (55150-159-74)  / 5 Ml In 1 Ampule","250","RC","55150-159-74","NDC","","","facility","both","1","EA","","2.46","2.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir Sodium: 10 Vial, Single-Dose In 1 Carton (55150-155-20)  / 20 Ml In 1 Vial, Single-Dose","250","RC","55150-155-20","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir Sodium: 10 Vial, Single-Dose In 1 Carton (55150-154-10)  / 10 Ml In 1 Vial, Single-Dose","250","RC","55150-154-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxacillin: 10 Vial In 1 Box (55150-128-24)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","55150-128-24","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-121-50)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","55150-121-50","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-120-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","55150-120-30","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-119-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","55150-119-30","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 1 Vial, Pharmacy Bulk Package In 1 Carton (55150-118-99)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","250","RC","55150-118-99","NDC","","","facility","both","1","EA","","2.8","2.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (55150-117-20)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","55150-117-20","NDC","","","facility","both","1","EA","","3.02","3.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (55150-116-20)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","55150-116-20","NDC","","","facility","both","1","EA","","3.15","3.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meropenem: 10 Vial In 1 Carton (55150-207-20)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","55150-207-20","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meropenem: 10 Vial In 1 Carton (55150-208-30)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","55150-208-30","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-459-01","NDC","","","facility","both","1","EA","","33.81","33.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-438-01","NDC","","","facility","both","1","EA","","12.05","12.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-403-01","NDC","","","facility","both","1","EA","","2.8","2.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gentamicin: 25 Vial, Multi-Dose In 1 Carton (55150-402-25)  / 2 Ml In 1 Vial, Multi-Dose (55150-402-01)","250","RC","55150-402-25","NDC","","","facility","both","1","EA","","2.62","2.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-402-01","NDC","","","facility","both","1","EA","","2.44","2.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carboprost Tromethamine: 10 Vial, Single-Dose In 1 Carton (55150-459-10)  / 1 Ml In 1 Vial, Single-Dose (55150-459-01)","250","RC","55150-459-10","NDC","","","facility","both","1","EA","","34.07","34.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-400-01","NDC","","","facility","both","1","EA","","2.58","2.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin: 25 Vial, Multi-Dose In 1 Carton (55150-370-25)  / 1 Ml In 1 Vial, Multi-Dose","250","RC","55150-370-25","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin: 1 Vial, Multi-Dose In 1 Carton (55150-370-01)  / 1 Ml In 1 Vial, Multi-Dose","250","RC","55150-370-01","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (55150-365-01)  / 12.5 Ml In 1 Vial, Single-Dose","250","RC","55150-365-01","NDC","","","facility","both","1","EA","","30.72","30.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (55150-365-01)  / 12.5 Ml In 1 Vial, Single-Dose","250","RC","55150-365-01","NDC","","","facility","both","1","EA","","96.58","96.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55292-133-01","NDC","","","facility","both","1","EA","","461.49","461.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55292-133-06","NDC","","","facility","both","1","EA","","461.49","461.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Signifor: 60 Package In 1 Box (55292-133-60)  / 6 Ampule In 1 Package (55292-133-06)  / 1 Ml In 1 Ampule (55292-133-01)","250","RC","55292-133-60","NDC","","","facility","both","1","EA","","461.49","461.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diclegis: 100 Tablet, Delayed Release In 1 Bottle (55494-100-10)","250","RC","55494-100-10","NDC","","","facility","both","1","EA","","3.46","3.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55329-301-24","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chemet: 100 Capsule In 1 Bottle (55292-201-11)","250","RC","55292-201-11","NDC","","","facility","both","1","EA","","39.66","39.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Tablet In 1 Bottle (57664-376-88)","250","RC","57664-376-88","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 10 Syringe In 1 Box (55150-345-10)  / 2 Ml In 1 Syringe","250","RC","55150-345-10","NDC","","","facility","both","1","EA","","10.81","10.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 1 Syringe In 1 Box (55150-345-01)  / 2 Ml In 1 Syringe","250","RC","55150-345-01","NDC","","","facility","both","1","EA","","11.27","11.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 25 Vial, Single-Dose In 1 Carton (55150-237-01)  / 1 Ml In 1 Vial, Single-Dose","250","RC","55150-237-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-236-01","NDC","","","facility","both","1","EA","","36.49","36.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vecuronium Bromide: 10 Vial In 1 Carton (55150-235-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (55150-235-01)","250","RC","55150-235-10","NDC","","","facility","both","1","EA","","15.04","15.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-235-01","NDC","","","facility","both","1","EA","","6.17","6.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polymyxin B: 10 Vial In 1 Carton (55150-234-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","55150-234-10","NDC","","","facility","both","1","EA","","4.96","4.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-233-00","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Carton (55150-225-05)  / 5 Ml In 1 Vial, Multi-Dose","250","RC","55150-225-05","NDC","","","facility","both","1","EA","","3.1","3.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 25 Vial, Single-Dose In 1 Carton (55150-223-10)  / 10 Ml In 1 Vial, Single-Dose","250","RC","55150-223-10","NDC","","","facility","both","1","EA","","2.74","2.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 25 Vial, Single-Dose In 1 Carton (55150-223-10)  / 10 Ml In 1 Vial, Single-Dose","250","RC","55150-223-10","NDC","","","facility","both","1","EA","","4.11","4.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmedetomidine: 25 Vial In 1 Carton (55150-209-02)  / 2 Ml In 1 Vial","250","RC","55150-209-02","NDC","","","facility","both","1","EA","","3.13","3.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-232-00","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 10 Pouch In 1 Carton (55150-242-51)  / 1 Bag In 1 Pouch / 300 Ml In 1 Bag","250","RC","55150-242-51","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 10 Pouch In 1 Carton (55150-248-47)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","250","RC","55150-248-47","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 1 Vial, Single-Dose In 1 Carton (55150-342-01)  / 2 Ml In 1 Vial, Single-Dose","250","RC","55150-342-01","NDC","","","facility","both","1","EA","","3.87","3.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-323-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-318-01","NDC","","","facility","both","1","EA","","28.91","28.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 24 Vial, Single-Dose In 1 Carton (55150-307-24)  / 100 Ml In 1 Vial, Single-Dose (55150-307-01)","250","RC","55150-307-24","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-297-01","NDC","","","facility","both","1","EA","","25.39","25.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","55150-287-01","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ertapenem: 10 Vial, Single-Dose In 1 Carton (55150-282-20)  / 1 Injection In 1 Vial, Single-Dose","250","RC","55150-282-20","NDC","","","facility","both","1","EA","","21.01","21.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Decanoate: 1 Vial, Multi-Dose In 1 Carton (55150-267-05)  / 5 Ml In 1 Vial, Multi-Dose","250","RC","55150-267-05","NDC","","","facility","both","1","EA","","12.89","12.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Tablet In 1 Bottle (57664-378-88)","250","RC","57664-378-88","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leflunomide: 30 Tablet, Film Coated In 1 Bottle (59651-348-30)","250","RC","59651-348-30","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flucytosine: 100 Capsule In 1 Bottle (59651-332-01)","250","RC","59651-332-01","NDC","","","facility","both","1","EA","","26.05","26.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flucytosine: 100 Capsule In 1 Bottle (59651-331-01)","250","RC","59651-331-01","NDC","","","facility","both","1","EA","","10.35","10.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tamoxifen Citrate: 60 Tablet, Film Coated In 1 Bottle (59651-299-60)","250","RC","59651-299-60","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Roflumilast: 30 Tablet In 1 Bottle (59651-275-30)","250","RC","59651-275-30","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propafenone Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (59651-256-01)","250","RC","59651-256-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 100 Tablet In 1 Bottle (59651-249-01)","250","RC","59651-249-01","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azelastine Hydrochloride: 1 Bottle, Spray In 1 Carton (59651-214-30)  / 200 Spray, Metered In 1 Bottle, Spray","250","RC","59651-214-30","NDC","","","facility","both","1","EA","","23.87","23.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eletriptan Hydrobromide: 1 Blister Pack In 1 Carton (59651-105-69)  / 6 Tablet, Film Coated In 1 Blister Pack (59651-105-06)","250","RC","59651-105-69","NDC","","","facility","both","1","EA","","15.79","15.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59651-105-06","NDC","","","facility","both","1","EA","","15.79","15.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darunavir: 60 Tablet, Film Coated In 1 Bottle (59651-085-60)","250","RC","59651-085-60","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 1 Bottle In 1 Carton (59651-032-47)  / 473 Ml In 1 Bottle","250","RC","59651-032-47","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (59651-026-55)","250","RC","59651-026-55","NDC","","","facility","both","1","EA","","2.39","2.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Niacin: 90 Tablet, Extended Release In 1 Bottle (59651-018-90)","250","RC","59651-018-90","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylin: 500 Ml In 1 Bottle (59630-750-50)","250","RC","59630-750-50","NDC","","","facility","both","1","EA","","2.15","2.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Progesterone: 100 Capsule In 1 Bottle (59651-152-01)","250","RC","59651-152-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clomipramine Hydrochloride: 100 Capsule In 1 Bottle (59651-381-01)","250","RC","59651-381-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (59651-397-08)","250","RC","59651-397-08","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (59651-489-01)","250","RC","59651-489-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (59651-488-01)","250","RC","59651-488-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (59651-486-01)","250","RC","59651-486-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (59651-485-01)","250","RC","59651-485-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 100 Tablet In 1 Bottle (59651-394-01)","250","RC","59651-394-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (59651-484-01)","250","RC","59651-484-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Tablet In 1 Bottle (59651-457-01)","250","RC","59651-457-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Tablet In 1 Bottle (59651-456-01)","250","RC","59651-456-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valganciclovir: 1 Bottle, Glass In 1 Carton (59651-444-01)  / 100 Ml In 1 Bottle, Glass","250","RC","59651-444-01","NDC","","","facility","both","1","EA","","53.89","53.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sildenafil Citrate: 1 Bottle In 1 Carton (59651-420-11)  / 112 Ml In 1 Bottle","250","RC","59651-420-11","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 100 Tablet In 1 Bottle (59651-414-01)","250","RC","59651-414-01","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 50 Tablet In 1 Bottle (59651-413-50)","250","RC","59651-413-50","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 1 Bottle In 1 Carton (59651-401-12)  / 120 Ml In 1 Bottle","250","RC","59651-401-12","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paragard T 380A: 1 Pouch In 1 Carton (59365-5128-1)  / 1 Intrauterine Device In 1 Pouch","250","RC","59365-5128-1","NDC","","","facility","both","1","EA","","1953","1953","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Qvar Redihaler: 1 Inhaler In 1 Carton (59310-304-80)  / 1 Canister In 1 Inhaler / 120 Aerosol, Metered In 1 Canister","250","RC","59310-304-80","NDC","","","facility","both","1","EA","","484.83","484.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Qvar Redihaler: 1 Inhaler In 1 Carton (59310-302-40)  / 1 Canister In 1 Inhaler / 120 Aerosol, Metered In 1 Canister","250","RC","59310-302-40","NDC","","","facility","both","1","EA","","362.83","362.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59267-4426-1","NDC","","","facility","both","1","EA","","93.15","93.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nuedexta: 60 Capsule, Gelatin Coated In 1 Bottle (59148-053-16)","250","RC","59148-053-16","NDC","","","facility","both","1","EA","","44.85","44.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rexulti: 1 Bottle In 1 Carton (59148-038-13)  / 30 Tablet In 1 Bottle","250","RC","59148-038-13","NDC","","","facility","both","1","EA","","83.5","83.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rexulti: 1 Bottle In 1 Carton (59148-037-13)  / 30 Tablet In 1 Bottle","250","RC","59148-037-13","NDC","","","facility","both","1","EA","","82.46","82.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rexulti: 1 Bottle In 1 Carton (59148-036-13)  / 30 Tablet In 1 Bottle","250","RC","59148-036-13","NDC","","","facility","both","1","EA","","83.77","83.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rexulti: 1 Bottle In 1 Carton (59148-035-13)  / 30 Tablet In 1 Bottle","250","RC","59148-035-13","NDC","","","facility","both","1","EA","","83.86","83.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycontin: 2 Blister Pack In 1 Carton (59011-440-20)  / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack","250","RC","59011-440-20","NDC","","","facility","both","1","EA","","25.51","25.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycontin: 2 Blister Pack In 1 Carton (59011-420-20)  / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack","250","RC","59011-420-20","NDC","","","facility","both","1","EA","","15.58","15.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59385-021-01","NDC","","","facility","both","1","EA","","12.39","12.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59385-022-01","NDC","","","facility","both","1","EA","","12.46","12.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59630-266-01","NDC","","","facility","both","1","EA","","3.86","3.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Candin: 1 Ml In 1 Vial, Multi-Dose (59584-138-01)","250","RC","59584-138-01","NDC","","","facility","both","1","EA","","131.27","131.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Istodax: 1 Kit In 1 Carton (59572-984-01)  *  2.2 Ml In 1 Vial, Glass (59572-962-10)  *  2.4 Ml In 1 Vial, Glass (59572-973-02)","250","RC","59572-984-01","NDC","","","facility","both","1","EA","","57.58","57.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Inrebic: 120 Capsule In 1 Bottle, Plastic (59572-720-12)","250","RC","59572-720-12","NDC","","","facility","both","1","EA","","414","414","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Idhifa: 30 Tablet, Film Coated In 1 Bottle (59572-710-30)","250","RC","59572-710-30","NDC","","","facility","both","1","EA","","1694.76","1694.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Idhifa: 30 Tablet, Film Coated In 1 Bottle (59572-705-30)","250","RC","59572-705-30","NDC","","","facility","both","1","EA","","1694.76","1694.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyvanse: 100 Capsule In 1 Bottle (59417-101-10)","250","RC","59417-101-10","NDC","","","facility","both","1","EA","","21.46","21.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59385-024-01","NDC","","","facility","both","1","EA","","26.52","26.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59385-023-01","NDC","","","facility","both","1","EA","","19.37","19.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (59651-499-01)","250","RC","59651-499-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Exemestane: 30 Tablet, Film Coated In 1 Bottle (59651-516-30)","250","RC","59651-516-30","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicloxacillin Sodium: 100 Capsule In 1 Bottle (59651-566-01)","250","RC","59651-566-01","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 100 Tablet In 1 Bottle (59762-0075-1)","250","RC","59762-0075-1","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 100 Tablet In 1 Bottle (59762-0074-1)","250","RC","59762-0074-1","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 50 Tablet In 1 Bottle (59762-0073-1)","250","RC","59762-0073-1","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 1 Bottle, Dropper In 1 Carton (59762-0067-1)  / 60 Ml In 1 Bottle, Dropper","250","RC","59762-0067-1","NDC","","","facility","both","1","EA","","8.71","8.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone: 25 Tablet In 1 Bottle (59762-0049-1)","250","RC","59762-0049-1","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valsartan: 90 Tablet In 1 Bottle (59746-361-90)","250","RC","59746-361-90","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 3 Blister Pack In 1 Carton (59746-307-32)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack (59746-307-12)","250","RC","59746-307-32","NDC","","","facility","both","1","EA","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 3 Blister Pack In 1 Carton (59746-306-32)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack (59746-306-12)","250","RC","59746-306-32","NDC","","","facility","both","1","EA","","1.43","1.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (59746-175-06)","250","RC","59746-175-06","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Maleate: 100 Tablet In 1 Bottle (59746-115-06)","250","RC","59746-115-06","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Maleate: 100 Tablet In 1 Bottle (59746-113-06)","250","RC","59746-113-06","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 7 Blister Pack In 1 Carton (59746-050-22)  / 4 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","59746-050-22","NDC","","","facility","both","1","EA","","3.8","3.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 180 Capsule, Delayed Release In 1 Bottle (59762-0117-1)","250","RC","59762-0117-1","NDC","","","facility","both","1","EA","","2.98","2.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenelzine Sulfate: 60 Tablet, Film Coated In 1 Bottle (59762-0119-1)","250","RC","59762-0119-1","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Silver Sulfadiazine: 1 Tube In 1 Carton (59762-0131-2)  / 25 G In 1 Tube","250","RC","59762-0131-2","NDC","","","facility","both","1","EA","","12.38","12.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59923-615-01","NDC","","","facility","both","1","EA","","33.19","33.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 1 Bottle In 1 Carton (59762-5030-1)  / 35 Ml In 1 Bottle","250","RC","59762-5030-1","NDC","","","facility","both","1","EA","","10.72","10.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfasalazine: 1 Bottle In 1 Carton (59762-5000-5)  / 100 Tablet In 1 Bottle","250","RC","59762-5000-5","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"medroxyprogesterone acetate: 1 BOTTLE in 1 CARTON (59762-3742-2)  / 100 TABLET in 1 BOTTLE","250","RC","59762-3742-2","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 1 Bottle In 1 Carton (59762-3140-1)  / 30 Ml In 1 Bottle","250","RC","59762-3140-1","NDC","","","facility","both","1","EA","","4.53","4.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Asenapine: 6 Blister Pack In 1 Box (59762-2888-6)  / 10 Tablet In 1 Blister Pack","250","RC","59762-2888-6","NDC","","","facility","both","1","EA","","9.97","9.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59762-2012-1","NDC","","","facility","both","1","EA","","9.97","9.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"100 BLISTER PACK in 1 CARTON (59762-1710-1)  / 1 TABLET, FILM COATED in 1 BLISTER PACK","250","RC","59762-1710-1","NDC","","","facility","both","1","EA","","4.96","4.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 1 Bottle In 1 Carton (59762-1576-1)  / 473 Ml In 1 Bottle","250","RC","59762-1576-1","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rifabutin: 100 Capsule In 1 Bottle (59762-1350-1)","250","RC","59762-1350-1","NDC","","","facility","both","1","EA","","21.09","21.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Liothyronine Sodium: 100 Tablet In 1 Bottle (59762-1206-1)","250","RC","59762-1206-1","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sirolimus: 100 Tablet, Sugar Coated In 1 Bottle (59762-1002-1)","250","RC","59762-1002-1","NDC","","","facility","both","1","EA","","11.57","11.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Bottle In 1 Carton (59762-0935-3)  / 75 Ml In 1 Bottle","250","RC","59762-0935-3","NDC","","","facility","both","1","EA","","64.17","64.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sucralfate: 100 Tablet In 1 Bottle (59762-0401-1)","250","RC","59762-0401-1","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Latanoprost: 1 Bottle, Dropper In 1 Carton (59762-0333-2)  / 2.5 Ml In 1 Bottle, Dropper","250","RC","59762-0333-2","NDC","","","facility","both","1","EA","","3.38","3.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 7 Blister Pack In 1 Carton (59746-040-22)  / 4 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","59746-040-22","NDC","","","facility","both","1","EA","","3.18","3.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 7 Blister Pack In 1 Carton (59746-030-22)  / 4 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","59746-030-22","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59676-304-00","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59676-303-00","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procrit: 6 Vial, Single-Dose In 1 Carton (59676-302-01)  / 1 Ml In 1 Vial, Single-Dose (59676-302-00)","250","RC","59676-302-01","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59676-302-00","NDC","","","facility","both","1","EA","","4.61","4.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Edurant: 30 Tablet, Film Coated In 1 Bottle (59676-278-01)","250","RC","59676-278-01","NDC","","","facility","both","1","EA","","82.06","82.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 50 Tablet, Film Coated In 1 Bottle (59651-873-50)","250","RC","59651-873-50","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loperamide Hydrochloride: 100 Capsule In 1 Bottle (59651-691-01)","250","RC","59651-691-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet In 1 Bottle (59651-686-01)","250","RC","59651-686-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 1 Bottle In 1 Carton (59651-646-26)  / 225 Ml In 1 Bottle","250","RC","59651-646-26","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyrimethamine: 100 Tablet In 1 Bottle (59651-590-01)","250","RC","59651-590-01","NDC","","","facility","both","1","EA","","485.49","485.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procrit: 6 Vial, Single-Dose In 1 Carton (59676-304-01)  / 1 Ml In 1 Vial, Single-Dose (59676-304-00)","250","RC","59676-304-01","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 7 Blister Pack In 1 Carton (59746-020-22)  / 4 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","59746-020-22","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 3 Blister Pack In 1 Carton (59746-010-32)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","59746-010-32","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sirturo: 188 Tablet In 1 Bottle (59676-701-01)","250","RC","59676-701-01","NDC","","","facility","both","1","EA","","287.24","287.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prezcobix: 30 Tablet, Film Coated In 1 Bottle (59676-575-30)","250","RC","59676-575-30","NDC","","","facility","both","1","EA","","136.47","136.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prezista: 1 Bottle, Glass In 1 Carton (59676-565-01)  / 200 Ml In 1 Bottle, Glass","250","RC","59676-565-01","NDC","","","facility","both","1","EA","","26.98","26.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prezista: 60 Tablet, Film Coated In 1 Bottle, Plastic (59676-562-01)","250","RC","59676-562-01","NDC","","","facility","both","1","EA","","59.7","59.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procrit: 4 Vial, Single-Dose In 1 Carton (59676-340-01)  / 1 Ml In 1 Vial, Single-Dose (59676-340-00)","250","RC","59676-340-01","NDC","","","facility","both","1","EA","","25.2","25.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","59676-310-00","NDC","","","facility","both","1","EA","","3.01","3.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycontin: 2 Blister Pack In 1 Carton (59011-410-20)  / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack","250","RC","59011-410-20","NDC","","","facility","both","1","EA","","8.4","8.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"100 TABLET in 1 BOTTLE (57896-201-01) ","250","RC","57896-201-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dibucaine: 1 Tube In 1 Box (57896-131-01)  / 28 G In 1 Tube","250","RC","57896-131-01","NDC","","","facility","both","1","EA","","6.56","6.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Analgesic Balm: 1 Tube In 1 Box (57896-116-03)  / 85 G In 1 Tube","250","RC","57896-116-03","NDC","","","facility","both","1","EA","","4.96","4.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Regular Strength Pain Relief: 1000 Tablet In 1 Bottle (57896-104-10)","250","RC","57896-104-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Regular Strength Pain Relief: 1000 Tablet In 1 Bottle (57896-102-10)","250","RC","57896-102-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01)  / 15 Ml In 1 Vial, Single-Dose","250","RC","57894-503-01","NDC","","","facility","both","1","EA","","99.73","99.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Extra Strength Pain Relief: 1000 Tablet In 1 Bottle (57896-201-10)","250","RC","57896-201-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Extra Strength Pain Relief: 1000 Tablet In 1 Bottle (57896-221-10)","250","RC","57896-221-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simethicone: 100 Tablet, Chewable In 1 Bottle (57896-791-01)","250","RC","57896-791-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Geri-Lanta Antacid Antigas: 355 Ml In 1 Bottle (57896-629-12)","250","RC","57896-629-12","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polyethylene Glycol 3350: 30 Packet In 1 Carton (57896-490-03)  / 17 G In 1 Packet (57896-490-01)","250","RC","57896-490-03","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","57896-490-01","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polyethylene Glycol 3350: 238 G In 1 Bottle (57896-489-14)","250","RC","57896-489-14","NDC","","","facility","both","1","EA","","2.52","2.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gericare Senna Syrup: 237 Ml In 1 Bottle (57896-472-08)","250","RC","57896-472-08","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"GeriCare Senna Syrup: 237 mL in 1 BOTTLE (57896-462-08) ","250","RC","57896-462-08","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Geri-Kot: 100 Tablet In 1 Bottle (57896-454-01)","250","RC","57896-454-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisacodyl: 2 Blister Pack In 1 Carton (57896-443-12)  / 6 Suppository In 1 Blister Pack (57896-443-66)","250","RC","57896-443-12","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stimulant Laxative Enteric Coated: 100 Tablet In 1 Bottle (57896-441-01)","250","RC","57896-441-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Geri-Kot: 100 Tablet In 1 Bottle (57896-434-01)","250","RC","57896-434-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"DIOCTO: 473 mL in 1 BOTTLE, PLASTIC (57896-403-16) ","250","RC","57896-403-16","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cromolyn Sodium: 1 Bottle In 1 Carton (57782-397-26)  / 200 Spray, Metered In 1 Bottle","250","RC","57782-397-26","NDC","","","facility","both","1","EA","","7.91","7.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Minocycline Hydrochloride: 50 Capsule In 1 Bottle (57664-853-85)","250","RC","57664-853-85","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pindolol: 100 Tablet In 1 Bottle, Plastic (57664-656-88)","250","RC","57664-656-88","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pindolol: 100 Tablet In 1 Bottle, Plastic (57664-655-88)","250","RC","57664-655-88","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 30 Tablet In 1 Bottle (57664-510-83)","250","RC","57664-510-83","NDC","","","facility","both","1","EA","","3.49","3.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01)  / 15 Ml In 1 Vial, Single-Dose","250","RC","57894-503-01","NDC","","","facility","both","1","EA","","102.88","102.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infants Gas Relief: 1 Bottle In 1 Box (57896-798-01)  / 30 Ml In 1 Bottle","250","RC","57896-798-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Regular Strength Enteric Coated Aspirin: 100 Tablet, Coated In 1 Bottle (57896-921-01)","250","RC","57896-921-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olopatadine Hydrochloride: 1 Bottle, Plastic In 1 Carton (58602-006-40)  / 5 Ml In 1 Bottle, Plastic","250","RC","58602-006-40","NDC","","","facility","both","1","EA","","12.67","12.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","58468-0132-1","NDC","","","facility","both","1","EA","","29.63","29.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thymoglobulin: 1 Vial, Glass In 1 Carton (58468-0080-1)  / 5 Ml In 1 Vial, Glass","250","RC","58468-0080-1","NDC","","","facility","both","1","EA","","959.52","959.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thymoglobulin: 1 Vial, Glass In 1 Carton (58468-0080-1)  / 5 Ml In 1 Vial, Glass","250","RC","58468-0080-1","NDC","","","facility","both","1","EA","","1650.78","1650.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","58406-021-01","NDC","","","facility","both","1","EA","","1780.4","1780.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diclofenac Sodium: 1 Tube In 1 Carton (58602-604-07)  / 100 G In 1 Tube","250","RC","58602-604-07","NDC","","","facility","both","1","EA","","13.07","13.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 10 Blister Pack In 1 Carton (58602-702-04)  / 10 Tablet In 1 Blister Pack","250","RC","58602-702-04","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stratuscare Adult Glycerin: 12 Suppository In 1 Jar (58980-410-12)","250","RC","58980-410-12","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stratuscare Glycerin Laxative Pediatric: 25 Suppository In 1 Jar (58980-409-25)","250","RC","58980-409-25","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stratuscare Glycerin Laxative Pediatric: 12 Suppository In 1 Jar (58980-409-12)","250","RC","58980-409-12","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bacitracin Zinc: 1 Tube In 1 Box (58980-011-10)  / 28.35 G In 1 Tube","250","RC","58980-011-10","NDC","","","facility","both","1","EA","","5.25","5.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Canasa: 30 Suppository In 1 Box (58914-501-56)","250","RC","58914-501-56","NDC","","","facility","both","1","EA","","64.28","64.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","58914-501-01","NDC","","","facility","both","1","EA","","64.27","64.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carafate: 420 Ml In 1 Bottle (58914-170-14)","250","RC","58914-170-14","NDC","","","facility","both","1","EA","","10.63","10.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Theratears: 7 Pouch In 1 Carton (58790-002-28)  / .6 Ml In 1 Pouch","250","RC","58790-002-28","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 100 Tablet, Coated In 1 Bottle (58657-675-01)","250","RC","58657-675-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"M-Dryl: 120 Ml In 1 Bottle (58657-528-04)","250","RC","58657-528-04","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guaifenesin: 473 Ml In 1 Bottle (58657-509-16)","250","RC","58657-509-16","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Urea Cream 40 Percent: 28.35 G In 1 Bottle (58657-489-01)","250","RC","58657-489-01","NDC","","","facility","both","1","EA","","75.68","75.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 100 Tablet In 1 Bottle (58602-773-21)","250","RC","58602-773-21","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 1 Blister Pack In 1 Carton (58602-702-83)  / 10 Tablet In 1 Blister Pack","250","RC","58602-702-83","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 5 Tube In 1 Box, Unit-Dose (58980-824-15)  / 5 G In 1 Tube","250","RC","58980-824-15","NDC","","","facility","both","1","EA","","4.53","4.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","58160-842-01","NDC","","","facility","both","1","EA","","66.11","66.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","58160-828-03","NDC","","","facility","both","1","EA","","353.71","353.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","58160-827-03","NDC","","","facility","both","1","EA","","201.06","201.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","58160-826-43","NDC","","","facility","both","1","EA","","125.97","125.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","58160-821-01","NDC","","","facility","both","1","EA","","83.01","83.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","58160-820-43","NDC","","","facility","both","1","EA","","35.81","35.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","58160-740-02","NDC","","","facility","both","1","EA","","199.11","199.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lyrica: 473 Ml In 1 Bottle (58151-244-35)","250","RC","58151-244-35","NDC","","","facility","both","1","EA","","7.41","7.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dilantin: 100 Capsule, Extended Release In 1 Bottle, Plastic (58151-118-01)","250","RC","58151-118-01","NDC","","","facility","both","1","EA","","2.47","2.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imbruvica: 1 Bottle, Glass In 1 Carton (57962-007-12)  / 108 Ml In 1 Bottle, Glass","250","RC","57962-007-12","NDC","","","facility","both","1","EA","","861.76","861.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Regular Strength Enteric Coated Aspirin: 1000 Tablet, Coated In 1 Bottle (57896-921-10)","250","RC","57896-921-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gleostine: 1 Bottle In 1 Carton (58181-3041-5)  / 5 Capsule, Gelatin Coated In 1 Bottle","250","RC","58181-3041-5","NDC","","","facility","both","1","EA","","806.56","806.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gleostine: 1 Bottle In 1 Carton (58181-3040-5)  / 5 Capsule, Gelatin Coated In 1 Bottle","250","RC","58181-3040-5","NDC","","","facility","both","1","EA","","196.67","196.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","58160-976-02","NDC","","","facility","both","1","EA","","151.47","151.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Boostrix: 10 Syringe In 1 Carton (58160-842-52)  / .5 Ml In 1 Syringe (58160-842-43)","250","RC","58160-842-52","NDC","","","facility","both","1","EA","","67.51","67.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","58160-842-43","NDC","","","facility","both","1","EA","","67.31","67.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (55111-467-01)","250","RC","55111-467-01","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Invega Sustenna: 1 Syringe In 1 Kit (50458-564-01)  / 1.5 Ml In 1 Syringe","250","RC","50458-564-01","NDC","","","facility","both","1","EA","","24.18","24.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xarelto: 1 Bottle In 1 Carton (50458-575-01)  / 1 Granule, For Suspension In 1 Bottle","250","RC","50458-575-01","NDC","","","facility","both","1","EA","","90.19","90.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neupro: 30 Pouch In 1 Carton (50474-802-03)  / 1 Patch In 1 Pouch / 24 H In 1 Patch","250","RC","50474-802-03","NDC","","","facility","both","1","EA","","47.8","47.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neupro: 30 Pouch In 1 Carton (50474-801-03)  / 1 Patch In 1 Pouch / 24 H In 1 Patch","250","RC","50474-801-03","NDC","","","facility","both","1","EA","","47.56","47.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Briviact: 1 Bottle In 1 Carton (50474-770-66)  / 60 Tablet, Film Coated In 1 Bottle","250","RC","50474-770-66","NDC","","","facility","both","1","EA","","40.75","40.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Briviact: 100 Blister Pack In 1 Carton (50474-570-09)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","50474-570-09","NDC","","","facility","both","1","EA","","40.54","40.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Briviact: 100 Blister Pack In 1 Carton (50474-470-09)  / 1 Tablet, Film Coated In 1 Blister Pack","250","RC","50474-470-09","NDC","","","facility","both","1","EA","","40.62","40.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Briviact: 1 Bottle In 1 Carton (50474-370-66)  / 60 Tablet, Film Coated In 1 Bottle","250","RC","50474-370-66","NDC","","","facility","both","1","EA","","40.75","40.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 30 Ml In 1 Bottle (50458-596-01)","250","RC","50458-596-01","NDC","","","facility","both","1","EA","","2.42","2.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50458-578-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xarelto: 30 Tablet, Film Coated In 1 Bottle (50458-580-30)","250","RC","50458-580-30","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xarelto: 10 Blister Pack In 1 Carton (50458-580-10)  / 10 Tablet, Film Coated In 1 Blister Pack (50458-580-01)","250","RC","50458-580-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50458-580-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xarelto: 10 Blister Pack In 1 Carton (50458-579-10)  / 10 Tablet, Film Coated In 1 Blister Pack (50458-579-01)","250","RC","50458-579-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50458-579-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xarelto: 10 Blister Pack In 1 Carton (50458-578-10)  / 10 Tablet, Film Coated In 1 Blister Pack (50458-578-01)","250","RC","50458-578-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Concerta: 100 Tablet, Extended Release In 1 Bottle (50458-586-01)","250","RC","50458-586-01","NDC","","","facility","both","1","EA","","22.64","22.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sporanox: 150 Ml In 1 Bottle (50458-295-15)","250","RC","50458-295-15","NDC","","","facility","both","1","EA","","92.84","92.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elmiron: 100 Capsule, Gelatin Coated In 1 Bottle (50458-098-01)","250","RC","50458-098-01","NDC","","","facility","both","1","EA","","19.85","19.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole and Trimethoprim: 473 mL in 1 BOTTLE (50383-824-16) ","250","RC","50383-824-16","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50383-779-30","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50383-779-15","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50383-775-15","NDC","","","facility","both","1","EA","","1.49","1.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 100 mL in 1 BOTTLE, PLASTIC (50383-775-04) ","250","RC","50383-775-04","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docu Liquid: 473 mL in 1 BOTTLE (50383-771-16) ","250","RC","50383-771-16","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 1 BOTTLE in 1 CARTON (50383-286-16)  / 480 mL in 1 BOTTLE","250","RC","50383-286-16","NDC","","","facility","both","1","EA","","13.35","13.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levocarnitine: 9 BLISTER PACK in 1 CARTON (50383-172-90)  / 10 TABLET in 1 BLISTER PACK","250","RC","50383-172-90","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine Hydrochloride: 30 Tablet In 1 Bottle (50383-924-93)","250","RC","50383-924-93","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50383-063-10","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Urea: 28.35 G In 1 Tube (50268-872-28)","250","RC","50268-872-28","NDC","","","facility","both","1","EA","","45.68","45.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-816-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-814-11","NDC","","","facility","both","1","EA","","3","3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone Hydrochloride: 20 Blister Pack In 1 Box (50268-812-12)  / 1 Capsule In 1 Blister Pack (50268-812-11)","250","RC","50268-812-12","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-812-11","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guaifenesin: 10 TRAY in 1 CASE (50383-063-12)  / 10 CUP, UNIT-DOSE in 1 TRAY / 10 mL in 1 CUP, UNIT-DOSE","250","RC","50383-063-12","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adempas: 90 Tablet, Film Coated In 1 Bottle (50419-250-01)","250","RC","50419-250-01","NDC","","","facility","both","1","EA","","261.02","261.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adempas: 9 Tablet, Film Coated In 1 Bottle (50419-250-91)","250","RC","50419-250-91","NDC","","","facility","both","1","EA","","219.17","219.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spravato: 2 Blister Pack In 1 Kit (50458-028-02)  / 1 Vial, Single-Use In 1 Blister Pack / .2 Ml In 1 Vial, Single-Use (50458-028-00)","250","RC","50458-028-02","NDC","","","facility","both","1","EA","","1282.04","1282.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50419-775-01","NDC","","","facility","both","1","EA","","2.1","2.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cipro: 1 Kit In 1 Kit (50419-773-01)  *  100 Ml In 1 Bottle, Glass *  100 Ml In 1 Bottle, Glass","250","RC","50419-773-01","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyleena: 1 Intrauterine Device In 1 Carton (50419-424-01)","250","RC","50419-424-01","NDC","","","facility","both","1","EA","","2186.34","2186.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirena: 1 Intrauterine Device In 1 Carton (50419-423-01)","250","RC","50419-423-01","NDC","","","facility","both","1","EA","","1458.92","1458.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirena: 1 Intrauterine Device In 1 Carton (50419-423-01)","250","RC","50419-423-01","NDC","","","facility","both","1","EA","","1782.22","1782.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adempas: 9 Tablet, Film Coated In 1 Bottle (50419-254-91)","250","RC","50419-254-91","NDC","","","facility","both","1","EA","","244.94","244.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adempas: 90 Tablet, Film Coated In 1 Bottle (50419-254-01)","250","RC","50419-254-01","NDC","","","facility","both","1","EA","","261.02","261.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adempas: 9 Tablet, Film Coated In 1 Bottle (50419-253-91)","250","RC","50419-253-91","NDC","","","facility","both","1","EA","","219.17","219.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adempas: 9 Tablet, Film Coated In 1 Bottle (50419-252-91)","250","RC","50419-252-91","NDC","","","facility","both","1","EA","","219.17","219.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adempas: 90 Tablet, Film Coated In 1 Bottle (50419-252-01)","250","RC","50419-252-01","NDC","","","facility","both","1","EA","","261.02","261.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adempas: 9 Tablet, Film Coated In 1 Bottle (50419-251-91)","250","RC","50419-251-91","NDC","","","facility","both","1","EA","","219.17","219.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adempas: 90 Tablet, Film Coated In 1 Bottle (50419-251-01)","250","RC","50419-251-01","NDC","","","facility","both","1","EA","","261.02","261.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Briviact: 1 Bottle In 1 Carton (50474-870-15)  / 300 Ml In 1 Bottle","250","RC","50474-870-15","NDC","","","facility","both","1","EA","","89.34","89.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-797-11","NDC","","","facility","both","1","EA","","3.17","3.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-051-01","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-028-01","NDC","","","facility","both","1","EA","","2.57","2.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metolazone: 100 Blister Pack In 1 Carton (51079-024-20)  / 1 Tablet In 1 Blister Pack (51079-024-01)","250","RC","51079-024-20","NDC","","","facility","both","1","EA","","6.18","6.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-024-01","NDC","","","facility","both","1","EA","","4.11","4.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-023-01","NDC","","","facility","both","1","EA","","3.58","3.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-058-01","NDC","","","facility","both","1","EA","","2.36","2.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jakafi: 60 Tablet In 1 Bottle, Plastic (50881-010-60)","250","RC","50881-010-60","NDC","","","facility","both","1","EA","","500.58","500.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jakafi: 60 Tablet In 1 Bottle, Plastic (50881-005-60)","250","RC","50881-005-60","NDC","","","facility","both","1","EA","","423.93","423.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50742-549-01","NDC","","","facility","both","1","EA","","7.31","7.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50742-515-01","NDC","","","facility","both","1","EA","","87.96","87.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Scopolamine: 24 Pouch In 1 Carton (50742-505-24)  / 1 Patch, Extended Release In 1 Pouch","250","RC","50742-505-24","NDC","","","facility","both","1","EA","","8.67","8.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jakafi: 60 Tablet In 1 Bottle, Plastic (50881-020-60)","250","RC","50881-020-60","NDC","","","facility","both","1","EA","","500.58","500.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50742-505-01","NDC","","","facility","both","1","EA","","15.72","15.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-074-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-169-01","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-165-01","NDC","","","facility","both","1","EA","","28.25","28.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-164-01","NDC","","","facility","both","1","EA","","8.93","8.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-142-01","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-141-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-103-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-088-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 100 Blister Pack In 1 Carton (51079-087-20)  / 1 Tablet, Film Coated In 1 Blister Pack (51079-087-01)","250","RC","51079-087-20","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 100 Blister Pack In 1 Carton (51079-086-20)  / 1 Tablet, Film Coated In 1 Blister Pack (51079-086-01)","250","RC","51079-086-20","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-086-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-083-01","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-076-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-075-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (51079-074-20)  / 1 Tablet In 1 Blister Pack (51079-074-01)","250","RC","51079-074-20","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-087-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50742-398-01","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine And Naloxone: 30 Pouch In 1 Carton (50742-365-30)  / 1 Film In 1 Pouch (50742-365-01)","250","RC","50742-365-30","NDC","","","facility","both","1","EA","","7.88","7.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desipramine Hydrochloride: 100 Tablet In 1 Bottle (50742-114-01)","250","RC","50742-114-01","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desipramine Hydrochloride: 100 Tablet In 1 Bottle (50742-113-01)","250","RC","50742-113-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desipramine Hydrochloride: 100 Tablet In 1 Bottle (50742-112-01)","250","RC","50742-112-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyanokit: 1 Vial, Glass In 1 Carton (50633-310-11)  / 250 Ml In 1 Vial, Glass","250","RC","50633-310-11","NDC","","","facility","both","1","EA","","1699.94","1699.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voraxaze: 1 Vial In 1 Carton (50633-210-11)  / 1 Injection, Powder, For Solution In 1 Vial","250","RC","50633-210-11","NDC","","","facility","both","1","EA","","45662.14","45662.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50632-013-01","NDC","","","facility","both","1","EA","","626.69","626.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desipramine Hydrochloride: 100 Tablet In 1 Bottle (50742-116-01)","250","RC","50742-116-01","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rabavert: 1 Kit In 1 Carton (50632-010-01)  *  1 Ml In 1 Syringe (50632-011-01)  *  1 Ml In 1 Vial, Glass (50632-013-01)","250","RC","50632-010-01","NDC","","","facility","both","1","EA","","676.41","676.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tylenol Regular Strength: 10 Blister Pack In 1 Carton (50580-458-11)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","50580-458-11","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tylenol Extra Strength: 10 Blister Pack In 1 Carton (50580-457-11)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","50580-457-11","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"10 BLISTER PACK in 1 CARTON (50580-412-02)  / 10 TABLET, FILM COATED in 1 BLISTER PACK","250","RC","50580-412-02","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tylenol For Children Plus Adults: 1 Bottle In 1 Carton (50580-177-08)  / 240 Ml In 1 Bottle","250","RC","50580-177-08","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Collagenase Santyl: 1 Tube In 1 Carton (50484-010-90)  / 90 G In 1 Tube","250","RC","50484-010-90","NDC","","","facility","both","1","EA","","1405.52","1405.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Collagenase Santyl: 1 Tube In 1 Carton (50484-010-30)  / 30 G In 1 Tube","250","RC","50484-010-30","NDC","","","facility","both","1","EA","","503.35","503.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"10 BLISTER PACK in 1 CARTON (50580-600-02)  / 10 TABLET, FILM COATED in 1 BLISTER PACK","250","RC","50580-600-02","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabergoline: 8 Tablet In 1 Bottle (50742-118-08)","250","RC","50742-118-08","NDC","","","facility","both","1","EA","","2.6","2.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50742-365-01","NDC","","","facility","both","1","EA","","10.21","10.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50742-364-01","NDC","","","facility","both","1","EA","","2.93","2.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (50742-363-60)","250","RC","50742-363-60","NDC","","","facility","both","1","EA","","2.88","2.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (50742-362-60)","250","RC","50742-362-60","NDC","","","facility","both","1","EA","","3.06","3.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Her Style: 1 Blister Pack In 1 Carton (50742-352-01)  / 1 Tablet In 1 Blister Pack","250","RC","50742-352-01","NDC","","","facility","both","1","EA","","12.6","12.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norethindrone Acetate: 50 Tablet In 1 Bottle (50742-267-50)","250","RC","50742-267-50","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine: 300 Tablet, Extended Release In 1 Bottle (50742-261-03)","250","RC","50742-261-03","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine: 300 Tablet, Extended Release In 1 Bottle (50742-260-03)","250","RC","50742-260-03","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (50742-250-90)","250","RC","50742-250-90","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (50742-249-90)","250","RC","50742-249-90","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine: 60 Tablet, Extended Release In 1 Bottle (50742-247-60)","250","RC","50742-247-60","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (50742-240-01)","250","RC","50742-240-01","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (50742-239-01)","250","RC","50742-239-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50474-970-63","NDC","","","facility","both","1","EA","","8.37","8.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-789-11","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-787-11","NDC","","","facility","both","1","EA","","21.17","21.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-399-11","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-398-11","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-367-11","NDC","","","facility","both","1","EA","","4.69","4.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-362-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glipizide: 50 Blister Pack In 1 Box (50268-361-15)  / 1 Tablet In 1 Blister Pack (50268-361-11)","250","RC","50268-361-15","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-361-11","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-339-11","NDC","","","facility","both","1","EA","","2.53","2.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-332-11","NDC","","","facility","both","1","EA","","165.58","165.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-325-11","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-321-11","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Finasteride: 50 Blister Pack In 1 Box (50268-314-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-314-11)","250","RC","50268-314-15","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-314-11","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate: 50 Blister Pack In 1 Box (50268-278-15)  / 1 Capsule In 1 Blister Pack (50268-278-11)","250","RC","50268-278-15","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-278-11","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-260-11","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-482-11","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-478-11","NDC","","","facility","both","1","EA","","2.56","2.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-476-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-449-11","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-448-11","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-447-11","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-405-11","NDC","","","facility","both","1","EA","","2.47","2.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-441-11","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-440-11","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indomethacin: 50 Blister Pack In 1 Box, Unit-Dose (50268-430-15)  / 1 Capsule In 1 Blister Pack (50268-430-11)","250","RC","50268-430-15","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-430-11","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-412-11","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone Acetate: 24 Suppository In 1 Carton (50268-411-24)","250","RC","50268-411-24","NDC","","","facility","both","1","EA","","1.9","1.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-411-11","NDC","","","facility","both","1","EA","","2.53","2.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-224-11","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-168-11","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-167-11","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-163-11","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-152-11","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-132-11","NDC","","","facility","both","1","EA","","2.19","2.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-131-11","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-127-11","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 50 Blister Pack In 1 Box (50268-107-15)  / 1 Tablet In 1 Blister Pack (50268-107-11)","250","RC","50268-107-15","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-107-11","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-105-11","NDC","","","facility","both","1","EA","","1.82","1.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-096-11","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-169-11","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 50 Blister Pack In 1 Box (50268-169-15)  / 1 Capsule In 1 Blister Pack (50268-169-11)","250","RC","50268-169-15","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-223-11","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-222-11","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Capsaicin External Analgesic: 1 Tube In 1 Carton (50268-195-60)  / 60 G In 1 Tube","250","RC","50268-195-60","NDC","","","facility","both","1","EA","","5.73","5.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-192-11","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-190-11","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clopidogrel: 20 Blister Pack In 1 Box (50268-184-12)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-184-11)","250","RC","50268-184-12","NDC","","","facility","both","1","EA","","10.35","10.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-184-11","NDC","","","facility","both","1","EA","","10.32","10.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-178-11","NDC","","","facility","both","1","EA","","3.8","3.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-177-11","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-176-11","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-175-11","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 50 Blister Pack In 1 Box (50268-174-15)  / 1 Tablet In 1 Blister Pack (50268-174-11)","250","RC","50268-174-15","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-173-11","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-504-11","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losortan Potassium: 50 Blister Pack In 1 Box (50268-504-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-504-11)","250","RC","50268-504-15","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-505-11","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-710-11","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-709-11","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-686-11","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-685-11","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 50 Blister Pack In 1 Box (50268-680-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-680-11)","250","RC","50268-680-15","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin: 50 Blister Pack In 1 Box (50268-710-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-710-11)","250","RC","50268-710-15","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-680-11","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polyvinyl Alcohol: 15 Ml In 1 Bottle (50268-678-15)","250","RC","50268-678-15","NDC","","","facility","both","1","EA","","9.87","9.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-665-11","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-664-11","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-663-11","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 50 Blister Pack In 1 Box (50268-662-15)  / 1 Tablet In 1 Blister Pack (50268-662-11)","250","RC","50268-662-15","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-711-11","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin: 50 Blister Pack In 1 Box (50268-711-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-711-11)","250","RC","50268-711-15","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-779-11","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-768-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-759-11","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Torsemide: 50 Blister Pack In 1 Box, Unit-Dose (50268-757-15)  / 1 Tablet In 1 Blister Pack (50268-757-11)","250","RC","50268-757-15","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-757-11","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-755-11","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-745-11","NDC","","","facility","both","1","EA","","6.66","6.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole Hydrochloride: 50 Blister Pack In 1 Box (50268-742-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-742-11)","250","RC","50268-742-15","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-742-11","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-731-11","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-730-11","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 50 Blister Pack In 1 Box, Unit-Dose (50268-728-15)  / 1 Tablet In 1 Blister Pack (50268-728-11)","250","RC","50268-728-15","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-728-11","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-725-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-720-11","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-662-11","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin Hydrochloride: 50 Blister Pack In 1 Box (50268-550-15)  / 1 Tablet, Extended Release In 1 Blister Pack (50268-550-11)","250","RC","50268-550-15","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-550-11","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 50 Blister Pack In 1 Box, Unit-Dose (50268-541-15)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (50268-541-11)","250","RC","50268-541-15","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-541-11","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-535-11","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meloxicam: 50 Blister Pack In 1 Box, Unit-Dose (50268-526-15)  / 1 Tablet In 1 Blister Pack (50268-526-11)","250","RC","50268-526-15","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-557-11","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-525-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-522-11","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-521-11","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-520-11","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losortan Potassium: 50 Blister Pack In 1 Box (50268-505-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-505-11)","250","RC","50268-505-15","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-526-11","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-562-11","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-647-11","NDC","","","facility","both","1","EA","","3.95","3.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-642-11","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-635-11","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine Fumarate: 50 Blister Pack In 1 Box (50268-633-15)  / 1 Tablet In 1 Blister Pack (50268-633-11)","250","RC","50268-633-15","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-633-11","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-631-11","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-625-11","NDC","","","facility","both","1","EA","","4.05","4.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-621-11","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine Er: 50 Blister Pack In 1 Box, Unit-Dose (50268-597-15)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (50268-597-11)","250","RC","50268-597-15","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-597-11","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-595-11","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-594-11","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-585-11","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-574-11","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","50268-652-11","NDC","","","facility","both","1","EA","","2.85","2.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Blister Pack In 1 Carton (51079-169-20)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (51079-169-01)","250","RC","51079-169-20","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-180-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Theo-24: 100 Capsule, Extended Release In 1 Bottle (52244-100-10)","250","RC","52244-100-10","NDC","","","facility","both","1","EA","","6.43","6.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dificid: 1 Bottle In 1 Carton (52015-080-01)  / 20 Tablet, Film Coated In 1 Bottle","250","RC","52015-080-01","NDC","","","facility","both","1","EA","","210.56","210.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Asenapine: 6 Blister Pack In 1 Box (51991-928-60)  / 10 Tablet In 1 Blister Pack","250","RC","51991-928-60","NDC","","","facility","both","1","EA","","6.78","6.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"100 TABLET in 1 BOTTLE (51991-901-01) ","250","RC","51991-901-01","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eplerenone: 30 Tablet, Film Coated In 1 Bottle (51991-877-33)","250","RC","51991-877-33","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine Delayed-Release: 90 Capsule, Delayed Release Pellets In 1 Bottle (51991-746-90)","250","RC","51991-746-90","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Theo-24: 100 Capsule, Extended Release In 1 Bottle (52244-200-10)","250","RC","52244-200-10","NDC","","","facility","both","1","EA","","9.51","9.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Asenapine: 6 Blister Pack In 1 Box (51991-360-60)  / 10 Tablet In 1 Blister Pack","250","RC","51991-360-60","NDC","","","facility","both","1","EA","","8.47","8.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Asenapine: 6 Blister Pack In 1 Box (51991-358-60)  / 10 Tablet In 1 Blister Pack","250","RC","51991-358-60","NDC","","","facility","both","1","EA","","8.42","8.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (51991-351-06)","250","RC","51991-351-06","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine: 90 Tablet, Extended Release In 1 Bottle (51991-312-90)","250","RC","51991-312-90","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 100 Tablet, Film Coated In 1 Bottle (51991-293-01)","250","RC","51991-293-01","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine: 90 Tablet, Extended Release In 1 Bottle (51991-006-90)","250","RC","51991-006-90","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","52268-011-01","NDC","","","facility","both","1","EA","","98.77","98.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbaglu: 5 Tablet, For Suspension In 1 Bottle (52276-312-05)","250","RC","52276-312-05","NDC","","","facility","both","1","EA","","408.93","408.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 100 Tablet In 1 Bottle, Plastic (52817-260-10)","250","RC","52817-260-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ramelteon: 30 Tablet, Film Coated In 1 Bottle, Plastic (52817-235-30)","250","RC","52817-235-30","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eprontia: 473 Ml In 1 Bottle (52652-9001-1)","250","RC","52652-9001-1","NDC","","","facility","both","1","EA","","9.16","9.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zonisade: 1 Bottle In 1 Carton (52652-8001-1)  / 150 Ml In 1 Bottle","250","RC","52652-8001-1","NDC","","","facility","both","1","EA","","42.62","42.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fleqsuvy: 1 Bottle In 1 Carton (52652-6001-2)  / 300 Ml In 1 Bottle","250","RC","52652-6001-2","NDC","","","facility","both","1","EA","","28.1","28.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fleqsuvy: 1 Bottle In 1 Carton (52652-6001-1)  / 120 Ml In 1 Bottle","250","RC","52652-6001-1","NDC","","","facility","both","1","EA","","25.25","25.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xatmep: 120 Ml In 1 Bottle (52652-2001-1)","250","RC","52652-2001-1","NDC","","","facility","both","1","EA","","33.16","33.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 1 Bottle In 1 Carton (52536-600-11)  / 120 Ml In 1 Bottle","250","RC","52536-600-11","NDC","","","facility","both","1","EA","","17.95","17.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin: 100 Tablet, Film Coated In 1 Bottle (52536-103-13)","250","RC","52536-103-13","NDC","","","facility","both","1","EA","","15.65","15.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"60 mL in 1 BOTTLE (52380-1905-2) ","250","RC","52380-1905-2","NDC","","","facility","both","1","EA","","1.76","1.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aplicare Povidone-Iodine: 1 g in 1 PACKET (52380-0026-1) ","250","RC","52380-0026-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epaned: 150 Ml In 1 Bottle (52652-4001-1)","250","RC","52652-4001-1","NDC","","","facility","both","1","EA","","6.65","6.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1 Vial, Glass In 1 Carton (51991-002-98)  / 20 Ml In 1 Vial, Glass","250","RC","51991-002-98","NDC","","","facility","both","1","EA","","11.98","11.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51862-460-01","NDC","","","facility","both","1","EA","","2.79","2.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Tube In 1 Carton (51672-4118-6)  / 40 G In 1 Tube","250","RC","51672-4118-6","NDC","","","facility","both","1","EA","","135.58","135.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenytoin Sodium: 100 Capsule, Extended Release In 1 Bottle (51672-4111-1)","250","RC","51672-4111-1","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenytoin: 1 Bottle In 1 Carton (51672-4069-2)  / 237 Ml In 1 Bottle","250","RC","51672-4069-2","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenytoin: 237 Ml In 1 Bottle (51672-4069-1)","250","RC","51672-4069-1","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 450 Ml In 1 Bottle (51672-4047-9)","250","RC","51672-4047-9","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 100 Tablet In 1 Bottle (51672-4037-1)","250","RC","51672-4037-1","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Tablet In 1 Bottle (51672-4131-1)","250","RC","51672-4131-1","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Warfarin Sodium: 100 Tablet In 1 Bottle (51672-4034-1)","250","RC","51672-4034-1","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 100 Tablet In 1 Bottle (51672-4023-1)","250","RC","51672-4023-1","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 100 Tablet In 1 Bottle (51672-4022-1)","250","RC","51672-4022-1","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clomipramine Hydrochloride: 90 Capsule In 1 Bottle (51672-4013-5)","250","RC","51672-4013-5","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 90 Capsule In 1 Bottle (51672-4004-5)","250","RC","51672-4004-5","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (51672-4004-1)","250","RC","51672-4004-1","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 1 Tube In 1 Carton (51672-3020-9)  / 35.44 G In 1 Tube","250","RC","51672-3020-9","NDC","","","facility","both","1","EA","","15.76","15.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Warfarin Sodium: 100 Tablet In 1 Bottle (51672-4030-1)","250","RC","51672-4030-1","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferiprone: 100 Tablet In 1 Bottle (51672-4196-1)","250","RC","51672-4196-1","NDC","","","facility","both","1","EA","","81.64","81.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 100 Tablet In 1 Bottle (51672-4225-1)","250","RC","51672-4225-1","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 100 Tablet In 1 Bottle (51672-4245-1)","250","RC","51672-4245-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ajovy: 1 Syringe, Glass In 1 Carton (51759-204-10)  / 1.5 Ml In 1 Syringe, Glass","250","RC","51759-204-10","NDC","","","facility","both","1","EA","","5.86","5.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ajovy: 1 Container In 1 Carton (51759-202-10)  / 1.5 Ml In 1 Container","250","RC","51759-202-10","NDC","","","facility","both","1","EA","","5.69","5.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51754-6015-1","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51754-6015-1","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51754-5012-1","NDC","","","facility","both","1","EA","","5.95","5.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51754-5011-1","NDC","","","facility","both","1","EA","","13.02","13.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Bicarbonate: 25 Vial In 1 Carton (51754-5001-4)  / 50 Ml In 1 Vial","250","RC","51754-5001-4","NDC","","","facility","both","1","EA","","6.81","6.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51754-5001-1","NDC","","","facility","both","1","EA","","6.57","6.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Akovaz: 10 Syringe, Plastic In 1 Carton (51754-4250-3)  / 5 Ml In 1 Syringe, Plastic","250","RC","51754-4250-3","NDC","","","facility","both","1","EA","","8.83","8.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51754-4250-1","NDC","","","facility","both","1","EA","","10.75","10.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Acetate: 25 Vial, Single-Dose In 1 Carton (51754-2001-4)  / 20 Ml In 1 Vial, Single-Dose","250","RC","51754-2001-4","NDC","","","facility","both","1","EA","","3.74","3.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Caffeine Citrate: 1 Vial In 1 Carton (51754-0500-1)  / 3 Ml In 1 Vial","250","RC","51754-0500-1","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid In Sodium Chloride: 100 Ml In 1 Bag (51754-0108-1)","250","RC","51754-0108-1","NDC","","","facility","both","1","EA","","10.36","10.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate Oral Solution: 1 Bottle In 1 Carton (51672-5316-9)  / 500 Ml In 1 Bottle","250","RC","51672-5316-9","NDC","","","facility","both","1","EA","","7.23","7.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 100 Tablet In 1 Bottle (52817-319-10)","250","RC","52817-319-10","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclobenzaprine Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (52817-330-50)","250","RC","52817-330-50","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54643-5659-1","NDC","","","facility","both","1","EA","","16.85","16.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54643-5657-1","NDC","","","facility","both","1","EA","","8.85","8.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infuvite Adult: 1 Kit In 1 Carton (54643-5649-1)  *  5 Ml In 1 Vial (54643-5657-1)  *  5 Ml In 1 Vial (54643-5659-1)","250","RC","54643-5649-1","NDC","","","facility","both","1","EA","","16.27","16.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54629-4097-60","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54629-0772-41","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54629-0095-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54629-0058-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"epinephrine: 2 CASE in 1 CARTON (54505-102-02)  / 1 SYRINGE, GLASS in 1 CASE / .3 mL in 1 SYRINGE, GLASS","250","RC","54505-102-02","NDC","","","facility","both","1","EA","","355.69","355.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carnitor Sf: 24 Bottle, Plastic In 1 Case (54482-148-02)  / 118 Ml In 1 Bottle, Plastic","250","RC","54482-148-02","NDC","","","facility","both","1","EA","","6.64","6.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carnitor Sf: 24 Bottle, Plastic In 1 Case (54482-148-01)  / 118 Ml In 1 Bottle, Plastic","250","RC","54482-148-01","NDC","","","facility","both","1","EA","","7.17","7.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 1 Vial In 1 Carton (54288-152-01)  / 30 Ml In 1 Vial","250","RC","54288-152-01","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54288-142-01","NDC","","","facility","both","1","EA","","17.83","17.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54629-0050-24","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 120 Ml In 1 Bottle, Dropper (54838-501-40)","250","RC","54838-501-40","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 473 Ml In 1 Bottle, Plastic (54838-502-80)","250","RC","54838-502-80","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glimepiride: 100 Tablet In 1 Bottle (55111-321-01)","250","RC","55111-321-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine Hydrochloride: 1 Blister Pack In 1 Carton (55111-284-48)  / 4 Capsule, Delayed Release Pellets In 1 Blister Pack","250","RC","55111-284-48","NDC","","","facility","both","1","EA","","42.42","42.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Tablet, Orally Disintegrating In 1 Blister Pack (55111-265-79)","250","RC","55111-265-79","NDC","","","facility","both","1","EA","","4.11","4.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Tablet, Orally Disintegrating In 1 Blister Pack (55111-264-79)","250","RC","55111-264-79","NDC","","","facility","both","1","EA","","4.05","4.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Tablet, Orally Disintegrating In 1 Blister Pack (55111-263-79)","250","RC","55111-263-79","NDC","","","facility","both","1","EA","","3.96","3.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Tablet, Orally Disintegrating In 1 Blister Pack (55111-262-79)","250","RC","55111-262-79","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tizanidine: 150 Tablet In 1 Bottle (55111-180-15)","250","RC","55111-180-15","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Moxifloxacin: 30 Tablet, Film Coated In 1 Bottle (55111-112-30)","250","RC","55111-112-30","NDC","","","facility","both","1","EA","","4.83","4.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docusate Sodium Liquid: 473 Ml In 1 Bottle (54859-813-16)","250","RC","54859-813-16","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Senna Syrup: 237 Ml In 1 Bottle (54859-808-08)","250","RC","54859-808-08","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamivudine: 240 Ml In 1 Bottle, Plastic (54838-566-70)","250","RC","54838-566-70","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 120 Ml In 1 Bottle, Plastic (54838-523-40)","250","RC","54838-523-40","NDC","","","facility","both","1","EA","","2.39","2.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxepin Hydrochloride: 120 Ml In 1 Bottle, Plastic (54838-512-40)","250","RC","54838-512-40","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 473 Ml In 1 Bottle, Plastic (54838-510-80)","250","RC","54838-510-80","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyosyne: 15 Ml In 1 Bottle, Plastic (54838-506-15)","250","RC","54838-506-15","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Loratadine Sugar Free: 1 Bottle In 1 Carton (51672-2131-8)  / 120 Ml In 1 Bottle","250","RC","51672-2131-8","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pentasa: 240 Capsule In 1 Bottle (54092-189-81)","250","RC","54092-189-81","NDC","","","facility","both","1","EA","","5.04","5.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 100 Tablet In 1 Bottle (53746-745-01)","250","RC","53746-745-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flecainide Acetate: 100 Tablet In 1 Bottle (53746-641-01)","250","RC","53746-641-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bethanechol Chloride: 100 Tablet In 1 Bottle (53746-571-01)","250","RC","53746-571-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle, Plastic (53489-145-01)","250","RC","53489-145-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 500 Tablet In 1 Bottle, Plastic (53489-143-05)","250","RC","53489-143-05","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quinidine Gluconate: 100 Tablet, Extended Release In 1 Bottle, Plastic (53489-141-01)","250","RC","53489-141-01","NDC","","","facility","both","1","EA","","10.14","10.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pentasa: 120 Capsule In 1 Bottle (54092-191-12)","250","RC","54092-191-12","NDC","","","facility","both","1","EA","","10.08","10.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","53436-168-01","NDC","","","facility","both","1","EA","","51.56","51.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","53436-084-01","NDC","","","facility","both","1","EA","","55.1","55.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Petroleum: 1 Tube In 1 Box (53329-068-01)  / 28.4 G In 1 Tube","250","RC","53329-068-01","NDC","","","facility","both","1","EA","","2.82","2.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","53276-1010-59","NDC","","","facility","both","1","EA","","1328.1","1328.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","53276-1010-02","NDC","","","facility","both","1","EA","","456.5","456.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","52817-820-05","NDC","","","facility","both","1","EA","","7.81","7.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetic Acid: 1 Bottle In 1 Carton (52817-816-15)  / 15 Ml In 1 Bottle","250","RC","52817-816-15","NDC","","","facility","both","1","EA","","30.62","30.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aminocaproic Acid: 236.5 Ml In 1 Bottle, Plastic (52817-815-08)","250","RC","52817-815-08","NDC","","","facility","both","1","EA","","20.66","20.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Transdermal System Usp, 0.3 Mg/Day: 4 Pouch In 1 Carton (52817-612-04)  / 1 Patch In 1 Pouch / 1 D In 1 Patch","250","RC","52817-612-04","NDC","","","facility","both","1","EA","","29.84","29.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate: 50 Capsule In 1 Bottle, Plastic (53489-118-02)","250","RC","53489-118-02","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adderall Xr: 100 Capsule, Extended Release In 1 Bottle (54092-381-01)","250","RC","54092-381-01","NDC","","","facility","both","1","EA","","11.83","11.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 1 Vial In 1 Carton (54288-120-01)  / 10 Ml In 1 Vial","250","RC","54288-120-01","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 25 Vial In 1 Carton (54288-119-25)  / 1 Ml In 1 Vial","250","RC","54288-119-25","NDC","","","facility","both","1","EA","","2.19","2.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54288-119-01","NDC","","","facility","both","1","EA","","2.24","2.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dehydrated Alcohol: 10 Ampule In 1 Carton (54288-105-15)  / 5 Ml In 1 Ampule (54288-105-02)","250","RC","54288-105-15","NDC","","","facility","both","1","EA","","1240.35","1240.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54288-105-02","NDC","","","facility","both","1","EA","","1292.97","1292.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54288-103-01","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"SENNA: 236 mL in 1 BOTTLE (54162-007-08) ","250","RC","54162-007-08","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Motegrity: 30 Tablet, Film Coated In 1 Bottle (54092-547-01)","250","RC","54092-547-01","NDC","","","facility","both","1","EA","","29.52","29.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Motegrity: 30 Tablet, Film Coated In 1 Bottle (54092-546-01)","250","RC","54092-546-01","NDC","","","facility","both","1","EA","","30.73","30.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Intuniv: 100 Tablet, Extended Release In 1 Bottle (54092-513-02)","250","RC","54092-513-02","NDC","","","facility","both","1","EA","","16.13","16.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adderall Xr: 100 Capsule, Extended Release In 1 Bottle (54092-387-01)","250","RC","54092-387-01","NDC","","","facility","both","1","EA","","11.72","11.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adderall Xr: 100 Capsule, Extended Release In 1 Bottle (54092-385-01)","250","RC","54092-385-01","NDC","","","facility","both","1","EA","","11.83","11.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54288-136-01","NDC","","","facility","both","1","EA","","17.14","17.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 1 Bottle In 1 Carton (51672-2130-8)  / 120 Ml In 1 Bottle","250","RC","51672-2130-8","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51672-2116-0","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-630-01","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fenofibrate: 100 Blister Pack In 1 Carton (51079-608-20)  / 1 Tablet, Film Coated In 1 Blister Pack (51079-608-01)","250","RC","51079-608-20","NDC","","","facility","both","1","EA","","3.64","3.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-608-01","NDC","","","facility","both","1","EA","","3.64","3.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-599-01","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-597-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-631-01","NDC","","","facility","both","1","EA","","2.61","2.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-580-01","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-544-01","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-460-01","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-458-01","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-453-01","NDC","","","facility","both","1","EA","","1.43","1.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-573-01","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-444-01","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-670-01","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-759-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sucralfate: 100 Blister Pack In 1 Carton (51079-753-20)  / 1 Tablet In 1 Blister Pack (51079-753-01)","250","RC","51079-753-20","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-753-01","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-735-01","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-734-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-632-01","NDC","","","facility","both","1","EA","","4.75","4.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-722-01","NDC","","","facility","both","1","EA","","4.43","4.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-721-01","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-690-01","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-685-01","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-684-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-733-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-443-01","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (51079-442-20)  / 1 Tablet In 1 Blister Pack (51079-442-01)","250","RC","51079-442-20","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-284-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-255-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-246-01","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-211-01","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-210-01","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-285-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-209-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-206-01","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 100 Blister Pack In 1 Carton (51079-205-20)  / 1 Tablet In 1 Blister Pack (51079-205-01)","250","RC","51079-205-20","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-205-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abacavir Sulfate: 50 Blister Pack In 1 Carton (51079-204-06)  / 1 Tablet, Film Coated In 1 Blister Pack (51079-204-01)","250","RC","51079-204-06","NDC","","","facility","both","1","EA","","14.34","14.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-204-01","NDC","","","facility","both","1","EA","","14.34","14.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-198-01","NDC","","","facility","both","1","EA","","16.63","16.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 100 Blister Pack In 1 Carton (51079-285-20)  / 1 Tablet In 1 Blister Pack (51079-285-01)","250","RC","51079-285-20","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-286-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-442-01","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (51079-441-20)  / 1 Tablet In 1 Blister Pack (51079-441-01)","250","RC","51079-441-20","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-441-01","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (51079-440-20)  / 1 Tablet In 1 Blister Pack (51079-440-01)","250","RC","51079-440-20","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-440-01","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-438-01","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-437-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-436-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-379-01","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-375-01","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-374-01","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-348-01","NDC","","","facility","both","1","EA","","6.22","6.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-767-01","NDC","","","facility","both","1","EA","","2.12","2.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-801-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Tartrate: 100 Blister Pack In 1 Carton (51079-801-20)  / 1 Tablet, Film Coated In 1 Blister Pack (51079-801-01)","250","RC","51079-801-20","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (51672-1258-1)  / 15 G In 1 Tube","250","RC","51672-1258-1","NDC","","","facility","both","1","EA","","13.29","13.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51552-0883-1","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenazopyridine Hydrochloride: 100 TABLET in 1 BOTTLE (51293-811-01) ","250","RC","51293-811-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Tablet In 1 Bottle, Plastic (51293-628-01)","250","RC","51293-628-01","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Tablet In 1 Bottle, Plastic (51293-627-01)","250","RC","51293-627-01","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phentolamine Mesylate: 10 Carton In 1 Tray (51224-012-10)  / 1 Vial In 1 Carton (51224-012-20)  / 1 Injection In 1 Vial","250","RC","51224-012-10","NDC","","","facility","both","1","EA","","423.58","423.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trikafta: 4 Package In 1 Carton (51167-446-01)  / 1 Kit In 1 Package *  1 Granule In 1 Packet (51167-746-07)  *  1 Granule In 1 Packet (51167-846-07)","250","RC","51167-446-01","NDC","","","facility","both","1","EA","","805.73","805.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trikafta: 4 Blister Pack In 1 Carton (51167-331-01)  / 1 Kit In 1 Blister Pack *  14 Tablet, Film Coated In 1 Blister Pack (51167-431-14)  *  7 Tablet, Film Coated In 1 Blister Pack (51167-531-07)","250","RC","51167-331-01","NDC","","","facility","both","1","EA","","537.16","537.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trikafta: 4 Blister Pack In 1 Carton (51167-106-02)  / 1 Kit In 1 Blister Pack *  14 Tablet, Film Coated In 1 Blister Pack (51167-206-14)  *  7 Tablet, Film Coated In 1 Blister Pack (51167-306-07)","250","RC","51167-106-02","NDC","","","facility","both","1","EA","","537.16","537.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01)  / 10.5 Ml In 1 Vial, Single-Dose","250","RC","51144-050-01","NDC","","","facility","both","1","EA","","194.53","194.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alyftrek: 4 Blister Pack In 1 Carton (51167-121-01)  / 14 Tablet, Film Coated In 1 Blister Pack","250","RC","51167-121-01","NDC","","","facility","both","1","EA","","913","913","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluocinonide: 1 Tube In 1 Carton (51672-1264-1)  / 15 G In 1 Tube","250","RC","51672-1264-1","NDC","","","facility","both","1","EA","","21.9","21.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluocinonide: 1 Tube In 1 Carton (51672-1264-3)  / 60 G In 1 Tube","250","RC","51672-1264-3","NDC","","","facility","both","1","EA","","48.5","48.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51672-2115-0","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51672-2114-0","NDC","","","facility","both","1","EA","","1.49","1.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Cetirizine Hydrochloride Sugar Free Grape: 1 Bottle In 1 Carton (51672-2102-8)  / 120 Ml In 1 Bottle","250","RC","51672-2102-8","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Terbinafine Hydrochloride: 1 Tube In 1 Carton (51672-2080-2)  / 30 G In 1 Tube","250","RC","51672-2080-2","NDC","","","facility","both","1","EA","","12.64","12.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Terbinafine Hydrochloride: 1 Tube In 1 Carton (51672-2080-1)  / 15 G In 1 Tube","250","RC","51672-2080-1","NDC","","","facility","both","1","EA","","8.46","8.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miconazole Nitrate: 1 Tube, With Applicator In 1 Carton (51672-2035-6)  / 45 G In 1 Tube, With Applicator","250","RC","51672-2035-6","NDC","","","facility","both","1","EA","","5.43","5.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triple Antibiotic: 1 Tube In 1 Carton (51672-2016-2)  / 28.4 G In 1 Tube","250","RC","51672-2016-2","NDC","","","facility","both","1","EA","","12.42","12.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miconazole Nitrate: 1 Tube In 1 Carton (51672-2001-2)  / 30 G In 1 Tube","250","RC","51672-2001-2","NDC","","","facility","both","1","EA","","4.53","4.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mupirocin: 1 Tube In 1 Carton (51672-1370-1)  / 15 G In 1 Tube","250","RC","51672-1370-1","NDC","","","facility","both","1","EA","","124.5","124.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluocinolone Acetonide: 1 Bottle In 1 Carton (51672-1357-8)  / 118.28 Ml In 1 Bottle","250","RC","51672-1357-8","NDC","","","facility","both","1","EA","","41.31","41.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mupirocin: 1 Tube In 1 Carton (51672-1312-0)  / 22 G In 1 Tube","250","RC","51672-1312-0","NDC","","","facility","both","1","EA","","11.49","11.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Econazole Nitrate: 1 Tube In 1 Carton (51672-1303-2)  / 30 G In 1 Tube","250","RC","51672-1303-2","NDC","","","facility","both","1","EA","","28.73","28.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketoconazole: 1 Tube In 1 Carton (51672-1298-1)  / 15 G In 1 Tube","250","RC","51672-1298-1","NDC","","","facility","both","1","EA","","16.06","16.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 1 Tube In 1 Carton (51672-1289-1)  / 15 G In 1 Tube","250","RC","51672-1289-1","NDC","","","facility","both","1","EA","","14.48","14.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (51672-1284-1)  / 15 G In 1 Tube","250","RC","51672-1284-1","NDC","","","facility","both","1","EA","","7.21","7.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (51672-1267-5)  / 5 G In 1 Tube","250","RC","51672-1267-5","NDC","","","facility","both","1","EA","","107","107","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-959-01","NDC","","","facility","both","1","EA","","4.54","4.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxazosin: 100 BLISTER PACK in 1 CARTON (51079-958-20)  / 1 TABLET in 1 BLISTER PACK (51079-958-01) ","250","RC","51079-958-20","NDC","","","facility","both","1","EA","","4.88","4.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-958-01","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-935-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-932-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-923-01","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-922-01","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clozapine: 100 Blister Pack In 1 Carton (51079-921-20)  / 1 Tablet In 1 Blister Pack (51079-921-01)","250","RC","51079-921-20","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-960-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-921-01","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-888-01","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-883-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-882-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-870-01","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 BLISTER PACK in 1 CARTON (51079-863-20)  / 1 TABLET in 1 BLISTER PACK (51079-863-01) ","250","RC","51079-863-20","NDC","","","facility","both","1","EA","","2.2","2.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-821-01","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-818-01","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glipizide: 100 BLISTER PACK in 1 CARTON (51079-811-20)  / 1 TABLET in 1 BLISTER PACK (51079-811-01) ","250","RC","51079-811-20","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-889-01","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Blister Pack In 1 Carton (51079-960-20)  / 1 Tablet In 1 Blister Pack (51079-960-01)","250","RC","51079-960-20","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-991-20)  / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-991-01) ","250","RC","51079-991-20","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-991-20)  / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-991-01) ","250","RC","51079-991-20","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Blister Pack In 1 Carton (51079-986-20)  / 1 Tablet In 1 Blister Pack (51079-986-01)","250","RC","51079-986-20","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-986-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-985-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-980-01","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (51079-978-20)  / 1 Tablet, Extended Release In 1 Blister Pack (51079-978-01)","250","RC","51079-978-20","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","51079-978-01","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (60219-1522-1)","250","RC","60219-1522-1","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (60219-1523-1)","250","RC","60219-1523-1","NDC","","","facility","both","1","EA","","2.96","2.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Protamine Sulfate: 25 Vial, Single-Dose In 1 Tray (63323-229-05)  / 5 Ml In 1 Vial, Single-Dose (63323-229-01)","250","RC","63323-229-05","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-229-01","NDC","","","facility","both","1","EA","","3.36","3.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 25 Vial, Single-Dose In 1 Tray (63323-208-05)  / 5 Ml In 1 Vial, Single-Dose (63323-208-01)","250","RC","63323-208-05","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-205-31","NDC","","","facility","both","1","EA","","41.12","41.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 25 Vial In 1 Tray (63323-201-10)  / 10 Ml In 1 Vial (63323-201-03)","250","RC","63323-201-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 25 Vial In 1 Tray (63323-201-10)  / 10 Ml In 1 Vial (63323-201-03)","250","RC","63323-201-10","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludarabine: 1 Vial In 1 Box (63323-192-02)  / 2 Ml In 1 Vial","250","RC","63323-192-02","NDC","","","facility","both","1","EA","","68.47","68.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 25 Vial, Single-Dose In 1 Tray (63323-187-30)  / 30 Ml In 1 Vial, Single-Dose","250","RC","63323-187-30","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-186-01","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 25 Vial, Single-Dose In 1 Tray (63323-186-00)  / 100 Ml In 1 Vial, Single-Dose","250","RC","63323-186-00","NDC","","","facility","both","1","EA","","14.4","14.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-185-07","NDC","","","facility","both","1","EA","","3.09","3.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folic Acid: 1 Vial, Multi-Dose In 1 Carton (63323-184-10)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","63323-184-10","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folic Acid: 1 Vial, Multi-Dose In 1 Carton (63323-184-10)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","63323-184-10","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Protamine Sulfate: 1 Vial, Single-Dose In 1 Box (63323-229-30)  / 25 Ml In 1 Vial, Single-Dose","250","RC","63323-229-30","NDC","","","facility","both","1","EA","","2.17","2.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Tray (63323-262-01)  / 1 Ml In 1 Vial","250","RC","63323-262-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diprivan: 10 Vial In 1 Box (63323-269-67)  / 100 Ml In 1 Vial (63323-269-21)","250","RC","63323-269-67","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diprivan: 10 Vial In 1 Box (63323-269-65)  / 100 Ml In 1 Vial (63323-269-35)","250","RC","63323-269-65","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diprivan: 20 Vial In 1 Box (63323-269-50)  / 50 Ml In 1 Vial (63323-269-30)","250","RC","63323-269-50","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-269-35","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-269-30","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-269-22","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Vial, Multi-Dose In 1 Carton (63323-265-30)  / 16 Ml In 1 Vial, Multi-Dose","250","RC","63323-265-30","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Tray (63323-262-06)  / 1 Ml In 1 Vial (63323-262-03)","250","RC","63323-262-06","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-262-03","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diprivan: 10 Vial In 1 Box (63323-269-29)  / 20 Ml In 1 Vial (63323-269-22)","250","RC","63323-269-29","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyridoxine Hydrochloride: 25 Vial In 1 Tray (63323-180-01)  / 1 Ml In 1 Vial (63323-180-00)","250","RC","63323-180-01","NDC","","","facility","both","1","EA","","7.23","7.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-180-00","NDC","","","facility","both","1","EA","","10.42","10.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial, Single-Dose In 1 Carton (63323-120-20)  / 20 Ml In 1 Vial, Single-Dose","250","RC","63323-120-20","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-61)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","250","RC","63323-117-61","NDC","","","facility","both","1","EA","","2.83","2.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-117-01","NDC","","","facility","both","1","EA","","3.86","3.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pentam 300: 10 Vial In 1 Tray (63323-113-10)  / 3 Ml In 1 Vial (63323-113-01)","250","RC","63323-113-10","NDC","","","facility","both","1","EA","","79.68","79.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-113-01","NDC","","","facility","both","1","EA","","48.72","48.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 24 Bag In 1 Case (63323-106-15)  / 500 Ml In 1 Bag","250","RC","63323-106-15","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-106-02","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-180-00","NDC","","","facility","both","1","EA","","12.67","12.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Phosphates: 25 Vial, Single-Dose In 1 Tray (63323-170-15)  / 15 Ml In 1 Vial, Single-Dose","250","RC","63323-170-15","NDC","","","facility","both","1","EA","","6.69","6.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 25 Vial, Multi-Dose In 1 Tray (63323-165-05)  / 5 Ml In 1 Vial, Multi-Dose (63323-165-03)","250","RC","63323-165-05","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-162-01)  / 1 Ml In 1 Vial, Single-Use (63323-162-00)","250","RC","63323-162-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-162-00","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-162-00","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-161-01)  / 1 Ml In 1 Vial, Single-Use (63323-161-00)","250","RC","63323-161-01","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-161-00","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitoxantrone: 1 Vial, Multi-Dose In 1 Box (63323-132-10)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","63323-132-10","NDC","","","facility","both","1","EA","","35.51","35.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-130-02","NDC","","","facility","both","1","EA","","26.62","26.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diprivan: 10 Vial In 1 Box (63323-269-69)  / 100 Ml In 1 Vial (63323-269-41)","250","RC","63323-269-69","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 24 Bag In 1 Case (63323-106-01)  / 100 Ml In 1 Bag (63323-106-00)","250","RC","63323-106-01","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-325-03","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-322-01","NDC","","","facility","both","1","EA","","8.86","8.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Bottle In 1 Carton (63323-314-61)  / 100 Ml In 1 Bottle","250","RC","63323-314-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Bottle In 1 Carton (63323-314-61)  / 100 Ml In 1 Bottle","250","RC","63323-314-61","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Bottle In 1 Carton (63323-314-61)  / 100 Ml In 1 Bottle","250","RC","63323-314-61","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 10 Vial, Multi-Dose In 1 Tray (63323-306-30)  / 30 Ml In 1 Vial, Multi-Dose (63323-306-05)","250","RC","63323-306-30","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-306-05","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 25 Vial, Multi-Dose In 1 Tray (63323-306-02)  / 2 Ml In 1 Vial, Multi-Dose (63323-306-01)","250","RC","63323-306-02","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-306-01","NDC","","","facility","both","1","EA","","2.17","2.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 6 Vial, Pharmacy Bulk Package In 1 Tray (63323-303-51)  / 30 Ml In 1 Vial, Pharmacy Bulk Package (63323-303-01)","250","RC","63323-303-51","NDC","","","facility","both","1","EA","","6.21","6.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polocaine-Mpf: 25 Vial, Single-Dose In 1 Tray (63323-293-37)  / 30 Ml In 1 Vial, Single-Dose (63323-293-01)","250","RC","63323-293-37","NDC","","","facility","both","1","EA","","4.48","4.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-325-09","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 10 Vial, Single-Dose In 1 Tray (63323-325-10)  / 10 Ml In 1 Vial, Single-Dose (63323-325-03)","250","RC","63323-325-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-376-00","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 1 Vial In 1 Box (63323-374-20)  / 20 Ml In 1 Vial","250","RC","63323-374-20","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-360-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-360-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rifampin: 1 Vial In 1 Box (63323-351-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","250","RC","63323-351-20","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-349-01","NDC","","","facility","both","1","EA","","10.31","10.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate: 25 Vial, Plastic In 1 Tray (63323-360-19)  / 10 Ml In 1 Vial, Plastic (63323-360-01)","250","RC","63323-360-19","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-288-11)  / 10 Ml In 1 Vial, Single-Dose (63323-288-03)","250","RC","63323-288-11","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-280-05","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-280-05","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-280-05","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Tray (63323-280-04)  / 4 Ml In 1 Vial (63323-280-03)","250","RC","63323-280-04","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Tray (63323-280-04)  / 4 Ml In 1 Vial (63323-280-03)","250","RC","63323-280-04","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Tray (63323-280-02)  / 2 Ml In 1 Vial (63323-280-01)","250","RC","63323-280-02","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Tray (63323-280-02)  / 2 Ml In 1 Vial (63323-280-01)","250","RC","63323-280-02","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Tray (63323-276-02)  / 2 Ml In 1 Vial (63323-276-01)","250","RC","63323-276-02","NDC","","","facility","both","1","EA","","4.38","4.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-276-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 1 Vial In 1 Box (63323-281-10)  / 10 Ml In 1 Vial","250","RC","63323-281-10","NDC","","","facility","both","1","EA","","9.11","9.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-288-07","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-286-35)  / 30 Ml In 1 Vial, Single-Dose (63323-286-11)","250","RC","63323-286-35","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naropin: 1 Vial, Single-Dose In 1 Box (63323-286-30)  / 30 Ml In 1 Vial, Single-Dose","250","RC","63323-286-30","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naropin: 1 Vial, Single-Dose In 1 Box (63323-286-30)  / 30 Ml In 1 Vial, Single-Dose","250","RC","63323-286-30","NDC","","","facility","both","1","EA","","5.87","5.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-286-11","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naropin: 12 Bottle In 1 Case (63323-285-68)  / 100 Ml In 1 Bottle (63323-285-53)","250","RC","63323-285-68","NDC","","","facility","both","1","EA","","23.94","23.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-285-57","NDC","","","facility","both","1","EA","","59.52","59.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-285-23)  / 20 Ml In 1 Vial, Single-Dose (63323-285-07)","250","RC","63323-285-23","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-284-01","NDC","","","facility","both","1","EA","","3.49","3.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin: 25 VIAL in 1 TRAY (63323-282-04)  / 4 mL in 1 VIAL","250","RC","63323-282-04","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin: 25 VIAL in 1 TRAY (63323-282-02)  / 2 mL in 1 VIAL","250","RC","63323-282-02","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-106-00","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propafenone Hydrochloride: 100 Tablet, Coated In 1 Bottle (62559-231-01)","250","RC","62559-231-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 1 Bottle In 1 Carton (62559-204-12)  / 120 Ml In 1 Bottle","250","RC","62559-204-12","NDC","","","facility","both","1","EA","","20.51","20.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 473 Ml In 1 Bottle, Plastic (62559-190-16)","250","RC","62559-190-16","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62559-157-17","NDC","","","facility","both","1","EA","","1.76","1.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 1 Bottle In 1 Carton (62559-151-16)  / 473 Ml In 1 Bottle","250","RC","62559-151-16","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62559-138-11","NDC","","","facility","both","1","EA","","29.62","29.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 30 Tablet In 1 Bottle (62559-265-30)","250","RC","62559-265-30","NDC","","","facility","both","1","EA","","4.42","4.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 7 Bottle In 1 Box (62559-138-07)  / 60 Ml In 1 Bottle (62559-138-11)","250","RC","62559-138-07","NDC","","","facility","both","1","EA","","29.62","29.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pancreaze: 1 Bottle, Glass In 1 Carton (62541-404-10)  / 100 Capsule, Delayed Release In 1 Bottle, Glass","250","RC","62541-404-10","NDC","","","facility","both","1","EA","","9.28","9.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pancreaze: 1 Bottle, Glass In 1 Carton (62541-403-10)  / 100 Capsule, Delayed Release In 1 Bottle, Glass","250","RC","62541-403-10","NDC","","","facility","both","1","EA","","5.78","5.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62484-0020-1","NDC","","","facility","both","1","EA","","29.98","29.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (62332-791-31)","250","RC","62332-791-31","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pancreaze: 1 Bottle, Glass In 1 Carton (62541-405-10)  / 100 Capsule, Delayed Release In 1 Bottle, Glass","250","RC","62541-405-10","NDC","","","facility","both","1","EA","","11.56","11.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guanfacine: 100 Tablet, Extended Release In 1 Bottle (62332-747-31)","250","RC","62332-747-31","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 2 Blister Pack In 1 Carton (62559-390-20)  / 10 Capsule In 1 Blister Pack","250","RC","62559-390-20","NDC","","","facility","both","1","EA","","4.16","4.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pindolol: 100 Tablet In 1 Bottle (62559-560-01)","250","RC","62559-560-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"cephalexin: 100 CAPSULE in 1 BOTTLE (62756-294-88) ","250","RC","62756-294-88","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (62756-233-01)  / 1 Injectable, Liposomal In 1 Vial, Single-Dose","250","RC","62756-233-01","NDC","","","facility","both","1","EA","","67.37","67.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62584-994-11","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Warfarin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (62584-994-01)  / 1 Tablet In 1 Blister Pack (62584-994-11)","250","RC","62584-994-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62584-984-11","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Warfarin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (62584-984-01)  / 1 Tablet In 1 Blister Pack (62584-984-11)","250","RC","62584-984-01","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62584-813-11","NDC","","","facility","both","1","EA","","4.36","4.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62584-734-11","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62584-733-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62584-267-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Felbamate: 100 Tablet In 1 Bottle (62559-731-01)","250","RC","62559-731-01","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Felbamate: 100 Tablet In 1 Bottle (62559-730-01)","250","RC","62559-730-01","NDC","","","facility","both","1","EA","","1.49","1.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin Ethylsuccinate: 100 Ml In 1 Bottle (62559-630-01)","250","RC","62559-630-01","NDC","","","facility","both","1","EA","","7.11","7.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pindolol: 100 Tablet In 1 Bottle (62559-561-01)","250","RC","62559-561-01","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62584-812-11","NDC","","","facility","both","1","EA","","3.17","3.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (62332-724-35)","250","RC","62332-724-35","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dabigatran Etexilate: 10 Blister Pack In 1 Carton (62332-634-06)  / 6 Capsule In 1 Blister Pack","250","RC","62332-634-06","NDC","","","facility","both","1","EA","","4.15","4.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Tablet, For Suspension In 1 Bottle (62332-096-31)","250","RC","62332-096-31","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Tablet, For Suspension In 1 Bottle (62332-095-31)","250","RC","62332-095-31","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leflunomide: 30 Tablet In 1 Bottle (62332-062-30)","250","RC","62332-062-30","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leflunomide: 30 Tablet In 1 Bottle (62332-061-30)","250","RC","62332-061-30","NDC","","","facility","both","1","EA","","1.43","1.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losartan Potassium And Hydrochlorothiazide: 90 Tablet, Film Coated In 1 Bottle (62332-048-90)","250","RC","62332-048-90","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Steritalc 4G: 4 Vial, Glass In 1 Box (62327-444-44)  / 50 Ml In 1 Vial, Glass (62327-444-04)","250","RC","62327-444-44","NDC","","","facility","both","1","EA","","252","252","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62327-444-04","NDC","","","facility","both","1","EA","","252","252","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62327-333-03","NDC","","","facility","both","1","EA","","175","175","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine Hydrochloride: 30 Tablet, Film Coated, Extended Release In 1 Bottle (62175-472-32)","250","RC","62175-472-32","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62332-198-10","NDC","","","facility","both","1","EA","","4.78","4.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine Hydrochloride: 30 Tablet, Film Coated, Extended Release In 1 Bottle (62175-471-32)","250","RC","62175-471-32","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (62175-311-37)","250","RC","62175-311-37","NDC","","","facility","both","1","EA","","8.82","8.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (62175-310-37)","250","RC","62175-310-37","NDC","","","facility","both","1","EA","","5.46","5.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62135-867-59","NDC","","","facility","both","1","EA","","146.43","146.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfadiazine: 60 Tablet In 1 Bottle (62135-842-60)","250","RC","62135-842-60","NDC","","","facility","both","1","EA","","26.25","26.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 473 Ml In 1 Bottle (62135-750-47)","250","RC","62135-750-47","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62135-730-45","NDC","","","facility","both","1","EA","","158.38","158.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 473 Ml In 1 Bottle (62135-520-47)","250","RC","62135-520-47","NDC","","","facility","both","1","EA","","4.39","4.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Asenapine: 100 Blister Pack In 1 Carton (62332-198-31)  / 10 Tablet In 1 Blister Pack","250","RC","62332-198-31","NDC","","","facility","both","1","EA","","4.79","4.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62332-199-10","NDC","","","facility","both","1","EA","","4.75","4.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Teriflunomide: 30 Tablet, Film Coated In 1 Bottle (62332-314-30)","250","RC","62332-314-30","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 1 Tube In 1 Carton (62332-630-60)  / 60 G In 1 Tube","250","RC","62332-630-60","NDC","","","facility","both","1","EA","","206.18","206.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 100 Capsule In 1 Bottle (62332-619-31)","250","RC","62332-619-31","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","62332-599-01","NDC","","","facility","both","1","EA","","2.92","2.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine And Prilocaine: 1 Tube In 1 Carton (62332-582-31)  / 30 G In 1 Tube","250","RC","62332-582-31","NDC","","","facility","both","1","EA","","37.59","37.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine And Prilocaine: 1 Tube In 1 Carton (62332-582-04)  / 5 G In 1 Tube","250","RC","62332-582-04","NDC","","","facility","both","1","EA","","13.72","13.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dorzolamide Hydrochloride And Timolol Maleate Ophthalmic Solution: 1 Bottle In 1 Carton (62332-553-10)  / 10 Ml In 1 Bottle","250","RC","62332-553-10","NDC","","","facility","both","1","EA","","33.2","33.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (62332-498-30)","250","RC","62332-498-30","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (62332-497-30)","250","RC","62332-497-30","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (62332-495-30)","250","RC","62332-495-30","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 60 Blister Pack In 1 Carton (62332-366-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","62332-366-06","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 60 Blister Pack In 1 Carton (62332-365-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","62332-365-06","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 60 Blister Pack In 1 Carton (62332-364-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","62332-364-06","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Riluzole: 60 Tablet, Film Coated In 1 Bottle (62756-538-86)","250","RC","62756-538-86","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-064-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-044-00","NDC","","","facility","both","1","EA","","2.1","2.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Bicarbonate: 25 VIAL, SINGLE-DOSE in 1 TRAY (63323-026-05)  / 5 mL in 1 VIAL, SINGLE-DOSE","250","RC","63323-026-05","NDC","","","facility","both","1","EA","","7.45","7.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mannitol: 25 Vial, Single-Dose In 1 Tray (63323-024-25)  / 50 Ml In 1 Vial, Single-Dose (63323-024-01)","250","RC","63323-024-25","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiamine: 25 Vial, Multi-Dose In 1 Tray (63323-013-02)  / 2 Ml In 1 Vial, Multi-Dose (63323-013-01)","250","RC","63323-013-02","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxytocin: 25 Vial In 1 Tray (63323-012-11)  / 1 Ml In 1 Vial (63323-012-03)","250","RC","63323-012-11","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-012-03","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-010-03","NDC","","","facility","both","1","EA","","2.43","2.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-013-01","NDC","","","facility","both","1","EA","","3.56","3.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-064-04","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial, Multi-Dose In 1 Carton (63323-104-25)  / 25 Ml In 1 Vial, Multi-Dose","250","RC","63323-104-25","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial, Multi-Dose In 1 Carton (63323-104-25)  / 25 Ml In 1 Vial, Multi-Dose","250","RC","63323-104-25","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial, Multi-Dose In 1 Carton (63323-104-06)  / 5 Ml In 1 Vial, Multi-Dose","250","RC","63323-104-06","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (63323-101-61)  / 100 Ml In 1 Vial, Multi-Dose","250","RC","63323-101-61","NDC","","","facility","both","1","EA","","4.08","4.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-095-02","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-095-02","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 25 Vial, Plastic In 1 Tray (63323-093-30)  / 30 Ml In 1 Vial, Plastic (63323-093-01)","250","RC","63323-093-30","NDC","","","facility","both","1","EA","","8.51","8.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-093-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-093-01","NDC","","","facility","both","1","EA","","1.82","1.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Bicarbonate: 25 Vial, Single-Dose In 1 Tray (63323-089-50)  / 50 Ml In 1 Vial, Single-Dose (63323-089-25)","250","RC","63323-089-50","NDC","","","facility","both","1","EA","","38.47","38.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-089-25","NDC","","","facility","both","1","EA","","39.11","39.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Phosphates: 25 VIAL, SINGLE-DOSE in 1 TRAY (63323-086-05)  / 5 mL in 1 VIAL, SINGLE-DOSE","250","RC","63323-086-05","NDC","","","facility","both","1","EA","","19.01","19.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Bicarbonate: 25 Vial, Single-Dose In 1 Tray (63323-083-05)  / 5 Ml In 1 Vial, Single-Dose (63323-083-03)","250","RC","63323-083-05","NDC","","","facility","both","1","EA","","23.69","23.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-083-03","NDC","","","facility","both","1","EA","","36.46","36.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-010-01","NDC","","","facility","both","1","EA","","5.87","5.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 100 Tablet, Extended Release In 1 Bottle (63304-987-01)","250","RC","63304-987-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Banzel: 120 Tablet, Film Coated In 1 Bottle (62856-583-52)","250","RC","62856-583-52","NDC","","","facility","both","1","EA","","43.82","43.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fycompa: 30 Tablet In 1 Bottle (62856-274-30)","250","RC","62856-274-30","NDC","","","facility","both","1","EA","","64.08","64.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (62756-956-01)","250","RC","62756-956-01","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-798-88)","250","RC","62756-798-88","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-797-88)","250","RC","62756-797-88","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-796-88)","250","RC","62756-796-88","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Banzel: 120 Tablet, Film Coated In 1 Bottle (62856-582-52)","250","RC","62856-582-52","NDC","","","facility","both","1","EA","","21.54","21.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"BROMOCRIPTINE MESYLATE: 100 TABLET in 1 BOTTLE (63304-962-01) ","250","RC","63304-962-01","NDC","","","facility","both","1","EA","","1.82","1.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir: 30 Tablet, Film Coated In 1 Bottle (63304-905-30)","250","RC","63304-905-30","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (63304-458-30)","250","RC","63304-458-30","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (63304-458-30)","250","RC","63304-458-30","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (63304-450-01)","250","RC","63304-450-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nuplazid: 30 Capsule In 1 Bottle, Plastic (63090-340-30)","250","RC","63090-340-30","NDC","","","facility","both","1","EA","","218.29","218.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nuplazid: 30 Tablet, Coated In 1 Bottle, Plastic (63090-100-30)","250","RC","63090-100-30","NDC","","","facility","both","1","EA","","218.28","218.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63037-101-05","NDC","","","facility","both","1","EA","","3.24","3.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Iclusig: 30 Tablet, Film Coated In 1 Bottle (63020-536-30)","250","RC","63020-536-30","NDC","","","facility","both","1","EA","","1074.78","1074.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Iclusig: 30 Tablet, Film Coated In 1 Bottle (63020-535-30)","250","RC","63020-535-30","NDC","","","facility","both","1","EA","","1074.78","1074.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetracaine Hydrochloride: 100 G In 1 Jar (62991-2067-2)","250","RC","62991-2067-2","NDC","","","facility","both","1","EA","","8.37","8.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefotetan: 10 Vial In 1 Carton (63323-385-10)  / 10 Ml In 1 Vial (63323-385-01)","250","RC","63323-385-10","NDC","","","facility","both","1","EA","","32.37","32.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10)  / 10 Ml In 1 Vial, Single-Use","250","RC","63459-103-10","NDC","","","facility","both","1","EA","","88.12","88.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10)  / 10 Ml In 1 Vial, Single-Use","250","RC","63459-103-10","NDC","","","facility","both","1","EA","","88.12","88.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Latuda: 30 Tablet, Film Coated In 1 Bottle (63402-304-30)","250","RC","63402-304-30","NDC","","","facility","both","1","EA","","65.2","65.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aptiom: 30 Tablet In 1 Bottle (63402-208-30)","250","RC","63402-208-30","NDC","","","facility","both","1","EA","","72.71","72.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aptiom: 30 Tablet In 1 Bottle (63402-204-30)","250","RC","63402-204-30","NDC","","","facility","both","1","EA","","74.26","74.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aptiom: 30 Tablet In 1 Bottle (63402-202-30)","250","RC","63402-202-30","NDC","","","facility","both","1","EA","","73.31","73.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63361-243-88","NDC","","","facility","both","1","EA","","260.12","260.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 25 Vial, Multi-Dose In 1 Tray (63323-967-30)  / 30 Ml In 1 Vial, Multi-Dose (63323-967-01)","250","RC","63323-967-30","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 25 Vial, Single-Dose In 1 Tray (63323-965-20)  / 20 Ml In 1 Vial, Single-Dose (63323-965-02)","250","RC","63323-965-20","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 25 Vial, Single-Dose In 1 Tray (63323-965-10)  / 10 Ml In 1 Vial, Single-Dose (63323-965-03)","250","RC","63323-965-10","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 25 Vial, Single-Dose In 1 Tray (63323-965-05)  / 5 Ml In 1 Vial, Single-Dose (63323-965-01)","250","RC","63323-965-05","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10)  / 10 Ml In 1 Vial, Single-Use","250","RC","63459-103-10","NDC","","","facility","both","1","EA","","54.22","54.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 3 Blister Pack In 1 Box, Unit-Dose (63739-069-33)  / 10 Tablet In 1 Blister Pack","250","RC","63739-069-33","NDC","","","facility","both","1","EA","","14.01","14.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mucus Relief: 30 Blister Pack In 1 Box (63739-067-02)  / 10 Tablet, Extended Release In 1 Blister Pack","250","RC","63739-067-02","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sky Oral Rinse: 15 Ml In 1 Cup, Unit-Dose (63739-052-74)","250","RC","63739-052-74","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"benzonatate: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-029-10)  / 10 CAPSULE in 1 BLISTER PACK","250","RC","63739-029-10","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-016-10)  / 10 CAPSULE, COATED, EXTENDED RELEASE in 1 BLISTER PACK","250","RC","63739-016-10","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 3 Blister Pack In 1 Box, Unit-Dose (63739-008-33)  / 10 Tablet In 1 Blister Pack","250","RC","63739-008-33","NDC","","","facility","both","1","EA","","27.41","27.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone Hydrochloride: 4 Blister Pack In 1 Box, Unit-Dose (63739-005-32)  / 10 Capsule In 1 Blister Pack","250","RC","63739-005-32","NDC","","","facility","both","1","EA","","3.92","3.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketoconazole: 120 Ml In 1 Bottle, Plastic (63646-010-04)","250","RC","63646-010-04","NDC","","","facility","both","1","EA","","17.28","17.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (63629-2458-1)  / 15 G In 1 Tube","250","RC","63629-2458-1","NDC","","","facility","both","1","EA","","11.96","11.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyoscyamine Sulfate: 100 Tablet In 1 Bottle (63629-1031-1)","250","RC","63629-1031-1","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bendeka: 1 Vial, Multi-Dose In 1 Carton (63459-348-04)  / 4 Ml In 1 Vial, Multi-Dose","250","RC","63459-348-04","NDC","","","facility","both","1","EA","","24.64","24.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50)  / 50 Ml In 1 Vial, Single-Use","250","RC","63459-104-50","NDC","","","facility","both","1","EA","","88.04","88.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50)  / 50 Ml In 1 Vial, Single-Use","250","RC","63459-104-50","NDC","","","facility","both","1","EA","","88.12","88.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50)  / 50 Ml In 1 Vial, Single-Use","250","RC","63459-104-50","NDC","","","facility","both","1","EA","","88.12","88.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-965-03","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-853-03","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-853-03","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 50 Ml In 1 Vial, Single-Dose (63323-851-50)","250","RC","63323-851-50","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 50 Ml In 1 Vial, Single-Dose (63323-851-50)","250","RC","63323-851-50","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-853-03","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Carton (63323-851-10)  / 1 Ml In 1 Vial, Single-Dose (63323-851-03)","250","RC","63323-851-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-851-07","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-851-03","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-820-04","NDC","","","facility","both","1","EA","","11.62","11.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-820-03","NDC","","","facility","both","1","EA","","14.14","14.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-820-01","NDC","","","facility","both","1","EA","","18","18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-965-02","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-965-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin: 25 Vial, Single-Dose In 1 Tray (63323-930-01)  / 1 Ml In 1 Vial, Single-Dose (63323-930-00)","250","RC","63323-930-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-930-00","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 1 Vial, Single-Dose In 1 Carton (63323-885-10)  / 5 Ml In 1 Vial, Single-Dose","250","RC","63323-885-10","NDC","","","facility","both","1","EA","","62.62","62.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Phosphates: 25 Vial, Single-Dose In 1 Tray (63323-884-06)  / 5 Ml In 1 Vial, Single-Dose (63323-884-01)","250","RC","63323-884-06","NDC","","","facility","both","1","EA","","11.59","11.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-884-01","NDC","","","facility","both","1","EA","","11.59","11.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (63323-883-30)  / 25 Ml In 1 Vial, Single-Dose","250","RC","63323-883-30","NDC","","","facility","both","1","EA","","3","3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Phosphates: 25 Vial, Single-Dose In 1 Tray (63323-881-16)  / 15 Ml In 1 Vial, Single-Dose (63323-881-01)","250","RC","63323-881-16","NDC","","","facility","both","1","EA","","6.77","6.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-881-01","NDC","","","facility","both","1","EA","","5.96","5.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 10 Blister Pack In 1 Box, Unit-Dose (63739-070-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-070-10","NDC","","","facility","both","1","EA","","8.08","8.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 10 Blister Pack In 1 Box, Unit-Dose (63739-074-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-074-10","NDC","","","facility","both","1","EA","","6.7","6.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine Fumarate: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-677-10)  / 10 TABLET in 1 BLISTER PACK","250","RC","63739-677-10","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losortan Potassium: 10 Blister Pack In 1 Box, Unit-Dose (63739-673-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-673-10","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-671-10)  / 10 TABLET, COATED in 1 BLISTER PACK","250","RC","63739-671-10","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 10 Blister Pack In 1 Box, Unit-Dose (63739-645-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-645-10","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amlodipine Besylate: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-631-10)  / 10 TABLET in 1 BLISTER PACK","250","RC","63739-631-10","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simvastatin: 10 Blister Pack In 1 Box, Unit-Dose (63739-573-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-573-10","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simvastatin: 10 Blister Pack In 1 Box, Unit-Dose (63739-572-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-572-10","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simvastatin: 10 Blister Pack In 1 Box, Unit-Dose (63739-571-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-571-10","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simvastatin: 10 Blister Pack In 1 Box, Unit-Dose (63739-570-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-570-10","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 10 Blister Pack In 1 Box, Unit-Dose (63739-569-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-569-10","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tamsulosin Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-567-10)  / 10 Capsule In 1 Blister Pack","250","RC","63739-567-10","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 10 Blister Pack In 1 Box, Unit-Dose (63739-564-10)  / 10 Tablet, Delayed Release In 1 Blister Pack","250","RC","63739-564-10","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 10 Blister Pack In 1 Box, Unit-Dose (63739-560-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-560-10","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losartan Potassium: 10 Blister Pack In 1 Box, Unit-Dose (63739-686-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-686-10","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63739-724-01","NDC","","","facility","both","1","EA","","13.77","13.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 10 Blister Pack In 1 Box, Unit-Dose (63739-992-10)  / 10 Tablet, Coated In 1 Blister Pack","250","RC","63739-992-10","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone Hydrochloride: 4 Blister Pack In 1 Box, Unit-Dose (63739-988-32)  / 10 Capsule In 1 Blister Pack","250","RC","63739-988-32","NDC","","","facility","both","1","EA","","3.64","3.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-984-10)  / 10 CAPSULE in 1 BLISTER PACK","250","RC","63739-984-10","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 10 Blister Pack In 1 Box, Unit-Dose (63739-963-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-963-10","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63739-953-11","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 10 Blister Pack In 1 Carton (63739-904-10)  / 10 Capsule In 1 Blister Pack","250","RC","63739-904-10","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 10 Blister Pack In 1 Carton (63739-903-10)  / 10 Capsule In 1 Blister Pack","250","RC","63739-903-10","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 10 Blister Pack In 1 Carton (63739-902-10)  / 10 Capsule In 1 Blister Pack","250","RC","63739-902-10","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 10 Blister Pack In 1 Box, Unit-Dose (63739-888-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-888-10","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-796-10)  / 10 TABLET in 1 BLISTER PACK","250","RC","63739-796-10","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 10 Blister Pack In 1 Box, Unit-Dose (63739-795-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-795-10","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 10 Blister Pack In 1 Box, Unit-Dose (63739-787-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-787-10","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxychloroquine Sulfate: 10 Blister Pack In 1 Box, Unit-Dose (63739-777-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-777-10","NDC","","","facility","both","1","EA","","4.13","4.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63739-760-01","NDC","","","facility","both","1","EA","","2.04","2.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-813-01","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 10 Blister Pack In 1 Box, Unit-Dose (63739-545-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-545-10","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 10 Blister Pack In 1 Box, Unit-Dose (63739-544-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-544-10","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-236-10)  / 10 CAPSULE in 1 BLISTER PACK","250","RC","63739-236-10","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Low Dose Aspirin: 30 Blister Pack In 1 Box (63739-212-02)  / 10 Tablet, Coated In 1 Blister Pack","250","RC","63739-212-02","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63739-193-72","NDC","","","facility","both","1","EA","","13.61","13.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 10 Blister Pack In 1 Box (63739-192-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-192-10","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63739-170-13","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Capsule In 1 Carton (63739-297-10)","250","RC","63739-297-10","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 5 Ml In 1 Cup, Unit-Dose (63739-160-70)","250","RC","63739-160-70","NDC","","","facility","both","1","EA","","1.58","1.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63739-159-77","NDC","","","facility","both","1","EA","","1.7","1.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63739-158-70","NDC","","","facility","both","1","EA","","3.4","3.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-145-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-145-10","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tamoxifen Citrate: 10 Blister Pack In 1 Box, Unit-Dose (63739-143-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-143-10","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride (Xl): 3 Blister Pack In 1 Box, Unit-Dose (63739-132-33)  / 10 Tablet, Extended Release In 1 Blister Pack","250","RC","63739-132-33","NDC","","","facility","both","1","EA","","3.19","3.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 10 Blister Pack In 1 Box (63739-098-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-098-10","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen 325Mg Rs: 30 Blister Pack In 1 Box (63739-087-02)  / 10 Tablet In 1 Blister Pack","250","RC","63739-087-02","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Capsule In 1 Carton (63739-298-10)","250","RC","63739-298-10","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 2 TRAY in 1 CASE (63739-539-50)  / 20 CUP, UNIT-DOSE in 1 TRAY / 5 mL in 1 CUP, UNIT-DOSE","250","RC","63739-539-50","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zolpidem Tartrate: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-526-10)  / 10 TABLET, FILM COATED in 1 BLISTER PACK","250","RC","63739-526-10","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir Hydrochloride: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-525-10)  / 10 TABLET, FILM COATED in 1 BLISTER PACK","250","RC","63739-525-10","NDC","","","facility","both","1","EA","","2.43","2.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-483-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-483-10","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 10 Blister Pack In 1 Box, Unit-Dose (63739-480-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-480-10","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 10 Blister Pack In 1 Box, Unit-Dose (63739-479-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-479-10","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin Chewable: 30 Blister Pack In 1 Box (63739-434-02)  / 10 Tablet In 1 Blister Pack","250","RC","63739-434-02","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rifampin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-415-10)  / 10 CAPSULE in 1 BLISTER PACK","250","RC","63739-415-10","NDC","","","facility","both","1","EA","","39.37","39.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 10 Blister Pack In 1 Box, Unit-Dose (63739-411-10)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","63739-411-10","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 10 Blister Pack In 1 Box, Unit-Dose (63739-410-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-410-10","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 10 Blister Pack In 1 Box, Unit-Dose (63739-367-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-367-10","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63739-354-10","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 10 Blister Pack In 1 Case (63739-328-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-328-10","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 10 Blister Pack In 1 Case (63739-327-10)  / 10 Tablet In 1 Blister Pack","250","RC","63739-327-10","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Disulfiram: 90 Tablet In 1 Bottle (62135-431-90)","250","RC","62135-431-90","NDC","","","facility","both","1","EA","","16.09","16.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Carton (63323-492-57)  / 5 Ml In 1 Vial, Single-Dose (63323-492-09)","250","RC","63323-492-57","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Carton (63323-492-27)  / 2 Ml In 1 Vial, Single-Dose (63323-492-04)","250","RC","63323-492-27","NDC","","","facility","both","1","EA","","2.94","2.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-492-09","NDC","","","facility","both","1","EA","","4.21","4.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-492-07","NDC","","","facility","both","1","EA","","8.1","8.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-489-27)  / 20 Ml In 1 Vial, Single-Dose (63323-489-02)","250","RC","63323-489-27","NDC","","","facility","both","1","EA","","17.6","17.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Tray (63323-489-17)  / 10 Ml In 1 Vial, Single-Dose (63323-489-01)","250","RC","63323-489-17","NDC","","","facility","both","1","EA","","14.22","14.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-494-01","NDC","","","facility","both","1","EA","","9.48","9.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-489-02","NDC","","","facility","both","1","EA","","21.11","21.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-486-57)  / 50 Ml In 1 Vial, Multi-Dose (63323-486-05)","250","RC","63323-486-57","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-486-17)  / 10 Ml In 1 Vial, Multi-Dose (63323-486-01)","250","RC","63323-486-17","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-486-05","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-483-03","NDC","","","facility","both","1","EA","","5.89","5.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-482-57)  / 50 Ml In 1 Vial, Multi-Dose (63323-482-05)","250","RC","63323-482-57","NDC","","","facility","both","1","EA","","4.06","4.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-487-07","NDC","","","facility","both","1","EA","","12.3","12.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-482-17)  / 10 Ml In 1 Vial, Multi-Dose (63323-482-01)","250","RC","63323-482-17","NDC","","","facility","both","1","EA","","2.59","2.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-495-04","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine Mpf: 5 Ampule In 1 Box (63323-496-97)  / 10 Ml In 1 Ampule (63323-496-03)","250","RC","63323-496-97","NDC","","","facility","both","1","EA","","8.19","8.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Tray (63323-540-11)  / 10 Ml In 1 Vial","250","RC","63323-540-11","NDC","","","facility","both","1","EA","","1.2","1.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-533-01","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 20 Bag In 1 Case (63323-530-75)  / 500 Ml In 1 Bag (63323-530-21)","250","RC","63323-530-75","NDC","","","facility","both","1","EA","","3.46","3.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-530-21","NDC","","","facility","both","1","EA","","3.35","3.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-495-04","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-523-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-517-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meropenem: 10 Vial In 1 Carton (63323-508-30)  / 20 Ml In 1 Vial (63323-508-01)","250","RC","63323-508-30","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-508-01","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-507-01","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 25 Vial In 1 Tray (63323-506-01)  / 1 Ml In 1 Vial (63323-506-00)","250","RC","63323-506-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-482-05","NDC","","","facility","both","1","EA","","2.39","2.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-482-03","NDC","","","facility","both","1","EA","","2.73","2.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-482-01","NDC","","","facility","both","1","EA","","4.01","4.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-421-01","NDC","","","facility","both","1","EA","","5.08","5.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisatracurium: 10 Vial In 1 Carton (63323-417-10)  / 10 Ml In 1 Vial (63323-417-01)","250","RC","63323-417-10","NDC","","","facility","both","1","EA","","5.29","5.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-417-01","NDC","","","facility","both","1","EA","","6.56","6.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-412-18","NDC","","","facility","both","1","EA","","4.76","4.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-403-04","NDC","","","facility","both","1","EA","","4.01","4.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flumazenil: 1 Vial, Multi-Dose In 1 Carton (63323-424-10)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","63323-424-10","NDC","","","facility","both","1","EA","","12.72","12.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-402-01","NDC","","","facility","both","1","EA","","4.19","4.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aztreonam: 10 Vial In 1 Tray (63323-401-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (63323-401-01)","250","RC","63323-401-20","NDC","","","facility","both","1","EA","","3.66","3.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-401-01","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefotetan: 10 Vial In 1 Carton (63323-386-20)  / 20 Ml In 1 Vial (63323-386-01)","250","RC","63323-386-20","NDC","","","facility","both","1","EA","","33.32","33.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-386-01","NDC","","","facility","both","1","EA","","31.46","31.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 20 Bag In 1 Case (63323-434-00)  / 100 Ml In 1 Bag (63323-434-41)","250","RC","63323-434-00","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-478-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-477-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nesacaine: 25 Vial, Multi-Dose In 1 Tray (63323-476-37)  / 30 Ml In 1 Vial, Multi-Dose (63323-476-01)","250","RC","63323-476-37","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 25 Vial In 1 Tray (63323-474-01)  / 1 Ml In 1 Vial (63323-474-00)","250","RC","63323-474-01","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-474-00","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sensorcaine: 25 Vial, Multi-Dose In 1 Tray (63323-461-57)  / 50 Ml In 1 Vial, Multi-Dose (63323-461-01)","250","RC","63323-461-57","NDC","","","facility","both","1","EA","","6.45","6.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 25 Vial, Single-Dose In 1 Box (63323-451-01)  / 1 Ml In 1 Vial, Single-Dose (63323-451-00)","250","RC","63323-451-01","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-451-00","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-434-41","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-545-05","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-559-21","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-729-01","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-724-01","NDC","","","facility","both","1","EA","","207.51","207.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 1 Vial, Multi-Dose In 1 Carton (63323-698-30)  / 30 Ml In 1 Vial, Multi-Dose","250","RC","63323-698-30","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-696-02","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-695-22","NDC","","","facility","both","1","EA","","17.44","17.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 25 Vial In 1 Carton (63323-695-04)  / 4 Ml In 1 Vial (63323-695-22)","250","RC","63323-695-04","NDC","","","facility","both","1","EA","","14.62","14.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-694-22","NDC","","","facility","both","1","EA","","19.88","19.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-694-22","NDC","","","facility","both","1","EA","","19.89","19.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 25 Vial In 1 Carton (63323-694-04)  / 4 Ml In 1 Vial (63323-694-22)","250","RC","63323-694-04","NDC","","","facility","both","1","EA","","19.74","19.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 25 Vial In 1 Carton (63323-694-04)  / 4 Ml In 1 Vial (63323-694-22)","250","RC","63323-694-04","NDC","","","facility","both","1","EA","","19.89","19.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 25 Vial In 1 Carton (63323-694-04)  / 4 Ml In 1 Vial (63323-694-22)","250","RC","63323-694-04","NDC","","","facility","both","1","EA","","20.36","20.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (63323-692-10)  / 10 Ml In 1 Vial (63323-692-22)","250","RC","63323-692-10","NDC","","","facility","both","1","EA","","8.21","8.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (63323-692-10)  / 10 Ml In 1 Vial (63323-692-22)","250","RC","63323-692-10","NDC","","","facility","both","1","EA","","15.09","15.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (63323-692-10)  / 10 Ml In 1 Vial (63323-692-22)","250","RC","63323-692-10","NDC","","","facility","both","1","EA","","15.62","15.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (63323-691-30)  / 30 Ml In 1 Vial (63323-691-22)","250","RC","63323-691-30","NDC","","","facility","both","1","EA","","3.42","3.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-738-06","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-739-11","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-812-01","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-806-14","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-806-13","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-806-12","NDC","","","facility","both","1","EA","","1.69","1.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-781-21","NDC","","","facility","both","1","EA","","8.42","8.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-778-21","NDC","","","facility","both","1","EA","","6.18","6.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-778-21","NDC","","","facility","both","1","EA","","7.06","7.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 25 Vial, Single-Dose In 1 Tray (63323-739-12)  / 2 Ml In 1 Vial, Single-Dose (63323-739-11)","250","RC","63323-739-12","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxacillin: 10 Vial, Single-Dose In 1 Carton (63323-812-20)  / 20 Ml In 1 Vial, Single-Dose (63323-812-01)","250","RC","63323-812-20","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (63323-691-30)  / 30 Ml In 1 Vial (63323-691-22)","250","RC","63323-691-30","NDC","","","facility","both","1","EA","","7.09","7.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-614-00","NDC","","","facility","both","1","EA","","2.74","2.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-596-03","NDC","","","facility","both","1","EA","","170.62","170.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-566-21","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-564-21","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Blister Pack In 1 Carton (63323-559-93)  / 1 Syringe In 1 Blister Pack (63323-559-21)  / .3 Ml In 1 Syringe","250","RC","63323-559-93","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glucagon: 1 Kit In 1 Carton (63323-593-03)  *  1 Ml In 1 Vial, Single-Dose (63323-596-03)  *  1 Ml In 1 Vial, Single-Dose (63323-185-03)","250","RC","63323-593-03","NDC","","","facility","both","1","EA","","149.62","149.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-616-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (63323-690-30)  / 30 Ml In 1 Vial (63323-690-22)","250","RC","63323-690-30","NDC","","","facility","both","1","EA","","4.47","4.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (63323-690-30)  / 30 Ml In 1 Vial (63323-690-22)","250","RC","63323-690-30","NDC","","","facility","both","1","EA","","8.51","8.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 1 Vial, Single-Dose In 1 Carton (63323-685-17)  / 16.7 Ml In 1 Vial, Single-Dose","250","RC","63323-685-17","NDC","","","facility","both","1","EA","","405.7","405.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-665-00","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-664-00","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-660-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide: 1 Vial In 1 Box (63323-658-20)  / 18 Ml In 1 Vial","250","RC","63323-658-20","NDC","","","facility","both","1","EA","","15.57","15.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","63323-624-03","NDC","","","facility","both","1","EA","","5.4","5.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amiodarone Hydrochloride: 25 Vial, Single-Dose In 1 Tray (63323-616-03)  / 3 Ml In 1 Vial, Single-Dose (63323-616-01)","250","RC","63323-616-03","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (63323-690-30)  / 30 Ml In 1 Vial (63323-690-22)","250","RC","63323-690-30","NDC","","","facility","both","1","EA","","4.32","4.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Disulfiram: 30 Tablet In 1 Bottle (62135-431-30)","250","RC","62135-431-30","NDC","","","facility","both","1","EA","","16.05","16.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methyldopa: 90 Tablet, Film Coated In 1 Bottle (62135-321-90)","250","RC","62135-321-90","NDC","","","facility","both","1","EA","","12.45","12.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-382-11","NDC","","","facility","both","1","EA","","1.29","1.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-377-11","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-375-11","NDC","","","facility","both","1","EA","","11.75","11.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methimazole: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (60687-370-01)  / 1 TABLET in 1 BLISTER PACK (60687-370-11) ","250","RC","60687-370-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-369-11","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-368-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-360-11","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (60687-356-01)  / 1 TABLET in 1 BLISTER PACK (60687-356-11) ","250","RC","60687-356-01","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-351-11","NDC","","","facility","both","1","EA","","1.82","1.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-349-11","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-345-11","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-340-11","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 30 Blister Pack In 1 Box, Unit-Dose (60687-384-25)  / 1 Tablet In 1 Blister Pack (60687-384-95)","250","RC","60687-384-25","NDC","","","facility","both","1","EA","","2.71","2.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-409-95","NDC","","","facility","both","1","EA","","1.43","1.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-404-11","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-402-11","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-398-11","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-397-95","NDC","","","facility","both","1","EA","","13.22","13.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-395-79","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-386-11","NDC","","","facility","both","1","EA","","11.88","11.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-391-11","NDC","","","facility","both","1","EA","","1.29","1.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-390-11","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-388-11","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alprazolam: 100 Blister Pack In 1 Box, Unit-Dose (60687-388-01)  / 1 Tablet In 1 Blister Pack (60687-388-11)","250","RC","60687-388-01","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-387-11","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-394-79","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-333-11","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-330-11","NDC","","","facility","both","1","EA","","9.22","9.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenytoin: 5 Tray In 1 Case (60687-275-66)  / 10 Cup, Unit-Dose In 1 Tray (60687-275-63)  / 4 Ml In 1 Cup, Unit-Dose (60687-275-62)","250","RC","60687-275-66","NDC","","","facility","both","1","EA","","11.13","11.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-275-62","NDC","","","facility","both","1","EA","","9.1","9.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-266-11","NDC","","","facility","both","1","EA","","7.58","7.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-256-11","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Box, Unit-Dose (60687-256-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-256-11)","250","RC","60687-256-01","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-253-11","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-281-01)  / 1 Capsule In 1 Blister Pack (60687-281-11)","250","RC","60687-281-01","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-253-01)  / 1 Tablet In 1 Blister Pack (60687-253-11)","250","RC","60687-253-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-252-40","NDC","","","facility","both","1","EA","","4.02","4.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-249-40","NDC","","","facility","both","1","EA","","6.37","6.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-245-11","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Box, Unit-Dose (60687-245-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-245-11)","250","RC","60687-245-01","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-242-11","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-242-01)  / 1 Tablet In 1 Blister Pack (60687-242-11)","250","RC","60687-242-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-281-11","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-283-11","NDC","","","facility","both","1","EA","","7.61","7.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-328-33","NDC","","","facility","both","1","EA","","6.2","6.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-319-11","NDC","","","facility","both","1","EA","","8.5","8.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-315-11","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-313-95","NDC","","","facility","both","1","EA","","4.59","4.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-312-11","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-312-01)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (60687-312-11)","250","RC","60687-312-01","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-309-11","NDC","","","facility","both","1","EA","","10.19","10.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-306-11","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-304-11","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-303-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-302-95","NDC","","","facility","both","1","EA","","3.72","3.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (60687-295-01)  / 1 TABLET in 1 BLISTER PACK (60687-295-11) ","250","RC","60687-295-01","NDC","","","facility","both","1","EA","","1.81","1.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-293-11","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-292-11","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-413-11","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-415-11","NDC","","","facility","both","1","EA","","2.76","2.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-494-11","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-487-11","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 100 Blister Pack In 1 Box, Unit-Dose (60687-487-01)  / 1 Tablet In 1 Blister Pack (60687-487-11)","250","RC","60687-487-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-486-11","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-479-11","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-476-11","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 100 Blister Pack In 1 Box, Unit-Dose (60687-495-01)  / 1 Capsule In 1 Blister Pack (60687-495-11)","250","RC","60687-495-01","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 100 Blister Pack In 1 Box, Unit-Dose (60687-476-01)  / 1 Tablet In 1 Blister Pack (60687-476-11)","250","RC","60687-476-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-475-11","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Box, Unit-Dose (60687-475-01)  / 1 Tablet In 1 Blister Pack (60687-475-11)","250","RC","60687-475-01","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-473-11","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 100 Blister Pack In 1 Box, Unit-Dose (60687-473-01)  / 1 Capsule In 1 Blister Pack (60687-473-11)","250","RC","60687-473-01","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-464-11","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-495-11","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-518-11","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Blister Pack In 1 Box, Unit-Dose (60687-518-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-518-11)","250","RC","60687-518-01","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate: 50 Blister Pack In 1 Box, Unit-Dose (60687-513-65)  / 1 Capsule In 1 Blister Pack (60687-513-11)","250","RC","60687-513-65","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate: 50 Blister Pack In 1 Box, Unit-Dose (60687-513-65)  / 1 Capsule In 1 Blister Pack (60687-513-11)","250","RC","60687-513-65","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-513-11","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-508-11","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Box, Unit-Dose (60687-508-01)  / 1 Tablet In 1 Blister Pack (60687-508-11)","250","RC","60687-508-01","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-507-11","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-506-11","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 100 Blister Pack In 1 Box, Unit-Dose (60687-506-01)  / 1 Capsule In 1 Blister Pack (60687-506-11)","250","RC","60687-506-01","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-497-11","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-496-11","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-462-11","NDC","","","facility","both","1","EA","","6.93","6.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-234-11","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-461-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-461-11)","250","RC","60687-461-01","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-439-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-439-11)","250","RC","60687-439-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-438-11","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 100 Blister Pack In 1 Box, Unit-Dose (60687-438-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-438-11)","250","RC","60687-438-01","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-437-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-436-11","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-439-11","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Blister Pack In 1 Carton (60687-436-01)  / 1 Capsule In 1 Blister Pack (60687-436-11)","250","RC","60687-436-01","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-433-11","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-433-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-433-11)","250","RC","60687-433-01","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-430-11","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-428-11","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-423-11","NDC","","","facility","both","1","EA","","2.91","2.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-420-95","NDC","","","facility","both","1","EA","","15.57","15.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-416-11","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-443-11","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 100 Blister Pack In 1 Box, Unit-Dose (60687-458-01)  / 1 Tablet In 1 Blister Pack (60687-458-11)","250","RC","60687-458-01","NDC","","","facility","both","1","EA","","1.76","1.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-457-11","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-454-11","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-453-11","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Box, Unit-Dose (60687-453-01)  / 1 Tablet In 1 Blister Pack (60687-453-11)","250","RC","60687-453-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-451-11","NDC","","","facility","both","1","EA","","4.76","4.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-450-11","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-450-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-450-11)","250","RC","60687-450-01","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-447-11","NDC","","","facility","both","1","EA","","2.96","2.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-446-11","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-444-11","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-461-11","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Box, Unit-Dose (60687-519-01)  / 1 Tablet In 1 Blister Pack (60687-519-11)","250","RC","60687-519-01","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclosporine, Modfied: 30 Blister Pack In 1 Carton (60505-4632-3)  / 6 Capsule, Liquid Filled In 1 Blister Pack","250","RC","60505-4632-3","NDC","","","facility","both","1","EA","","7.3","7.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guanfacine Extended-Release: 100 Tablet, Extended Release In 1 Bottle (60505-3929-1)","250","RC","60505-3929-1","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guanfacine Extended-Release: 100 Tablet, Extended Release In 1 Bottle (60505-3927-1)","250","RC","60505-3927-1","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dasatinib: 30 Tablet, Film Coated In 1 Bottle (60505-3631-3)","250","RC","60505-3631-3","NDC","","","facility","both","1","EA","","461.03","461.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dasatinib: 60 Tablet, Film Coated In 1 Bottle (60505-3630-6)","250","RC","60505-3630-6","NDC","","","facility","both","1","EA","","278.52","278.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dasatinib: 60 Tablet, Film Coated In 1 Bottle (60505-3629-6)","250","RC","60505-3629-6","NDC","","","facility","both","1","EA","","261.6","261.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dasatinib: 60 Tablet, Film Coated In 1 Bottle (60505-3628-6)","250","RC","60505-3628-6","NDC","","","facility","both","1","EA","","56","56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prasugrel: 30 Tablet, Film Coated In 1 Bottle (60505-4642-3)","250","RC","60505-4642-3","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Selegiline Hydrochloride: 60 Tablet In 1 Bottle (60505-3438-3)","250","RC","60505-3438-3","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3275-0)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","60505-3275-0","NDC","","","facility","both","1","EA","","2.94","2.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamivudine: 60 Tablet, Film Coated In 1 Bottle (60505-3251-6)","250","RC","60505-3251-6","NDC","","","facility","both","1","EA","","6.23","6.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamivudine: 60 Tablet, Film Coated In 1 Bottle (60505-3250-6)","250","RC","60505-3250-6","NDC","","","facility","both","1","EA","","11.55","11.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3140-0)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","60505-3140-0","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3114-0)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","60505-3114-0","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3276-0)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","250","RC","60505-3276-0","NDC","","","facility","both","1","EA","","1.95","1.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3113-0)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","60505-3113-0","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prasugrel: 30 Tablet, Film Coated In 1 Bottle (60505-4643-3)","250","RC","60505-4643-3","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (60505-4741-1)","250","RC","60505-4741-1","NDC","","","facility","both","1","EA","","10.24","10.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6147-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","250","RC","60505-6147-0","NDC","","","facility","both","1","EA","","2.33","2.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6146-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","250","RC","60505-6146-0","NDC","","","facility","both","1","EA","","2.24","2.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxaliplatin: 1 Vial In 1 Carton (60505-6132-7)  / 20 Ml In 1 Vial","250","RC","60505-6132-7","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 25 Vial, Single-Use In 1 Carton (60505-6130-5)  / 2 Ml In 1 Vial, Single-Use (60505-6130-0)","250","RC","60505-6130-5","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60505-6130-0","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3112-0)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","60505-3112-0","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3111-0)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","60505-3111-0","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluvoxamine Maleate: 100 Tablet In 1 Bottle (60505-0164-1)","250","RC","60505-0164-1","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sotalol Hydrochloride: 100 Tablet In 1 Bottle (60505-0080-0)","250","RC","60505-0080-0","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 500 mL in 1 BOTTLE, PLASTIC (60432-706-05) ","250","RC","60432-706-05","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 473 mL in 1 BOTTLE, PLASTIC (60432-537-16) ","250","RC","60432-537-16","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 473 mL in 1 BOTTLE, PLASTIC (60432-150-16) ","250","RC","60432-150-16","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle, Plastic (60432-065-47)","250","RC","60432-065-47","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Generlac: 1892 mL in 1 BOTTLE, PLASTIC (60432-038-64) ","250","RC","60432-038-64","NDC","","","facility","both","1","EA","","7.02","7.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluvoxamine Maleate: 100 Tablet In 1 Bottle (60505-0165-1)","250","RC","60505-0165-1","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluticasone Propionate: 1 Bottle, Spray In 1 Carton (60429-195-15)  / 120 Spray, Metered In 1 Bottle, Spray","250","RC","60429-195-15","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sf: 1 Tube In 1 Carton (60258-151-01)  / 56 G In 1 Tube","250","RC","60258-151-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azathioprine: 100 Tablet In 1 Bottle (60219-2036-1)","250","RC","60219-2036-1","NDC","","","facility","both","1","EA","","10.47","10.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine: 1 Bottle, Dropper In 1 Carton (60219-1748-2)  / 2 Ml In 1 Bottle, Dropper","250","RC","60219-1748-2","NDC","","","facility","both","1","EA","","59.58","59.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etravirine: 60 Tablet In 1 Bottle, Plastic (60219-1722-6)","250","RC","60219-1722-6","NDC","","","facility","both","1","EA","","22.46","22.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiothixene: 100 Capsule In 1 Bottle, Plastic (60219-1675-1)","250","RC","60219-1675-1","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorometholone Ophthalmic Suspension: 1 Bottle, Dropper In 1 Carton (60219-1585-3)  / 5 Ml In 1 Bottle, Dropper","250","RC","60219-1585-3","NDC","","","facility","both","1","EA","","102.82","102.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Thiosulfate: 50 Ml In 1 Vial, Single-Dose (60267-705-50)","250","RC","60267-705-50","NDC","","","facility","both","1","EA","","161.53","161.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluvoxamine Maleate: 100 Tablet In 1 Bottle (60505-0166-1)","250","RC","60505-0166-1","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3110-0)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","60505-3110-0","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 120 Capsule, Extended Release In 1 Bottle (60505-2807-7)","250","RC","60505-2807-7","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 120 Capsule, Extended Release In 1 Bottle (60505-2806-7)","250","RC","60505-2806-7","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Tablet In 1 Bottle (60505-2654-1)","250","RC","60505-2654-1","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cilostazol: 60 Tablet In 1 Bottle (60505-2522-1)","250","RC","60505-2522-1","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 100 Tablet In 1 Bottle (60505-1320-1)","250","RC","60505-1320-1","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine Hydrochloride: 30 Tablet, Film Coated, Extended Release In 1 Bottle (60505-1316-3)","250","RC","60505-1316-3","NDC","","","facility","both","1","EA","","1.53","1.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azelastine Hydrochloride: 1 Bottle, Spray In 1 Carton (60505-0833-5)  / 200 Spray, Metered In 1 Bottle, Spray","250","RC","60505-0833-5","NDC","","","facility","both","1","EA","","25.82","25.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluticasone Propionate: 1 Bottle, Spray In 1 Carton (60505-0829-1)  / 120 Spray, Metered In 1 Bottle, Spray","250","RC","60505-0829-1","NDC","","","facility","both","1","EA","","29.9","29.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitonin Salmon: 1 Bottle, Glass In 1 Carton (60505-0823-6)  / 30 Spray, Metered In 1 Bottle, Glass","250","RC","60505-0823-6","NDC","","","facility","both","1","EA","","96.89","96.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 1 Bottle, Spray In 1 Carton (60505-0815-0)  / 50 Spray In 1 Bottle, Spray","250","RC","60505-0815-0","NDC","","","facility","both","1","EA","","164.28","164.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ofloxacin: 1 Bottle, Dropper In 1 Carton (60505-0560-0)  / 5 Ml In 1 Bottle, Dropper","250","RC","60505-0560-0","NDC","","","facility","both","1","EA","","27.81","27.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 100 Tablet In 1 Bottle (60505-0258-1)","250","RC","60505-0258-1","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 100 Tablet In 1 Bottle (60505-0257-1)","250","RC","60505-0257-1","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 10 Vial, Single-Dose In 1 Carton (60505-6147-4)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","250","RC","60505-6147-4","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride Extended-Release: 100 Blister Pack In 1 Box, Unit-Dose (60687-195-01)  / 1 Capsule, Coated, Extended Release In 1 Blister Pack (60687-195-11)","250","RC","60687-195-01","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-192-11","NDC","","","facility","both","1","EA","","6.19","6.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-191-11","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-188-11","NDC","","","facility","both","1","EA","","5.47","5.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-184-11","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-179-11","NDC","","","facility","both","1","EA","","8.86","8.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-178-11","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-195-11","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (60687-178-01)  / 1 Tablet In 1 Blister Pack (60687-178-11)","250","RC","60687-178-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-163-11","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-161-11","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 100 Blister Pack In 1 Box, Unit-Dose (60687-161-01)  / 1 Tablet In 1 Blister Pack (60687-161-11)","250","RC","60687-161-01","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-156-95","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenytoin: 30 Blister Pack In 1 Box, Unit-Dose (60687-156-25)  / 1 Tablet, Chewable In 1 Blister Pack (60687-156-95)","250","RC","60687-156-25","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-155-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-168-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-199-11","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-231-11","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-230-11","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zonisamide: 100 Blister Pack In 1 Box, Unit-Dose (60687-230-01)  / 1 Capsule In 1 Blister Pack (60687-230-11)","250","RC","60687-230-01","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-229-11","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-228-11","NDC","","","facility","both","1","EA","","2.64","2.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-227-11","NDC","","","facility","both","1","EA","","11.86","11.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-224-11","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemfibrozil: 100 Blister Pack In 1 Box, Unit-Dose (60687-224-01)  / 1 Tablet In 1 Blister Pack (60687-224-11)","250","RC","60687-224-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-217-11","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-211-11","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-210-11","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simvastatin: 100 Blister Pack In 1 Box, Unit-Dose (60687-210-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-210-11)","250","RC","60687-210-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-206-11","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-203-95","NDC","","","facility","both","1","EA","","19.86","19.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-202-11","NDC","","","facility","both","1","EA","","16.71","16.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-152-11","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Box, Unit-Dose (60687-234-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-234-11)","250","RC","60687-234-01","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Capecitabine: 20 Blister Pack In 1 Box, Unit-Dose (60687-149-94)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-149-11)","250","RC","60687-149-94","NDC","","","facility","both","1","EA","","20.75","20.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-149-11","NDC","","","facility","both","1","EA","","20.75","20.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine: 1 Bottle, Dropper In 1 Carton (60505-6226-1)  / 5 Ml In 1 Bottle, Dropper","250","RC","60505-6226-1","NDC","","","facility","both","1","EA","","58.92","58.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine: 1 Bottle, Dropper In 1 Carton (60505-6226-0)  / 2 Ml In 1 Bottle, Dropper","250","RC","60505-6226-0","NDC","","","facility","both","1","EA","","29.51","29.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclosporine: 60 Vial In 1 Tray (60505-6202-2)  / .4 Ml In 1 Vial","250","RC","60505-6202-2","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60505-7061-0","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclosporine: 30 Vial In 1 Tray (60505-6202-1)  / .4 Ml In 1 Vial","250","RC","60505-6202-1","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60505-6196-0","NDC","","","facility","both","1","EA","","24.9","24.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60505-6157-0","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone Sodium: 1 Vial, Pharmacy Bulk Package In 1 Carton (60505-6150-5)  / 1 Injection, Powder, For Solution In 1 Vial, Pharmacy Bulk Package","250","RC","60505-6150-5","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60505-7062-0","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-145-11","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Blister Pack In 1 Box, Unit-Dose (60687-145-01)  / 1 Tablet In 1 Blister Pack (60687-145-11)","250","RC","60687-145-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-134-11","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-129-11","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Omega-3-Acid Ethyl Esters: 50 Blister Pack In 1 Box, Unit-Dose (60687-127-65)  / 1 Capsule, Liquid Filled In 1 Blister Pack (60687-127-11)","250","RC","60687-127-65","NDC","","","facility","both","1","EA","","5.05","5.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-124-11","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-122-11","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Blister Pack In 1 Box, Unit-Dose (60687-122-01)  / 1 Tablet In 1 Blister Pack (60687-122-11)","250","RC","60687-122-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-121-95","NDC","","","facility","both","1","EA","","2.99","2.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-113-11","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-113-01)  / 1 Tablet In 1 Blister Pack (60687-113-11)","250","RC","60687-113-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Anastrozole: 30 Blister Pack In 1 Box, Unit-Dose (60687-112-21)  / 1 Tablet, Coated In 1 Blister Pack (60687-112-11)","250","RC","60687-112-21","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-112-11","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-100-11","NDC","","","facility","both","1","EA","","3.51","3.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60505-7063-0","NDC","","","facility","both","1","EA","","3.28","3.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-519-11","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-524-79","NDC","","","facility","both","1","EA","","12.79","12.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Betaxolol Hydrochloride: 1 Bottle, Plastic In 1 Carton (61314-245-01)  / 5 Ml In 1 Bottle, Plastic","250","RC","61314-245-01","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Betaxolol Hydrochloride: 1 Bottle, Plastic In 1 Carton (61314-245-01)  / 5 Ml In 1 Bottle, Plastic","250","RC","61314-245-01","NDC","","","facility","both","1","EA","","68.03","68.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Timolol Maleate: 5 Ml In 1 Bottle, Plastic (61314-226-05)","250","RC","61314-226-05","NDC","","","facility","both","1","EA","","4.16","4.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brimonidine Tartrate: 1 Bottle In 1 Carton (61314-143-05)  / 5 Ml In 1 Bottle","250","RC","61314-143-05","NDC","","","facility","both","1","EA","","10.55","10.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 1 Bottle In 1 Carton (61314-126-05)  / 5 Ml In 1 Bottle","250","RC","61314-126-05","NDC","","","facility","both","1","EA","","19.35","19.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dorzolamide Hydrochloride: 10 Ml In 1 Bottle (61314-019-10)","250","RC","61314-019-10","NDC","","","facility","both","1","EA","","33.18","33.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docosanol: 1 Bottle, Pump In 1 Package (61269-989-37)  / 2 G In 1 Bottle, Pump","250","RC","61269-989-37","NDC","","","facility","both","1","EA","","22.18","22.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docosanol: 1 Tube In 1 Package (61269-981-35)  / 2 G In 1 Tube","250","RC","61269-981-35","NDC","","","facility","both","1","EA","","17.57","17.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docosanol: 2 G In 1 Tube (61269-881-35)","250","RC","61269-881-35","NDC","","","facility","both","1","EA","","17.74","17.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miconazole 7: 7 Suppository In 1 Box (61269-736-07)","250","RC","61269-736-07","NDC","","","facility","both","1","EA","","2.1","2.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pulmicort Flexhaler: 1 Inhaler In 1 Carton (61269-518-12)  / 120 Aerosol, Powder In 1 Inhaler","250","RC","61269-518-12","NDC","","","facility","both","1","EA","","439.16","439.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyridium: 100 Tablet, Film Coated In 1 Bottle (60846-501-01)","250","RC","60846-501-01","NDC","","","facility","both","1","EA","","7.03","7.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60793-702-04","NDC","","","facility","both","1","EA","","44.96","44.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","61314-318-05","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tropicamide: 1 Bottle, Plastic In 1 Carton (61314-354-01)  / 15 Ml In 1 Bottle, Plastic","250","RC","61314-354-01","NDC","","","facility","both","1","EA","","12.67","12.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","61314-326-05","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","61314-326-05","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bicillin L-A: 10 Syringe In 1 Package (60793-701-10)  / 2 Ml In 1 Syringe (60793-701-02)","250","RC","60793-701-10","NDC","","","facility","both","1","EA","","51.04","51.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (60687-836-01)  / 1 Tablet In 1 Blister Pack (60687-836-11)","250","RC","60687-836-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-833-11","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (60687-833-01)  / 1 Tablet In 1 Blister Pack (60687-833-11)","250","RC","60687-833-01","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-822-11","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (60687-822-01)  / 1 Tablet In 1 Blister Pack (60687-822-11)","250","RC","60687-822-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-818-40","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-836-11","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-813-11","NDC","","","facility","both","1","EA","","91.29","91.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-811-11","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-810-11","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-808-11","NDC","","","facility","both","1","EA","","13.7","13.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-807-11","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-795-11","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-815-11","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-837-42","NDC","","","facility","both","1","EA","","6.72","6.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-838-11","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60793-701-02","NDC","","","facility","both","1","EA","","50.23","50.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytomel: 100 Tablet In 1 Bottle (60793-115-01)","250","RC","60793-115-01","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorometholone: 1 Bottle, Dropper In 1 Carton (60758-880-05)  / 5 Ml In 1 Bottle, Dropper","250","RC","60758-880-05","NDC","","","facility","both","1","EA","","113.09","113.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Timolol Maleate: 1 Bottle, Dropper In 1 Carton (60758-802-05)  / 5 Ml In 1 Bottle, Dropper","250","RC","60758-802-05","NDC","","","facility","both","1","EA","","3.95","3.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gentamicin Sulfate: 1 Bottle, Dropper In 1 Carton (60758-188-05)  / 5 Ml In 1 Bottle, Dropper","250","RC","60758-188-05","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisolone Acetate: 1 Bottle, Dropper In 1 Carton (60758-119-10)  / 10 Ml In 1 Bottle, Dropper","250","RC","60758-119-10","NDC","","","facility","both","1","EA","","94.23","94.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisolone Acetate: 1 Bottle, Dropper In 1 Carton (60758-119-05)  / 5 Ml In 1 Bottle, Dropper","250","RC","60758-119-05","NDC","","","facility","both","1","EA","","11.64","11.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-886-11","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-885-11","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-879-11","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-872-11","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-868-11","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-858-11","NDC","","","facility","both","1","EA","","1.7","1.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-854-11","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tropicamide: 1 Bottle, Plastic In 1 Carton (61314-355-02)  / 15 Ml In 1 Bottle, Plastic","250","RC","61314-355-02","NDC","","","facility","both","1","EA","","24.22","24.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclopentolate Hydrochloride: 15 Ml In 1 Bottle (61314-396-03)","250","RC","61314-396-03","NDC","","","facility","both","1","EA","","46.47","46.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Latanoprost: 1 Bottle In 1 Carton (61314-547-01)  / 2.5 Ml In 1 Bottle","250","RC","61314-547-01","NDC","","","facility","both","1","EA","","14.15","14.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neomycin And Polymyxin B Sulfates And Dexamethasone: 5 Ml In 1 Bottle, Plastic (61314-630-06)","250","RC","61314-630-06","NDC","","","facility","both","1","EA","","7.76","7.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Biktarvy: 30 Tablet In 1 Bottle, Plastic (61958-2501-1)","250","RC","61958-2501-1","NDC","","","facility","both","1","EA","","230.98","230.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vemlidy: 30 Tablet In 1 Bottle, Plastic (61958-2301-1)","250","RC","61958-2301-1","NDC","","","facility","both","1","EA","","83.42","83.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epclusa: 28 Tablet, Film Coated In 1 Bottle, Plastic (61958-2201-1)","250","RC","61958-2201-1","NDC","","","facility","both","1","EA","","1477.21","1477.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Descovy: 30 Tablet In 1 Blister Pack (61958-2002-2)","250","RC","61958-2002-2","NDC","","","facility","both","1","EA","","121.85","121.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Descovy: 30 Tablet In 1 Bottle, Plastic (61958-2002-1)","250","RC","61958-2002-1","NDC","","","facility","both","1","EA","","121.84","121.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Genvoya: 30 Tablet In 1 Bottle, Plastic (61958-1901-1)","250","RC","61958-1901-1","NDC","","","facility","both","1","EA","","230.37","230.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","250","RC","61958-2901-2","NDC","","","facility","both","1","EA","","1162.38","1162.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tybost: 30 Tablet, Film Coated In 1 Bottle (61958-1401-1)","250","RC","61958-1401-1","NDC","","","facility","both","1","EA","","17.42","17.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stribild: 30 Tablet, Film Coated In 1 Bottle, Plastic (61958-1201-1)","250","RC","61958-1201-1","NDC","","","facility","both","1","EA","","244.7","244.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Emtriva: 1 Bottle, Dispensing In 1 Carton (61958-0602-1)  / 170 Ml In 1 Bottle, Dispensing","250","RC","61958-0602-1","NDC","","","facility","both","1","EA","","11.75","11.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","61874-130-11","NDC","","","facility","both","1","EA","","82.53","82.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","61874-115-11","NDC","","","facility","both","1","EA","","82.82","82.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01)  / 7 Ml In 1 Vial, Single-Use","250","RC","61755-008-01","NDC","","","facility","both","1","EA","","52.28","52.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methyldopa: 180 Tablet, Film Coated In 1 Bottle (62135-321-18)","250","RC","62135-321-18","NDC","","","facility","both","1","EA","","12.45","12.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naltrexone Hydrochloride: 60 Tablet, Film Coated In 1 Bottle (62135-242-60)","250","RC","62135-242-60","NDC","","","facility","both","1","EA","","9.34","9.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (62037-727-01)","250","RC","62037-727-01","NDC","","","facility","both","1","EA","","8.82","8.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dihydroergotamine Mesylate: 10 AMPULE in 1 CARTON (61990-0411-2)  / 1 mL in 1 AMPULE (61990-0411-0) ","250","RC","61990-0411-2","NDC","","","facility","both","1","EA","","36.23","36.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","250","RC","61958-2901-2","NDC","","","facility","both","1","EA","","11.43","11.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","250","RC","61958-2901-2","NDC","","","facility","both","1","EA","","11.52","11.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","250","RC","61958-2901-2","NDC","","","facility","both","1","EA","","26.45","26.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","250","RC","61958-2901-2","NDC","","","facility","both","1","EA","","1079.07","1079.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride: 30 Blister Pack In 1 Carton (60687-793-21)  / 1 Tablet, Extended Release In 1 Blister Pack (60687-793-11)","250","RC","60687-793-21","NDC","","","facility","both","1","EA","","2.85","2.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-06)  / 1 Ml In 1 Vial, Single-Dose","250","RC","61703-309-06","NDC","","","facility","both","1","EA","","9.38","9.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","61703-305-58","NDC","","","facility","both","1","EA","","2.46","2.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 5 Vial, Single-Dose In 1 Carton (61703-305-38)  / 5 Ml In 1 Vial, Single-Dose (61703-305-58)","250","RC","61703-305-38","NDC","","","facility","both","1","EA","","2.76","2.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Silvadene: 50 G In 1 Jar (61570-131-50)","250","RC","61570-131-50","NDC","","","facility","both","1","EA","","14.67","14.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Silvadene: 400 G In 1 Jar (61570-131-40)","250","RC","61570-131-40","NDC","","","facility","both","1","EA","","57.6","57.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-06)  / 1 Ml In 1 Vial, Single-Dose","250","RC","61703-309-06","NDC","","","facility","both","1","EA","","6.79","6.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","61553-822-41","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","61553-822-41","NDC","","","facility","both","1","EA","","19.8","19.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","61553-397-65","NDC","","","facility","both","1","EA","","10.7","10.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","61553-136-02","NDC","","","facility","both","1","EA","","27.45","27.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Apraclonidine: 5 Ml In 1 Bottle (61314-665-05)","250","RC","61314-665-05","NDC","","","facility","both","1","EA","","106.64","106.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin Hydrochloride: 1 Bottle, Plastic In 1 Carton (61314-656-25)  / 2.5 Ml In 1 Bottle, Plastic","250","RC","61314-656-25","NDC","","","facility","both","1","EA","","3.21","3.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin Hydrochloride: 1 Bottle, Plastic In 1 Carton (61314-656-05)  / 5 Ml In 1 Bottle, Plastic","250","RC","61314-656-05","NDC","","","facility","both","1","EA","","10.19","10.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin And Dexamethasone: 1 Bottle In 1 Carton (61314-647-25)  / 2.5 Ml In 1 Bottle","250","RC","61314-647-25","NDC","","","facility","both","1","EA","","49.84","49.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin And Dexamethasone: 1 Bottle In 1 Carton (61314-647-05)  / 5 Ml In 1 Bottle","250","RC","61314-647-05","NDC","","","facility","both","1","EA","","69.79","69.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisolone Acetate: 1 Bottle, Plastic In 1 Carton (61314-637-05)  / 5 Ml In 1 Bottle, Plastic","250","RC","61314-637-05","NDC","","","facility","both","1","EA","","73.44","73.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gentamicin Sulfate: 1 Bottle, Dropper In 1 Carton (61314-633-05)  / 5 Ml In 1 Bottle, Dropper","250","RC","61314-633-05","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-16)  / 2 Ml In 1 Vial, Single-Dose","250","RC","61703-309-16","NDC","","","facility","both","1","EA","","8.24","8.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial, Single-Dose In 1 Carton (61703-408-41)  / 40 Ml In 1 Vial, Single-Dose","250","RC","61703-408-41","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitoxantrone: 1 Vial, Multi-Dose In 1 Carton (61703-343-18)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","61703-343-18","NDC","","","facility","both","1","EA","","62.99","62.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial, Multi-Dose In 1 Carton (61703-342-50)  / 50 Ml In 1 Vial, Multi-Dose","250","RC","61703-342-50","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carboplatin: 1 Vial, Multi-Dose In 1 Carton (61703-339-50)  / 45 Ml In 1 Vial, Multi-Dose","250","RC","61703-339-50","NDC","","","facility","both","1","EA","","3.4","3.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carboplatin: 1 Vial, Multi-Dose In 1 Carton (61703-339-22)  / 15 Ml In 1 Vial, Multi-Dose","250","RC","61703-339-22","NDC","","","facility","both","1","EA","","5.51","5.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pamidronate Disodium: 1 Vial, Single-Dose In 1 Carton (61703-324-18)  / 10 Ml In 1 Vial, Single-Dose","250","RC","61703-324-18","NDC","","","facility","both","1","EA","","23.19","23.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial, Single-Dose In 1 Carton (61703-319-22)  / 20 Ml In 1 Vial, Single-Dose","250","RC","61703-319-22","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-793-11","NDC","","","facility","both","1","EA","","3.12","3.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-789-11","NDC","","","facility","both","1","EA","","9.64","9.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-594-11","NDC","","","facility","both","1","EA","","9.64","9.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-593-11","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrochlorothiazide: 100 Blister Pack In 1 Box, Unit-Dose (60687-593-01)  / 1 Tablet In 1 Blister Pack (60687-593-11)","250","RC","60687-593-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-591-11","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-590-11","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-595-11","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-588-11","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-587-11","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-586-11","NDC","","","facility","both","1","EA","","2.84","2.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rifampin: 100 Blister Pack In 1 Box, Unit-Dose (60687-586-01)  / 1 Capsule In 1 Blister Pack (60687-586-11)","250","RC","60687-586-01","NDC","","","facility","both","1","EA","","2.84","2.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-585-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-584-11","NDC","","","facility","both","1","EA","","4.69","4.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-590-01)  / 1 Tablet In 1 Blister Pack (60687-590-11)","250","RC","60687-590-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-596-33","NDC","","","facility","both","1","EA","","17.93","17.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-623-11","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valsartan: 100 Blister Pack In 1 Box, Unit-Dose (60687-623-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-623-11)","250","RC","60687-623-01","NDC","","","facility","both","1","EA","","1.78","1.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-620-11","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-620-11","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 100 Blister Pack In 1 Box, Unit-Dose (60687-620-01)  / 1 Tablet In 1 Blister Pack (60687-620-11)","250","RC","60687-620-01","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-618-11","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-598-11","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valsartan: 30 Blister Pack In 1 Box, Unit-Dose (60687-612-21)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-612-11)","250","RC","60687-612-21","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-612-11","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-609-11","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-609-01)  / 1 Tablet In 1 Blister Pack (60687-609-11)","250","RC","60687-609-01","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-602-11","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-614-11","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-583-11","NDC","","","facility","both","1","EA","","4.47","4.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-580-11","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-550-11","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 100 Blister Pack In 1 Box, Unit-Dose (60687-550-01)  / 1 Tablet In 1 Blister Pack (60687-550-11)","250","RC","60687-550-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 100 Blister Pack In 1 Box, Unit-Dose (60687-550-01)  / 1 Tablet In 1 Blister Pack (60687-550-11)","250","RC","60687-550-01","NDC","","","facility","both","1","EA","","5.38","5.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-549-11","NDC","","","facility","both","1","EA","","2.33","2.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-544-11","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 100 Blister Pack In 1 Box, Unit-Dose (60687-544-01)  / 1 Tablet In 1 Blister Pack (60687-544-11)","250","RC","60687-544-01","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-551-11","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-540-11","NDC","","","facility","both","1","EA","","1.73","1.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-538-11","NDC","","","facility","both","1","EA","","3.29","3.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-534-40","NDC","","","facility","both","1","EA","","49.21","49.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-530-11","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Box (60687-530-01)  / 1 Tablet In 1 Blister Pack (60687-530-11)","250","RC","60687-530-01","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-524-79","NDC","","","facility","both","1","EA","","12.4","12.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-552-11","NDC","","","facility","both","1","EA","","1.24","1.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-579-11","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-579-01)  / 1 Tablet In 1 Blister Pack (60687-579-11)","250","RC","60687-579-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-578-11","NDC","","","facility","both","1","EA","","6.31","6.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rifampin: 30 Blister Pack In 1 Box, Unit-Dose (60687-575-21)  / 1 Capsule In 1 Blister Pack (60687-575-11)","250","RC","60687-575-21","NDC","","","facility","both","1","EA","","5.29","5.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-575-11","NDC","","","facility","both","1","EA","","5.29","5.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-570-11","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pramipexole Dihydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-570-01)  / 1 Tablet In 1 Blister Pack (60687-570-11)","250","RC","60687-570-01","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-568-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 100 Blister Pack In 1 Box, Unit-Dose (60687-568-01)  / 1 Tablet In 1 Blister Pack (60687-568-11)","250","RC","60687-568-01","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-563-11","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-559-11","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-558-11","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-555-11","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-627-11","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-629-11","NDC","","","facility","both","1","EA","","5.48","5.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-729-11","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-728-11","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (60687-728-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-728-11)","250","RC","60687-728-01","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-725-11","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 100 Blister Pack In 1 Carton (60687-725-01)  / 1 Tablet, Delayed Release In 1 Blister Pack (60687-725-11)","250","RC","60687-725-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-730-11","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-723-11","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-722-11","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-719-95","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-717-11","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (60687-717-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-717-11)","250","RC","60687-717-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-711-11","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Pamoate: 50 Blister Pack In 1 Carton (60687-707-65)  / 1 Capsule In 1 Blister Pack (60687-707-11)","250","RC","60687-707-65","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-732-11","NDC","","","facility","both","1","EA","","5.21","5.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 100 Blister Pack In 1 Carton (60687-733-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-733-11)","250","RC","60687-733-01","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-788-11","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-783-11","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Mononitrate: 100 Blister Pack In 1 Carton (60687-783-01)  / 1 Tablet, Extended Release In 1 Blister Pack (60687-783-11)","250","RC","60687-783-01","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-778-11","NDC","","","facility","both","1","EA","","2.92","2.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-775-11","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-761-11","NDC","","","facility","both","1","EA","","8.36","8.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-756-11","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-755-40","NDC","","","facility","both","1","EA","","2.44","2.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-746-11","NDC","","","facility","both","1","EA","","2.96","2.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-745-11","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-742-11","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-736-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 80 Blister Pack In 1 Carton (60687-736-09)  / 1 Tablet, Delayed Release In 1 Blister Pack (60687-736-11)","250","RC","60687-736-09","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-733-11","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-707-11","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Blister Pack In 1 Carton (60687-704-01)  / 1 Tablet In 1 Blister Pack (60687-704-11)","250","RC","60687-704-01","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-661-11","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-660-11","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 100 Blister Pack In 1 Carton (60687-660-01)  / 1 Tablet In 1 Blister Pack (60687-660-11)","250","RC","60687-660-01","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-657-11","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-656-11","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 100 Blister Pack In 1 Carton (60687-664-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-664-11)","250","RC","60687-664-01","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 100 Blister Pack In 1 Box, Unit-Dose (60687-649-01)  / 1 Tablet In 1 Blister Pack (60687-649-11)","250","RC","60687-649-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valsartan: 100 Blister Pack In 1 Box, Unit-Dose (60687-634-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-634-11)","250","RC","60687-634-01","NDC","","","facility","both","1","EA","","1.87","1.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-633-11","NDC","","","facility","both","1","EA","","4.89","4.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-632-11","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-631-11","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 100 Blister Pack In 1 Box, Unit-Dose (60687-631-01)  / 1 Tablet In 1 Blister Pack (60687-631-11)","250","RC","60687-631-01","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-634-11","NDC","","","facility","both","1","EA","","1.95","1.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-664-11","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methimazole: 100 Blister Pack In 1 Carton (60687-669-01)  / 1 Tablet In 1 Blister Pack (60687-669-11)","250","RC","60687-669-01","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-698-11","NDC","","","facility","both","1","EA","","5.4","5.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-696-11","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-695-11","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-693-11","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Blister Pack In 1 Carton (60687-693-01)  / 1 Tablet In 1 Blister Pack (60687-693-11)","250","RC","60687-693-01","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-683-11","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrochlorothiazide: 100 Blister Pack In 1 Carton (60687-683-01)  / 1 Capsule In 1 Blister Pack (60687-683-11)","250","RC","60687-683-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-681-11","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folic Acid: 100 Blister Pack In 1 Carton (60687-681-01)  / 1 Tablet In 1 Blister Pack (60687-681-11)","250","RC","60687-681-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-680-11","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methimazole: 100 Blister Pack In 1 Carton (60687-680-01)  / 1 Tablet In 1 Blister Pack (60687-680-11)","250","RC","60687-680-01","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-677-11","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-676-11","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-669-11","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","60687-704-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","99999-6142-14","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","S25354","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-0221-01","NDC","","","facility","both","1","EA","","19.54","19.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3877903585","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3877905108","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3877905518","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3877911865","NDC","","","facility","both","1","EA","","2.56","2.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3877917798","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3877920388","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3877924805","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3877926008","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3932801416","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3932801816","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3932806412","NDC","","","facility","both","1","EA","","22.71","22.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3932835760","NDC","","","facility","both","1","EA","","4.81","4.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4843310401","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4746907405","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4746904408","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4628750816","NDC","","","facility","both","1","EA","","45.14","45.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3700074092","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4628750001","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4467710202","NDC","","","facility","both","1","EA","","174.26","174.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4390097647","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4329255857","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4203710478","NDC","","","facility","both","1","EA","","8.37","8.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4110080676","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4056512249","NDC","","","facility","both","1","EA","","146.6","146.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4601701816","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3660219209","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","2055503300","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","2055502700","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","2055502500","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","2055503601","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","2055502101","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","2055501900","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","2055500600","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","2055500100","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1878777232","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4858200330","NDC","","","facility","both","1","EA","","10.22","10.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3660207917","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3504600222","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3172293847","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3172293747","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","2055503901","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3172213747","NDC","","","facility","both","1","EA","","4.53","4.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3010304200","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","3010304000","NDC","","","facility","both","1","EA","","3.73","3.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","2435730030","NDC","","","facility","both","1","EA","","117","117","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","2055504000","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1802985005","NDC","","","facility","both","1","EA","","6.33","6.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5019014263","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5026818311","NDC","","","facility","both","1","EA","","4.36","4.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5789633345","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5789645101","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5789663412","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5789675201","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5789684401","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5789686406","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5789687503","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5865717001","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6299117011","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6253000011","NDC","","","facility","both","1","EA","","6.53","6.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6248400202","NDC","","","facility","both","1","EA","","15.35","15.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6025816001","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6025800615","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5865732250","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5865731216","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5865731016","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6025800601","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5777100704","NDC","","","facility","both","1","EA","","8.41","8.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5777100109","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5777048478","NDC","","","facility","both","1","EA","","113.4","113.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5192712020","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5192710880","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5155204125","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5155200516","NDC","","","facility","both","1","EA","","2.47","2.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5026886011","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5192712020","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5026885311","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5026885211","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5026885115","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5026852411","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5026837511","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5280048816","NDC","","","facility","both","1","EA","","4.47","4.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5618412041","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5485951608","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5483801150","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5192726100","NDC","","","facility","both","1","EA","","5.84","5.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5483800530","NDC","","","facility","both","1","EA","","10.87","10.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5475800628","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5319136201","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5280048826","NDC","","","facility","both","1","EA","","4.47","4.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","5483800650","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","395266216","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","395268594","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","487900330","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","487900360","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","487900760","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","536134380","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","536135807","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","536344308","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","536440601","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","536466110","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","536730001","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","573051330","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","573475652","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","592800100","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","574031216","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","574031116","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","574030316","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","574030216","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","574007216","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","574030416","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","395266128","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","395266116","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","121059515","NDC","","","facility","both","1","EA","","7.58","7.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","121053005","NDC","","","facility","both","1","EA","","3.29","3.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","87086644","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","87040501","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","121059516","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","87040203","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","54311763","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","45091032","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","45008002","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","39413012","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","592800308","NDC","","","facility","both","1","EA","","1.98","1.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","121059530","NDC","","","facility","both","1","EA","","3.3","3.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","395009016","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","378699789","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","299024132","NDC","","","facility","both","1","EA","","9.82","9.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","299011022","NDC","","","facility","both","1","EA","","18.74","18.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","149003991","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","132030140","NDC","","","facility","both","1","EA","","2.88","2.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","132007924","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","121119030","NDC","","","facility","both","1","EA","","7.84","7.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","121067716","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","121067616","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","149003956","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1785600102","NDC","","","facility","both","1","EA","","2.7","2.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1011900252","NDC","","","facility","both","1","EA","","5.95","5.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1013574901","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1013578801","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1093904633","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1093914433","NDC","","","facility","both","1","EA","","7.78","7.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1093915933","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1093920444","NDC","","","facility","both","1","EA","","11.72","11.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1093960244","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1093969133","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1093976644","NDC","","","facility","both","1","EA","","1.89","1.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1093976744","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1657187290","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1650055434","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1184507791","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1152372688","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1000670038","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1093995959","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1093995607","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1093995585","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1093978744","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1000670028","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","1000670012","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904421551","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904227260","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904208560","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904188361","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904522452","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904188260","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904053061","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904052361","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","884629730","NDC","","","facility","both","1","EA","","7.57","7.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","802392716","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","761012012","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904759161","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904740361","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904727770","NDC","","","facility","both","1","EA","","3.27","3.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904727741","NDC","","","facility","both","1","EA","","3.62","3.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904546072","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904598463","NDC","","","facility","both","1","EA","","7.92","7.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904590887","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904582360","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904549261","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904546080","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","904719106","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6299127531","NDC","","","facility","both","1","EA","","2.07","2.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","4009311213","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-17)  / 3 Ml In 1 Vial, Multi-Dose","250","RC","0002-8215-17","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin N: 1 Vial, Multi-Dose In 1 Carton (0002-8315-01)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","0002-8315-01","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin 70/30: 1 Vial, Multi-Dose In 1 Carton (0002-8715-01)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","0002-8715-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0002-8803-01","NDC","","","facility","both","1","EA","","23.37","23.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0002-8805-01","NDC","","","facility","both","1","EA","","23.37","23.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin N: 5 Syringe In 1 Carton (0002-8805-59)  / 3 Ml In 1 Syringe (0002-8805-01)","250","RC","0002-8805-59","NDC","","","facility","both","1","EA","","23.37","23.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0002-8824-01","NDC","","","facility","both","1","EA","","496.28","496.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin R U-500 Kwikpen: 2 Syringe In 1 Carton (0002-8824-27)  / 3 Ml In 1 Syringe","250","RC","0002-8824-27","NDC","","","facility","both","1","EA","","496.28","496.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cobenfy: 60 Capsule, Coated Pellets In 1 Bottle (0003-0050-60)","250","RC","0003-0050-60","NDC","","","facility","both","1","EA","","51.18","51.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sprycel: 1 Bottle In 1 Carton (0003-0527-11)  / 60 Tablet In 1 Bottle","250","RC","0003-0527-11","NDC","","","facility","both","1","EA","","280.06","280.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sprycel: 1 Bottle In 1 Carton (0003-0524-11)  / 60 Tablet In 1 Bottle","250","RC","0003-0524-11","NDC","","","facility","both","1","EA","","560.11","560.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kenalog-10: 1 Vial, Multi-Dose In 1 Carton (0003-0494-20)  / 5 Ml In 1 Vial, Multi-Dose","250","RC","0003-0494-20","NDC","","","facility","both","1","EA","","4.02","4.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kenalog-40: 1 Vial, Single-Dose In 1 Carton (0003-0293-05)  / 1 Ml In 1 Vial, Single-Dose","250","RC","0003-0293-05","NDC","","","facility","both","1","EA","","3.89","3.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cobenfy: 60 Capsule, Coated Pellets In 1 Bottle (0003-0125-60)","250","RC","0003-0125-60","NDC","","","facility","both","1","EA","","51.17","51.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nulojix: 1 Vial, Single-Use In 1 Carton (0003-0371-13)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","250","RC","0003-0371-13","NDC","","","facility","both","1","EA","","5.07","5.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-01)  / 10 Ml In 1 Vial, Multi-Dose","250","RC","0002-8215-01","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-0213-01)  / 3 Ml In 1 Vial, Multi-Dose","250","RC","0002-0213-01","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","97344038787","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0002-1433-01","NDC","","","facility","both","1","EA","","430.91","430.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9866900201","NDC","","","facility","both","1","EA","","7.94","7.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8839501540","NDC","","","facility","both","1","EA","","3.14","3.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8770143017","NDC","","","facility","both","1","EA","","35.96","35.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8770140065","NDC","","","facility","both","1","EA","","2.72","2.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8380007905","NDC","","","facility","both","1","EA","","4.48","4.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8349030760","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","9277159007","NDC","","","facility","both","1","EA","","2.58","2.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sprycel: 1 Bottle In 1 Carton (0003-0528-11)  / 60 Tablet In 1 Bottle","250","RC","0003-0528-11","NDC","","","facility","both","1","EA","","560.11","560.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0002-1457-01","NDC","","","facility","both","1","EA","","448.05","448.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0002-1506-01","NDC","","","facility","both","1","EA","","448.03","448.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mounjaro: 4 Syringe In 1 Carton (0002-1460-80)  / .5 Ml In 1 Syringe (0002-1460-01)","250","RC","0002-1460-80","NDC","","","facility","both","1","EA","","447.98","447.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zyprexa Intramuscular: 1 Vial In 1 Carton (0002-7597-01)  / 2 Ml In 1 Vial","250","RC","0002-7597-01","NDC","","","facility","both","1","EA","","4.17","4.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Effient: 90 BLISTER PACK in 1 CARTON (0002-5123-77)  / 1 TABLET, FILM COATED in 1 BLISTER PACK (0002-5123-01) ","250","RC","0002-5123-77","NDC","","","facility","both","1","EA","","25.47","25.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cialis: 30 Tablet, Film Coated In 1 Bottle (0002-4462-30)","250","RC","0002-4462-30","NDC","","","facility","both","1","EA","","15.95","15.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olumiant: 30 Tablet, Film Coated In 1 Bottle (0002-4182-30)","250","RC","0002-4182-30","NDC","","","facility","both","1","EA","","150.78","150.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Strattera: 30 Capsule In 1 Bottle (0002-3229-30)","250","RC","0002-3229-30","NDC","","","facility","both","1","EA","","23.77","23.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zyprexa Intramuscular: 1 Vial In 1 Carton (0002-7597-01)  / 2 Ml In 1 Vial","250","RC","0002-7597-01","NDC","","","facility","both","1","EA","","4.17","4.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sprycel: 1 Bottle In 1 Carton (0003-0852-22)  / 30 Tablet In 1 Bottle","250","RC","0003-0852-22","NDC","","","facility","both","1","EA","","1009.5","1009.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eliquis: 10 Blister Pack In 1 Carton (0003-0893-31)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","0003-0893-31","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Boniva: 1 BLISTER PACK in 1 BOX (0004-0186-83)  / 3 TABLET, FILM COATED in 1 BLISTER PACK","250","RC","0004-0186-83","NDC","","","facility","both","1","EA","","333.4","333.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tamiflu: 1 Blister Pack In 1 Carton (0004-0800-85)  / 10 Capsule In 1 Blister Pack","250","RC","0004-0800-85","NDC","","","facility","both","1","EA","","25.21","25.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Januvia: 30 Tablet, Film Coated In 1 Bottle (0006-0112-31)","250","RC","0006-0112-31","NDC","","","facility","both","1","EA","","18.26","18.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0006-0112-01","NDC","","","facility","both","1","EA","","19.74","19.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stromectol: 2 Blister Pack In 1 Carton (0006-0032-20)  / 10 Tablet In 1 Blister Pack","250","RC","0006-0032-20","NDC","","","facility","both","1","EA","","7.72","7.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0005-4344-15","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tamiflu: 1 Blister Pack In 1 Carton (0004-0801-85)  / 10 Capsule In 1 Blister Pack","250","RC","0004-0801-85","NDC","","","facility","both","1","EA","","23.2","23.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02)  / .5 Ml In 1 Syringe (0005-2000-01)","250","RC","0005-2000-02","NDC","","","facility","both","1","EA","","415.94","415.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","0005-2000-01","NDC","","","facility","both","1","EA","","422.19","422.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tamiflu: 1 Blister Pack In 1 Carton (0004-0802-85)  / 10 Capsule In 1 Blister Pack","250","RC","0004-0802-85","NDC","","","facility","both","1","EA","","23.13","23.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8290306547","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cobenfy: 60 Capsule, Coated Pellets In 1 Bottle (0003-1100-60)","250","RC","0003-1100-60","NDC","","","facility","both","1","EA","","51.18","51.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eliquis: 10 Blister Pack In 1 Carton (0003-0894-31)  / 10 Tablet, Film Coated In 1 Blister Pack","250","RC","0003-0894-31","NDC","","","facility","both","1","EA","","2.45","2.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eliquis: 60 Tablet, Film Coated In 1 Bottle, Plastic (0003-0894-21)","250","RC","0003-0894-21","NDC","","","facility","both","1","EA","","2.48","2.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baraclude: 1 Bottle In 1 Carton (0003-1614-12)  / 210 Ml In 1 Bottle","250","RC","0003-1614-12","NDC","","","facility","both","1","EA","","90.47","90.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6299130932","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azactam: 10 Vial, Single-Dose In 1 Carton (0003-2570-16)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","250","RC","0003-2570-16","NDC","","","facility","both","1","EA","","4.93","4.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7139974015","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7135101099","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7135101012","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7135101001","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7132180230","NDC","","","facility","both","1","EA","","5.94","5.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6961801854","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6954326810","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6954323460","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6936728302","NDC","","","facility","both","1","EA","","1.58","1.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6936722001","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7214000021","NDC","","","facility","both","1","EA","","21.11","21.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7431200640","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7430000071","NDC","","","facility","both","1","EA","","7.73","7.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7214063608","NDC","","","facility","both","1","EA","","19.25","19.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7214063386","NDC","","","facility","both","1","EA","","17.82","17.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7139974805","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7214045231","NDC","","","facility","both","1","EA","","8.67","8.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7214003711","NDC","","","facility","both","1","EA","","10.66","10.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7214003147","NDC","","","facility","both","1","EA","","26.1","26.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7214000022","NDC","","","facility","both","1","EA","","9.15","9.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6498010401","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6425333335","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6425333333","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6373601210","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6332325410","NDC","","","facility","both","1","EA","","35.6","35.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6332325402","NDC","","","facility","both","1","EA","","29.02","29.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8290306547","NDC","","","facility","both","1","EA","","7.76","7.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6373612002","NDC","","","facility","both","1","EA","","13.07","13.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6845510890","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6498033901","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6498033990","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6845510849","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6845510826","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6817600015","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6817600011","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6809422458","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6809422401","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6761811128","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","6817600010","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7431203201","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7513758507","NDC","","","facility","both","1","EA","","10.75","10.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8065183055","NDC","","","facility","both","1","EA","","254.81","254.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068101000","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068102500","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068104100","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068104900","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068107100","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068109700","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068109800","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068110000","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068111600","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068113400","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068114000","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8290306423","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8290306413","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8137003601","NDC","","","facility","both","1","EA","","8.18","8.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068117200","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068116900","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068116500","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068115500","NDC","","","facility","both","1","EA","","3.46","3.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7985450032","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8068105700","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7811201103","NDC","","","facility","both","1","EA","","7.97","7.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733393725","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733393710","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733386125","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733352025","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733351625","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7985407724","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733311025","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7628045931","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7583402001","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7583401060","NDC","","","facility","both","1","EA","","1.9","1.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733343025","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733393810","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733343050","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7431207961","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733398325","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733398310","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733395125","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733394825","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","8290306424","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733394025","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733394010","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733393825","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","250","RC","7733394810","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 32 Pouch In 1 Case (0990-7983-61)  / 1 Bag In 1 Pouch / 150 Ml In 1 Bag","253","RC","0990-7983-61","NDC","","","facility","both","1","EA","","18.36","18.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meropenem: 10 Vial In 1 Carton (0143-9431-10)  / 30 Ml In 1 Vial (0143-9431-01)","253","RC","0143-9431-10","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial In 1 Package (0143-9162-10)  / 1025 Mg In 1 Vial (0143-9162-01)","253","RC","0143-9162-10","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02)","253","RC","0338-0049-02","NDC","","","facility","both","1","EA","","5.65","5.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 84 Container In 1 Case (0264-1800-31)  / 50 Ml In 1 Container","253","RC","0264-1800-31","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-11)  / 50 Ml In 1 Bag","253","RC","0338-0049-11","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-18)  / 100 Ml In 1 Bag","253","RC","0338-0049-18","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ganciclovir: 25 Vial In 1 Carton (70436-089-55)  / 10 Ml In 1 Vial","253","RC","70436-089-55","NDC","","","facility","both","1","EA","","27.75","27.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-121-50)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","253","RC","55150-121-50","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-120-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","253","RC","55150-120-30","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meropenem: 10 Vial In 1 Carton (55150-208-30)  / 1 Injection, Powder, For Solution In 1 Vial","253","RC","55150-208-30","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aztreonam: 10 Vial In 1 Tray (63323-402-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (63323-402-01)","253","RC","63323-402-20","NDC","","","facility","both","1","EA","","3.74","3.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6147-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","253","RC","60505-6147-0","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6147-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","253","RC","60505-6147-0","NDC","","","facility","both","1","EA","","2.24","2.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6146-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","253","RC","60505-6146-0","NDC","","","facility","both","1","EA","","2.28","2.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium In Dextrose: 24 Container In 1 Case (0264-9587-20)  / 250 Ml In 1 Container","258","RC","0264-9587-20","NDC","","","facility","both","1","EA","","212","212","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Plenamine: 4 Container In 1 Case (0264-4500-05)  / 2000 Ml In 1 Container","258","RC","0264-4500-05","NDC","","","facility","both","1","EA","","212","212","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zinc Sulfate: 25 VIAL, SINGLE-DOSE in 1 TRAY (0517-6110-25)  / 10 mL in 1 VIAL, SINGLE-DOSE","258","RC","0517-6110-25","NDC","","","facility","both","1","EA","","160","160","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","258","RC","0517-9305-01","NDC","","","facility","both","1","EA","","154.9","154.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sterile Water: 12 POUCH in 1 CASE (0409-7990-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","258","RC","0409-7990-09","NDC","","","facility","both","1","EA","","160","160","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vitamin K1: 5 Tray In 1 Container (0409-9158-01)  / 5 Ampule In 1 Tray (0409-9158-50)  / 1 Ml In 1 Ampule (0409-9158-31)","258","RC","0409-9158-01","NDC","","","facility","both","1","EA","","212","212","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 25 Vial In 1 Carton (0641-6022-25)  / 2 Ml In 1 Vial (0641-6022-01)","258","RC","0641-6022-25","NDC","","","facility","both","1","EA","","153.98","153.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Copper: 25 Vial, Single-Dose In 1 Tray (0409-4092-01)  / 10 Ml In 1 Vial, Single-Dose (0409-4092-11)","258","RC","0409-4092-01","NDC","","","facility","both","1","EA","","141.5","141.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ascorbic Acid: 1 VIAL, GLASS in 1 CARTON (67457-118-50)  / 50 mL in 1 VIAL, GLASS","258","RC","67457-118-50","NDC","","","facility","both","1","EA","","160","160","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infuvite Adult: 1 Kit In 1 Carton (54643-5649-1)  *  5 Ml In 1 Vial (54643-5657-1)  *  5 Ml In 1 Vial (54643-5659-1)","258","RC","54643-5649-1","NDC","","","facility","both","1","EA","","201.32","201.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carnitor: 5 Vial In 1 Carton (54482-147-01)  / 5 Ml In 1 Vial","258","RC","54482-147-01","NDC","","","facility","both","1","EA","","157.78","157.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folic Acid: 1 Vial, Multi-Dose In 1 Carton (63323-184-10)  / 10 Ml In 1 Vial, Multi-Dose","258","RC","63323-184-10","NDC","","","facility","both","1","EA","","141.5","141.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiamine: 25 Vial, Multi-Dose In 1 Tray (63323-013-02)  / 2 Ml In 1 Vial, Multi-Dose (63323-013-01)","258","RC","63323-013-02","NDC","","","facility","both","1","EA","","156.87","156.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","258","RC","63323-738-04","NDC","","","facility","both","1","EA","","158.58","158.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"M.V.I. Pediatric: 10 VIAL, SINGLE-DOSE in 1 BOX (61703-421-53)  / 5 mL in 1 VIAL, SINGLE-DOSE (61703-421-63) ","258","RC","61703-421-53","NDC","","","facility","both","1","EA","","201.15","201.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-01)  / 10 Ml In 1 Vial, Multi-Dose","258","RC","0002-8215-01","NDC","","","facility","both","1","EA","","157.04","157.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","273","RC","99999-1008-76","NDC","","","facility","both","1","EA","","13.38","13.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","273","RC","99999-1008-75","NDC","","","facility","both","1","EA","","5.3","5.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Technelite: 1 Vial In 1 Carton (11994-090-01)  / 12 Ml In 1 Vial","343","RC","11994-090-01","NDC","","","facility","both","1","EA","","322.04","322.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neurolite: 2 Kit In 1 Package, Combination (11994-006-02)  / 1 Kit In 1 Kit *  1 Injection In 1 Vial (11994-002-01)  *  1 Ml In 1 Vial (11994-004-01)","343","RC","11994-006-02","NDC","","","facility","both","1","EA","","2959.82","2959.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indium Dtpa In 111: 1.5 Ml In 1 Vial, Glass (17156-251-08)","343","RC","17156-251-08","NDC","","","facility","both","1","EA","","1354.02","1354.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adreview: 1 Vial, Glass In 1 Container (17156-235-01)  / 5 Ml In 1 Vial, Glass","343","RC","17156-235-01","NDC","","","facility","both","1","EA","","9133.71","9133.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Iodide: 1 CAPSULE in 1 BOX (17156-201-05) ","343","RC","17156-201-05","NDC","","","facility","both","1","EA","","824.16","824.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indium In 111 Oxyquinoline: 1 Vial In 1 Box (17156-021-01)  / 1 Ml In 1 Vial","343","RC","17156-021-01","NDC","","","facility","both","1","EA","","3254.78","3254.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indium In 111 Oxyquinoline: 1 Vial In 1 Box (17156-021-01)  / 1 Ml In 1 Vial","343","RC","17156-021-01","NDC","","","facility","both","1","EA","","5514.07","5514.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kit For The Preparation Of Technetium Tc 99M Medronate: 5 Vial, Multi-Dose In 1 Kit (45567-0040-1)  / 10 Ml In 1 Vial, Multi-Dose","343","RC","45567-0040-1","NDC","","","facility","both","1","EA","","68.61","68.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kit For The Preparation Of Technetium Tc 99M Medronate: 5 Vial, Multi-Dose In 1 Kit (45567-0040-1)  / 10 Ml In 1 Vial, Multi-Dose","343","RC","45567-0040-1","NDC","","","facility","both","1","EA","","76.76","76.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kit For The Prepartion Of Technetium Tc99M Sulfur Colloid: 1 Kit In 1 Package (45567-0030-1)  *  3 Ml In 1 Vial *  3 Ml In 1 Vial *  10 Ml In 1 Vial","343","RC","45567-0030-1","NDC","","","facility","both","1","EA","","167.93","167.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludeoxyglucose F 18: 30 Ml In 1 Vial, Multi-Dose (49609-101-01)","343","RC","49609-101-01","NDC","","","facility","both","1","EA","","194.4","194.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludeoxyglucose F 18: 30 Ml In 1 Vial, Multi-Dose (49609-101-01)","343","RC","49609-101-01","NDC","","","facility","both","1","EA","","194.4","194.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludeoxyglucose F 18: 30 Ml In 1 Vial, Multi-Dose (49609-101-01)","343","RC","49609-101-01","NDC","","","facility","both","1","EA","","228.68","228.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludeoxyglucose F 18: 30 Ml In 1 Vial, Multi-Dose (49609-101-01)","343","RC","49609-101-01","NDC","","","facility","both","1","EA","","231.48","231.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludeoxyglucose F 18: 30 Ml In 1 Vial, Multi-Dose (49609-101-01)","343","RC","49609-101-01","NDC","","","facility","both","1","EA","","277.83","277.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludeoxyglucose F 18: 30 Ml In 1 Vial, Multi-Dose (49609-101-01)","343","RC","49609-101-01","NDC","","","facility","both","1","EA","","277.83","277.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ammonia N 13: 20 Ml In 1 Vial, Glass (40089-113-20)","343","RC","40089-113-20","NDC","","","facility","both","1","EA","","2216.47","2216.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Choletec: 10 Vial In 1 Carton (0270-0083-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","343","RC","0270-0083-20","NDC","","","facility","both","1","EA","","55.6","55.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"OCTREOSCAN: 1 KIT in 1 BOX (0019-9050-40)  *  1 mL in 1 VIAL, GLASS *  1 mL in 1 VIAL, GLASS","343","RC","0019-9050-40","NDC","","","facility","both","1","EA","","3714.4","3714.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pluvicto: 1 Vial, Glass In 1 Package (69488-010-61)  / 7.5 Ml In 1 Vial, Glass","343","RC","69488-010-61","NDC","","","facility","both","1","EA","","258.46","258.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pluvicto: 1 Vial, Glass In 1 Package (69488-010-61)  / 7.5 Ml In 1 Vial, Glass","343","RC","69488-010-61","NDC","","","facility","both","1","EA","","267.25","267.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pluvicto: 1 Vial, Glass In 1 Package (69488-010-61)  / 7.5 Ml In 1 Vial, Glass","343","RC","69488-010-61","NDC","","","facility","both","1","EA","","272.64","272.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Netspot: 1 Kit In 1 Kit (69488-001-40)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","343","RC","69488-001-40","NDC","","","facility","both","1","EA","","89.72","89.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Netspot: 1 Kit In 1 Kit (69488-001-40)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","343","RC","69488-001-40","NDC","","","facility","both","1","EA","","93.6","93.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Netspot: 1 Kit In 1 Kit (69488-001-40)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","343","RC","69488-001-40","NDC","","","facility","both","1","EA","","97.4","97.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Netspot: 1 Kit In 1 Kit (69488-001-40)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","343","RC","69488-001-40","NDC","","","facility","both","1","EA","","100.75","100.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Netspot: 1 Kit In 1 Kit (69488-001-40)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","343","RC","69488-001-40","NDC","","","facility","both","1","EA","","115.81","115.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultratag Rbc: 5 Cello Pack In 1 Box (69945-068-20)  / 1 Kit In 1 Cello Pack (69945-068-10)  *  .6 Ml In 1 Syringe, Glass *  1 Ml In 1 Syringe, Glass *  9.5 Mg In 1 Vial, Glass","343","RC","69945-068-20","NDC","","","facility","both","1","EA","","314.35","314.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Technescan Hdp: 5 Vial In 1 Cello Pack (69945-091-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (69945-091-01)","343","RC","69945-091-20","NDC","","","facility","both","1","EA","","221.98","221.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Technetium Tc 99M Sestamibi: 5 Vial In 1 Cello Pack (69945-092-20)  / 10 Ml In 1 Vial","343","RC","69945-092-20","NDC","","","facility","both","1","EA","","54.6","54.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Iodide I 123: 1 Bottle In 1 Can (69945-601-10)  / 1 Capsule, Gelatin Coated In 1 Bottle","343","RC","69945-601-10","NDC","","","facility","both","1","EA","","115.52","115.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Iodide I 123: 1 Bottle In 1 Can (69945-601-10)  / 1 Capsule, Gelatin Coated In 1 Bottle","343","RC","69945-601-10","NDC","","","facility","both","1","EA","","131.81","131.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indium In 111 Chloride: 1 Vial, Glass In 1 Can (69945-132-06)  / .5 Ml In 1 Vial, Glass","343","RC","69945-132-06","NDC","","","facility","both","1","EA","","14.73","14.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Technescan Mag3: 5 Vial In 1 Cello Pack (69945-096-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","343","RC","69945-096-20","NDC","","","facility","both","1","EA","","617.99","617.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Technescan Pyp: 5 Vial In 1 Cello Pack (69945-094-20)  / 10 Ml In 1 Vial (69945-094-01)","343","RC","69945-094-20","NDC","","","facility","both","1","EA","","269.72","269.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","65174-288-05","NDC","","","facility","both","1","EA","","253.87","253.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Draximage Maa: 30 Injection, Powder, For Solution In 1 Kit (65174-270-30)","343","RC","65174-270-30","NDC","","","facility","both","1","EA","","265.9","265.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Drax Exametazime: 5 Vial In 1 Carton (65174-200-05)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (65174-200-01)","343","RC","65174-200-05","NDC","","","facility","both","1","EA","","2691.62","2691.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Illuccix: 1 Kit In 1 Carton (74725-100-64)  *  2.5 Ml In 1 Vial, Multi-Dose (74725-102-25)  *  6.4 Ml In 1 Vial, Multi-Dose (74725-103-64)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Multi-Dose (74725-101-25)","343","RC","74725-100-64","NDC","","","facility","both","1","EA","","1325.24","1325.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Illuccix: 1 Kit In 1 Carton (74725-100-64)  *  2.5 Ml In 1 Vial, Multi-Dose (74725-102-25)  *  6.4 Ml In 1 Vial, Multi-Dose (74725-103-64)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Multi-Dose (74725-101-25)","343","RC","74725-100-64","NDC","","","facility","both","1","EA","","1528.93","1528.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","9999-5208-01","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","9999-5111-88","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","99999-4088-70","NDC","","","facility","both","1","EA","","23.99","23.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","99999-5100-34","NDC","","","facility","both","1","EA","","57.8","57.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","99999-5100-32","NDC","","","facility","both","1","EA","","165.67","165.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","99999-5100-31","NDC","","","facility","both","1","EA","","56.76","56.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","99999-5100-30","NDC","","","facility","both","1","EA","","8.66","8.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","99999-5100-21","NDC","","","facility","both","1","EA","","600.83","600.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","99999-5100-21","NDC","","","facility","both","1","EA","","806.31","806.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","99999-5100-14","NDC","","","facility","both","1","EA","","291.71","291.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","99999-5100-03","NDC","","","facility","both","1","EA","","4040.06","4040.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","71258-022-00","NDC","","","facility","both","1","EA","","705.07","705.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","71258-022-00","NDC","","","facility","both","1","EA","","881.76","881.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","71258-022-00","NDC","","","facility","both","1","EA","","1394.38","1394.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nephroscan: 5 Vial, Single-Dose In 1 Carton (71083-0020-5)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose (71083-0020-1)","343","RC","71083-0020-5","NDC","","","facility","both","1","EA","","2574.77","2574.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","343","RC","54828-001-01","NDC","","","facility","both","1","EA","","5452.2","5452.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amyvid: 1 Vial, Multi-Dose In 1 Can (0002-1200-50)  / 50 Ml In 1 Vial, Multi-Dose","343","RC","0002-1200-50","NDC","","","facility","both","1","EA","","5398.2","5398.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1000 Ml In 1 Bag (0338-0049-04)","344","RC","0338-0049-04","NDC","","","facility","both","1","EA","","637.5","637.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lutathera: 1 Vial In 1 Package (69488-003-01)  / 20.5 Ml In 1 Vial","344","RC","69488-003-01","NDC","","","facility","both","1","EA","","320.55","320.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lutathera: 1 Vial In 1 Package (69488-003-01)  / 20.5 Ml In 1 Vial","344","RC","69488-003-01","NDC","","","facility","both","1","EA","","323.58","323.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lutathera: 1 Vial In 1 Package (69488-003-01)  / 20.5 Ml In 1 Vial","344","RC","69488-003-01","NDC","","","facility","both","1","EA","","339.04","339.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hicon: 1 Vial In 1 Kit (65174-880-50)  / .5 Ml In 1 Vial","344","RC","65174-880-50","NDC","","","facility","both","1","EA","","14.63","14.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hicon: 1 Vial In 1 Kit (65174-880-50)  / .5 Ml In 1 Vial","344","RC","65174-880-50","NDC","","","facility","both","1","EA","","27.75","27.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","344","RC","9999-5208-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","344","RC","9999-5111-88","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","344","RC","9999-5108-51","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-21","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-21","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-21","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-21","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","62.57","62.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","62.73","62.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","62.79","62.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","62.81","62.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","62.9","62.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","62.75","62.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-25","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-25","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-25","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-25","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","62.59","62.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","62.7","62.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","62.72","62.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","62.73","62.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","62.77","62.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","63.35","63.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-24)  / 200 Ml In 1 Vial, Glass (13533-800-25)","636","RC","13533-800-24","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-20)  / 50 Ml In 1 Vial, Glass (13533-800-21)","636","RC","13533-800-20","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-634-20","NDC","","","facility","both","1","EA","","945.9","945.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hypertet: 1 Syringe, Glass In 1 Box (13533-634-02)  / 1 Ml In 1 Syringe, Glass (13533-634-20)","636","RC","13533-634-02","NDC","","","facility","both","1","EA","","839.15","839.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thrombate Iii: 1 Kit In 1 Carton (13533-606-12)  *  10 Ml In 1 Vial, Glass (13533-605-21)  *  10 Ml In 1 Vial, Glass (76297-002-12)","636","RC","13533-606-12","NDC","","","facility","both","1","EA","","6.42","6.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thrombate Iii: 1 Kit In 1 Carton (13533-606-12)  *  10 Ml In 1 Vial, Glass (13533-605-21)  *  10 Ml In 1 Vial, Glass (76297-002-12)","636","RC","13533-606-12","NDC","","","facility","both","1","EA","","6.43","6.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-605-21","NDC","","","facility","both","1","EA","","6.43","6.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-318-50","NDC","","","facility","both","1","EA","","391.15","391.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-318-50","NDC","","","facility","both","1","EA","","398.3","398.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-318-50","NDC","","","facility","both","1","EA","","478.03","478.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-318-10","NDC","","","facility","both","1","EA","","361.06","361.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-318-10","NDC","","","facility","both","1","EA","","403.69","403.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-318-10","NDC","","","facility","both","1","EA","","555.48","555.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyperrab: 1 Vial In 1 Carton (13533-318-05)  / 5 Ml In 1 Vial (13533-318-50)","636","RC","13533-318-05","NDC","","","facility","both","1","EA","","366.35","366.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyperrab: 1 Vial In 1 Carton (13533-318-05)  / 5 Ml In 1 Vial (13533-318-50)","636","RC","13533-318-05","NDC","","","facility","both","1","EA","","390.46","390.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-605-21","NDC","","","facility","both","1","EA","","6.43","6.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","63.34","63.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","63.22","63.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-15)  / 25 Ml In 1 Vial, Glass (13533-800-16)","636","RC","13533-800-15","NDC","","","facility","both","1","EA","","63.08","63.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-15)  / 25 Ml In 1 Vial, Glass (13533-800-16)","636","RC","13533-800-15","NDC","","","facility","both","1","EA","","63.1","63.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-15)  / 25 Ml In 1 Vial, Glass (13533-800-16)","636","RC","13533-800-15","NDC","","","facility","both","1","EA","","63.12","63.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-15)  / 25 Ml In 1 Vial, Glass (13533-800-16)","636","RC","13533-800-15","NDC","","","facility","both","1","EA","","63.38","63.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-15)  / 25 Ml In 1 Vial, Glass (13533-800-16)","636","RC","13533-800-15","NDC","","","facility","both","1","EA","","63.38","63.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-13","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-13","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-13","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-13","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","62.44","62.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","62.52","62.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","62.59","62.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","62.7","62.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","62.72","62.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","62.74","62.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-12)  / 10 Ml In 1 Vial, Glass (13533-800-13)","636","RC","13533-800-12","NDC","","","facility","both","1","EA","","62.88","62.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam In Sodium Chloride: 10 Bag In 1 Carton (14789-330-15)  / 100 Ml In 1 Bag (14789-330-08)","636","RC","14789-330-15","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","14789-330-08","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","14789-137-07","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","14789-136-07","NDC","","","facility","both","1","EA","","2.52","2.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital Sodium: 10 Vial, Glass In 1 Carton (14789-128-05)  / 1 Ml In 1 Vial, Glass (14789-128-07)","636","RC","14789-128-05","NDC","","","facility","both","1","EA","","25.05","25.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital Sodium: 10 Vial, Glass In 1 Carton (14789-127-05)  / 1 Ml In 1 Vial, Glass (14789-127-07)","636","RC","14789-127-05","NDC","","","facility","both","1","EA","","9.54","9.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Papaverine Hydrochloride: 10 Vial, Single-Use In 1 Carton (14789-121-05)  / 2 Ml In 1 Vial, Single-Use (14789-121-07)","636","RC","14789-121-05","NDC","","","facility","both","1","EA","","26.5","26.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","14789-116-07","NDC","","","facility","both","1","EA","","141.45","141.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","14789-108-16","NDC","","","facility","both","1","EA","","5.54","5.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","14789-121-07","NDC","","","facility","both","1","EA","","18.79","18.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procainamide Hydrochloride: 10 Vial, Multi-Dose In 1 Carton (14789-900-02)  / 2 Ml In 1 Vial, Multi-Dose","636","RC","14789-900-02","NDC","","","facility","both","1","EA","","946.08","946.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Onivyde: 1 Vial, Single-Dose In 1 Carton (15054-0043-1)  / 10 Ml In 1 Vial, Single-Dose","636","RC","15054-0043-1","NDC","","","facility","both","1","EA","","101.07","101.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Somatuline Depot: 1 Pouch In 1 Carton (15054-1120-4)  / 1 Syringe In 1 Pouch / .5 Ml In 1 Syringe","636","RC","15054-1120-4","NDC","","","facility","both","1","EA","","81.22","81.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Somatuline Depot: 1 Pouch In 1 Carton (15054-1120-4)  / 1 Syringe In 1 Pouch / .5 Ml In 1 Syringe","636","RC","15054-1120-4","NDC","","","facility","both","1","EA","","85.17","85.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Somatuline Depot: 1 Pouch In 1 Carton (15054-1120-4)  / 1 Syringe In 1 Pouch / .5 Ml In 1 Syringe","636","RC","15054-1120-4","NDC","","","facility","both","1","EA","","139.5","139.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Somatuline Depot: 1 Pouch In 1 Carton (15054-1120-4)  / 1 Syringe In 1 Pouch / .5 Ml In 1 Syringe","636","RC","15054-1120-4","NDC","","","facility","both","1","EA","","143.43","143.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Somatuline Depot: 1 Pouch In 1 Carton (15054-1090-4)  / 1 Syringe In 1 Pouch / .3 Ml In 1 Syringe","636","RC","15054-1090-4","NDC","","","facility","both","1","EA","","162.16","162.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Somatuline Depot: 1 Pouch In 1 Carton (15054-1060-4)  / 1 Syringe In 1 Pouch / .2 Ml In 1 Syringe","636","RC","15054-1060-4","NDC","","","facility","both","1","EA","","182.64","182.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Somatuline Depot: 1 Pouch In 1 Carton (15054-1060-4)  / 1 Syringe In 1 Pouch / .2 Ml In 1 Syringe","636","RC","15054-1060-4","NDC","","","facility","both","1","EA","","182.64","182.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dysport: 1 Vial In 1 Carton (15054-0530-6)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","15054-0530-6","NDC","","","facility","both","1","EA","","15.47","15.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dysport: 1 Vial In 1 Carton (15054-0530-6)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","15054-0530-6","NDC","","","facility","both","1","EA","","15.65","15.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dysport: 1 Vial In 1 Carton (15054-0500-1)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","15054-0500-1","NDC","","","facility","both","1","EA","","15.46","15.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","14789-901-07","NDC","","","facility","both","1","EA","","517.57","517.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dysport: 1 Vial In 1 Carton (15054-0500-1)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","15054-0500-1","NDC","","","facility","both","1","EA","","15.46","15.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dysport: 1 Vial In 1 Carton (15054-0500-1)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","15054-0500-1","NDC","","","facility","both","1","EA","","15.77","15.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dysport: 1 Vial In 1 Carton (15054-0500-1)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","15054-0500-1","NDC","","","facility","both","1","EA","","15.85","15.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dysport: 1 Vial In 1 Carton (15054-0500-1)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","15054-0500-1","NDC","","","facility","both","1","EA","","15.85","15.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dysport: 1 Vial In 1 Carton (15054-0500-1)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","15054-0500-1","NDC","","","facility","both","1","EA","","16.2","16.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dysport: 1 Vial In 1 Carton (15054-0500-1)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","15054-0500-1","NDC","","","facility","both","1","EA","","16.62","16.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Onivyde: 1 Vial, Single-Dose In 1 Carton (15054-0043-1)  / 10 Ml In 1 Vial, Single-Dose","636","RC","15054-0043-1","NDC","","","facility","both","1","EA","","97.94","97.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Onivyde: 1 Vial, Single-Dose In 1 Carton (15054-0043-1)  / 10 Ml In 1 Vial, Single-Dose","636","RC","15054-0043-1","NDC","","","facility","both","1","EA","","98","98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Onivyde: 1 Vial, Single-Dose In 1 Carton (15054-0043-1)  / 10 Ml In 1 Vial, Single-Dose","636","RC","15054-0043-1","NDC","","","facility","both","1","EA","","98.02","98.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Onivyde: 1 Vial, Single-Dose In 1 Carton (15054-0043-1)  / 10 Ml In 1 Vial, Single-Dose","636","RC","15054-0043-1","NDC","","","facility","both","1","EA","","98.13","98.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Onivyde: 1 Vial, Single-Dose In 1 Carton (15054-0043-1)  / 10 Ml In 1 Vial, Single-Dose","636","RC","15054-0043-1","NDC","","","facility","both","1","EA","","100.7","100.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dysport: 1 Vial In 1 Carton (15054-0500-1)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","15054-0500-1","NDC","","","facility","both","1","EA","","15.75","15.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-72","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-72","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-72","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13533-800-72","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","62.6","62.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","62.72","62.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","62.72","62.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","62.75","62.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","62.78","62.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","63.37","63.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamunex-C: 1 Vial, Glass In 1 Carton (13533-800-71)  / 100 Ml In 1 Vial, Glass (13533-800-72)","636","RC","13533-800-71","NDC","","","facility","both","1","EA","","62.43","62.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","13668-593-80","NDC","","","facility","both","1","EA","","11.69","11.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyperrab: 1 Vial In 1 Carton (13533-318-05)  / 5 Ml In 1 Vial (13533-318-50)","636","RC","13533-318-05","NDC","","","facility","both","1","EA","","527.1","527.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyperrab: 1 Vial In 1 Carton (13533-318-01)  / 1 Ml In 1 Vial (13533-318-10)","636","RC","13533-318-01","NDC","","","facility","both","1","EA","","368.81","368.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Pouch In 1 Case (0990-7983-09)  / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag","636","RC","0990-7983-09","NDC","","","facility","both","1","EA","","4.79","4.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Pouch In 1 Case (0990-7983-02)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag","636","RC","0990-7983-02","NDC","","","facility","both","1","EA","","8.1","8.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 12 Pouch In 1 Case (0990-7953-09)  / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag","636","RC","0990-7953-09","NDC","","","facility","both","1","EA","","9.37","9.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 12 Pouch In 1 Case (0990-7953-09)  / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag","636","RC","0990-7953-09","NDC","","","facility","both","1","EA","","10.8","10.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 24 Pouch In 1 Case (0990-7953-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag","636","RC","0990-7953-03","NDC","","","facility","both","1","EA","","7.99","7.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 24 Pouch In 1 Case (0990-7953-02)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag","636","RC","0990-7953-02","NDC","","","facility","both","1","EA","","12.25","12.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 12 Pouch In 1 Case (0990-7941-09)  / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag","636","RC","0990-7941-09","NDC","","","facility","both","1","EA","","5.1","5.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 Pouch In 1 Case (0990-7936-19)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag","636","RC","0990-7936-19","NDC","","","facility","both","1","EA","","27","27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 Pouch In 1 Case (0990-7935-19)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag","636","RC","0990-7935-19","NDC","","","facility","both","1","EA","","21.18","21.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 Pouch In 1 Case (0990-7930-09)  / 1 Bag In 1 Pouch / 1000 Ml In 1 Bag","636","RC","0990-7930-09","NDC","","","facility","both","1","EA","","5.4","5.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Pouch In 1 Case (0990-7930-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag","636","RC","0990-7930-03","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Pouch In 1 Case (0990-7922-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag","636","RC","0990-7922-03","NDC","","","facility","both","1","EA","","8.85","8.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 Pouch In 1 Case (0990-7918-19)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag","636","RC","0990-7918-19","NDC","","","facility","both","1","EA","","1.98","1.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0990-7715-13","NDC","","","facility","both","1","EA","","3.05","3.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 32 Pouch In 1 Case (0990-7983-61)  / 1 Bag In 1 Pouch / 150 Ml In 1 Bag","636","RC","0990-7983-61","NDC","","","facility","both","1","EA","","5.7","5.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 60 BAG in 1 CASE (0990-7984-11)  / 100 mL in 1 BAG","636","RC","0990-7984-11","NDC","","","facility","both","1","EA","","7.21","7.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","10019-926-16","NDC","","","facility","both","1","EA","","55.33","55.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ifosfamide: 1 Vial, Single-Dose In 1 Carton (10019-926-02)  / 60 Ml In 1 Vial, Single-Dose (10019-926-16)","636","RC","10019-926-02","NDC","","","facility","both","1","EA","","43.1","43.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ifosfamide: 1 Vial, Single-Dose In 1 Carton (10019-926-02)  / 60 Ml In 1 Vial, Single-Dose (10019-926-16)","636","RC","10019-926-02","NDC","","","facility","both","1","EA","","45.51","45.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","10019-925-82","NDC","","","facility","both","1","EA","","35.86","35.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ifosfamide: 1 Vial, Single-Dose In 1 Carton (10019-925-01)  / 20 Ml In 1 Vial, Single-Dose (10019-925-82)","636","RC","10019-925-01","NDC","","","facility","both","1","EA","","44.55","44.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brevibloc: 10 Bag In 1 Carton (10019-670-10)  / 250 Ml In 1 Bag","636","RC","10019-670-10","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (10019-080-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","10019-080-01","NDC","","","facility","both","1","EA","","75.6","75.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bendamustine Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (10019-079-01)  / 1 Injection In 1 Vial, Multi-Dose","636","RC","10019-079-01","NDC","","","facility","both","1","EA","","20.71","20.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 48 Pouch In 1 Case (0990-7984-23)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","0990-7984-23","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Pouch In 1 Case (0990-7984-20)  / 4 Bag In 1 Pouch / 25 Ml In 1 Bag","636","RC","0990-7984-20","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (10019-080-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","10019-080-01","NDC","","","facility","both","1","EA","","61.57","61.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-3045-12","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-3045-11","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-3045-11","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-3045-11","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Advate: 1 Blister Pack In 1 Container (0944-3045-10)  / 1 Container In 1 Blister Pack (0944-3045-12)  / 1 Kit In 1 Container (0944-3045-11)  *  5 Ml In 1 Vial, Glass (0944-2945-01)  *  5 Ml In 1 Vial, Glass (64764-515-50)","636","RC","0944-3045-10","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Advate: 1 Blister Pack In 1 Container (0944-3045-10)  / 1 Container In 1 Blister Pack (0944-3045-12)  / 1 Kit In 1 Container (0944-3045-11)  *  5 Ml In 1 Vial, Glass (0944-2945-01)  *  5 Ml In 1 Vial, Glass (64764-515-50)","636","RC","0944-3045-10","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Advate: 1 Blister Pack In 1 Container (0944-3045-10)  / 1 Container In 1 Blister Pack (0944-3045-12)  / 1 Kit In 1 Container (0944-3045-11)  *  5 Ml In 1 Vial, Glass (0944-2945-01)  *  5 Ml In 1 Vial, Glass (64764-515-50)","636","RC","0944-3045-10","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-12","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-12","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-12","NDC","","","facility","both","1","EA","","67.31","67.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Advate: 1 Blister Pack In 1 Carton (0944-3051-02)  / 1 Container In 1 Blister Pack (0944-3051-03)  / 1 Kit In 1 Container (0944-3051-04)  *  5 Ml In 1 Vial, Glass (0944-2941-01)  *  2 Ml In 1 Vial, Glass (64764-514-02)","636","RC","0944-3051-02","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-12","NDC","","","facility","both","1","EA","","95.5","95.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-11","NDC","","","facility","both","1","EA","","67.67","67.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-11","NDC","","","facility","both","1","EA","","85.23","85.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-11","NDC","","","facility","both","1","EA","","98.73","98.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-10","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-10","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-10","NDC","","","facility","both","1","EA","","84.56","84.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-10","NDC","","","facility","both","1","EA","","98.73","98.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-10","NDC","","","facility","both","1","EA","","98.73","98.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-12","NDC","","","facility","both","1","EA","","74.43","74.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-3051-03","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-3051-03","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Advate: 1 Blister Pack In 1 Carton (0944-3052-02)  / 1 Container In 1 Blister Pack (0944-3052-03)  / 1 Kit In 1 Container (0944-3052-04)  *  5 Ml In 1 Vial, Glass (0944-2942-02)  *  2 Ml In 1 Vial, Glass (64764-514-02)","636","RC","0944-3052-02","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mannitol: 12 Pouch In 1 Case (0990-7715-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag (0990-7715-13)","636","RC","0990-7715-03","NDC","","","facility","both","1","EA","","3.09","3.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 24 Pouch In 1 Case (0990-7075-26)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","0990-7075-26","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 24 Pouch In 1 Case (0990-7074-26)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","0990-7074-26","NDC","","","facility","both","1","EA","","1.69","1.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Cello Pack In 1 Carton (0955-1006-10)  / 1 Syringe In 1 Cello Pack (0955-1006-01)  / .6 Ml In 1 Syringe","636","RC","0955-1006-10","NDC","","","facility","both","1","EA","","10.36","10.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Cello Pack In 1 Carton (0955-1004-10)  / 1 Syringe In 1 Cello Pack (0955-1004-01)  / .4 Ml In 1 Syringe","636","RC","0955-1004-10","NDC","","","facility","both","1","EA","","10.35","10.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-3054-04","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-3054-03","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Advate: 1 Blister Pack In 1 Carton (0944-3054-02)  / 1 Container In 1 Blister Pack (0944-3054-03)  / 1 Kit In 1 Container (0944-3054-04)  *  5 Ml In 1 Vial, Glass (0944-2944-02)  *  2 Ml In 1 Vial, Glass (64764-514-02)","636","RC","0944-3054-02","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Advate: 1 Blister Pack In 1 Carton (0944-3054-02)  / 1 Container In 1 Blister Pack (0944-3054-03)  / 1 Kit In 1 Container (0944-3054-04)  *  5 Ml In 1 Vial, Glass (0944-2944-02)  *  2 Ml In 1 Vial, Glass (64764-514-02)","636","RC","0944-3054-02","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-3053-03","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-3053-03","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-3053-03","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Advate: 1 Blister Pack In 1 Carton (0944-3053-02)  / 1 Container In 1 Blister Pack (0944-3053-04)  / 1 Kit In 1 Container (0944-3053-03)  *  5 Ml In 1 Vial, Glass (0944-2943-02)  *  2 Ml In 1 Vial, Glass (64764-514-02)","636","RC","0944-3053-02","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Advate: 1 Blister Pack In 1 Carton (0944-3053-02)  / 1 Container In 1 Blister Pack (0944-3053-04)  / 1 Kit In 1 Container (0944-3053-03)  *  5 Ml In 1 Vial, Glass (0944-2943-02)  *  2 Ml In 1 Vial, Glass (64764-514-02)","636","RC","0944-3053-02","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Advate: 1 Blister Pack In 1 Carton (0944-3053-02)  / 1 Container In 1 Blister Pack (0944-3053-04)  / 1 Kit In 1 Container (0944-3053-03)  *  5 Ml In 1 Vial, Glass (0944-2943-02)  *  2 Ml In 1 Vial, Glass (64764-514-02)","636","RC","0944-3053-02","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Advate: 1 Blister Pack In 1 Carton (0944-3052-02)  / 1 Container In 1 Blister Pack (0944-3052-03)  / 1 Kit In 1 Container (0944-3052-04)  *  5 Ml In 1 Vial, Glass (0944-2942-02)  *  2 Ml In 1 Vial, Glass (64764-514-02)","636","RC","0944-3052-02","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Advate: 1 Blister Pack In 1 Carton (0944-3052-02)  / 1 Container In 1 Blister Pack (0944-3052-03)  / 1 Kit In 1 Container (0944-3052-04)  *  5 Ml In 1 Vial, Glass (0944-2942-02)  *  2 Ml In 1 Vial, Glass (64764-514-02)","636","RC","0944-3052-02","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","10019-926-16","NDC","","","facility","both","1","EA","","44.8","44.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","10019-926-16","NDC","","","facility","both","1","EA","","43.19","43.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","12496-0100-2","NDC","","","facility","both","1","EA","","3629.74","3629.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sublocade: 1 Pouch In 1 Carton (12496-0100-1)  / 1 Syringe In 1 Pouch (12496-0100-2)  / 1 Solution In 1 Syringe (12496-0100-5)","636","RC","12496-0100-1","NDC","","","facility","both","1","EA","","3629.74","3629.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sublocade: 1 Pouch In 1 Carton (12496-0100-1)  / 1 Syringe In 1 Pouch (12496-0100-2)  / 1 Solution In 1 Syringe (12496-0100-5)","636","RC","12496-0100-1","NDC","","","facility","both","1","EA","","3629.74","3629.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","12496-0100-2","NDC","","","facility","both","1","EA","","3629.74","3629.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sublocade: 1 Pouch In 1 Carton (12496-0300-1)  / 1 Syringe In 1 Pouch (12496-0300-2)  / 1 Solution In 1 Syringe (12496-0300-5)","636","RC","12496-0300-1","NDC","","","facility","both","1","EA","","1209.91","1209.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","12496-0300-2","NDC","","","facility","both","1","EA","","1209.91","1209.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","12496-0757-1","NDC","","","facility","both","1","EA","","8.39","8.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyperrab: 1 Vial In 1 Carton (13533-318-01)  / 1 Ml In 1 Vial (13533-318-10)","636","RC","13533-318-01","NDC","","","facility","both","1","EA","","403.69","403.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyperrab: 1 Vial In 1 Carton (13533-318-01)  / 1 Ml In 1 Vial (13533-318-10)","636","RC","13533-318-01","NDC","","","facility","both","1","EA","","647.52","647.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","12496-1202-1","NDC","","","facility","both","1","EA","","8.4","8.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenex: 5 AMPULE in 1 CARTON (12496-0757-5)  / 1 mL in 1 AMPULE (12496-0757-1) ","636","RC","12496-0757-5","NDC","","","facility","both","1","EA","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Somatuline Depot: 1 Pouch In 1 Carton (15054-1120-4)  / 1 Syringe In 1 Pouch / .5 Ml In 1 Syringe","636","RC","15054-1120-4","NDC","","","facility","both","1","EA","","75","75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bethkis: 14 Pouch In 1 Carton (10122-820-56)  / 4 Ampule In 1 Pouch / 4 Ml In 1 Ampule","636","RC","10122-820-56","NDC","","","facility","both","1","EA","","222.04","222.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kengreal: 10 Vial, Single-Use In 1 Carton (10122-620-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use (10122-620-01)","636","RC","10122-620-10","NDC","","","facility","both","1","EA","","32.78","32.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kengreal: 10 Vial, Single-Use In 1 Carton (10122-620-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use (10122-620-01)","636","RC","10122-620-10","NDC","","","facility","both","1","EA","","32.86","32.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","10122-620-01","NDC","","","facility","both","1","EA","","33.06","33.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","10122-620-01","NDC","","","facility","both","1","EA","","33.13","33.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","10122-160-01","NDC","","","facility","both","1","EA","","327.78","327.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","10122-160-01","NDC","","","facility","both","1","EA","","440.79","440.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","10019-957-11","NDC","","","facility","both","1","EA","","1.23","1.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","10019-957-11","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","10019-953-62","NDC","","","facility","both","1","EA","","2.47","2.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesna: 1 Vial, Multi-Dose In 1 Box (10019-953-01)  / 10 Ml In 1 Vial, Multi-Dose (10019-953-62)","636","RC","10019-953-01","NDC","","","facility","both","1","EA","","2.62","2.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cysview: 1 Kit In 1 Carton (10511-3001-2)  *  50 Ml In 1 Syringe, Plastic *  50 Ml In 1 Vial, Glass","636","RC","10511-3001-2","NDC","","","facility","both","1","EA","","2176.2","2176.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myobloc: 1 Vial, Single-Use In 1 Carton (10454-712-10)  / 2 Ml In 1 Vial, Single-Use","636","RC","10454-712-10","NDC","","","facility","both","1","EA","","22.47","22.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myobloc: 1 Vial, Single-Use In 1 Carton (10454-712-10)  / 2 Ml In 1 Vial, Single-Use","636","RC","10454-712-10","NDC","","","facility","both","1","EA","","22.86","22.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myobloc: 1 Vial, Single-Use In 1 Carton (10454-712-10)  / 2 Ml In 1 Vial, Single-Use","636","RC","10454-712-10","NDC","","","facility","both","1","EA","","22.92","22.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myobloc: 1 Vial, Single-Use In 1 Carton (10454-711-10)  / 1 Ml In 1 Vial, Single-Use","636","RC","10454-711-10","NDC","","","facility","both","1","EA","","22.7","22.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myobloc: 1 Vial, Single-Use In 1 Carton (10454-711-10)  / 1 Ml In 1 Vial, Single-Use","636","RC","10454-711-10","NDC","","","facility","both","1","EA","","22.7","22.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myobloc: 1 Vial, Single-Use In 1 Carton (10454-711-10)  / 1 Ml In 1 Vial, Single-Use","636","RC","10454-711-10","NDC","","","facility","both","1","EA","","23.17","23.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myobloc: 1 Vial, Single-Use In 1 Carton (10454-710-10)  / .5 Ml In 1 Vial, Single-Use","636","RC","10454-710-10","NDC","","","facility","both","1","EA","","22.41","22.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myobloc: 1 Vial, Single-Use In 1 Carton (10454-710-10)  / .5 Ml In 1 Vial, Single-Use","636","RC","10454-710-10","NDC","","","facility","both","1","EA","","22.67","22.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myobloc: 1 Vial, Single-Use In 1 Carton (10454-710-10)  / .5 Ml In 1 Vial, Single-Use","636","RC","10454-710-10","NDC","","","facility","both","1","EA","","22.72","22.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (10135-779-01)","636","RC","10135-779-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Topotecan Hydrochloride: 1 Vial In 1 Package (16729-151-31)  / 4 Ml In 1 Vial","636","RC","16729-151-31","NDC","","","facility","both","1","EA","","5.23","5.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Carton (16729-115-05)  / 10 Ml In 1 Vial","636","RC","16729-115-05","NDC","","","facility","both","1","EA","","131.79","131.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Carton (16729-115-05)  / 10 Ml In 1 Vial","636","RC","16729-115-05","NDC","","","facility","both","1","EA","","206.41","206.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial, Multi-Dose In 1 Box (16729-114-11)  / 50 Ml In 1 Vial, Multi-Dose","636","RC","16729-114-11","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial, Multi-Dose In 1 Box (16729-114-08)  / 25 Ml In 1 Vial, Multi-Dose","636","RC","16729-114-08","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Box, Unit-Dose (16729-108-11)  / 40 Ml In 1 Vial","636","RC","16729-108-11","NDC","","","facility","both","1","EA","","70.27","70.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Box, Unit-Dose (16729-108-11)  / 40 Ml In 1 Vial","636","RC","16729-108-11","NDC","","","facility","both","1","EA","","98.04","98.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 100 Capsule In 1 Bottle (16729-094-01)","636","RC","16729-094-01","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Bottle (16729-043-01)","636","RC","16729-043-01","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial, Multi-Dose In 1 Box (16729-114-31)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","16729-114-31","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolic Acid: 120 Tablet, Delayed Release In 1 Bottle (16729-189-29)","636","RC","16729-189-29","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial In 1 Carton (16729-224-05)  / 20 Ml In 1 Vial","636","RC","16729-224-05","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16729-351-03","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 20 Ml In 1 Vial (16729-298-05)","636","RC","16729-298-05","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial In 1 Carton (16729-224-05)  / 20 Ml In 1 Vial","636","RC","16729-224-05","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisplatin: 100 Ml In 1 Vial (16729-288-38)","636","RC","16729-288-38","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial In 1 Carton (16729-277-30)  / 2 Ml In 1 Vial","636","RC","16729-277-30","NDC","","","facility","both","1","EA","","2.25","2.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial In 1 Carton (16729-277-30)  / 2 Ml In 1 Vial","636","RC","16729-277-30","NDC","","","facility","both","1","EA","","3.49","3.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial In 1 Carton (16729-277-03)  / 10 Ml In 1 Vial","636","RC","16729-277-03","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16729-276-03","NDC","","","facility","both","1","EA","","21.29","21.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16729-276-03","NDC","","","facility","both","1","EA","","21.43","21.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 500 Tablet In 1 Bottle (16729-019-16)","636","RC","16729-019-16","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bleomycin: 1 Vial, Single-Dose In 1 Carton (16714-886-01)  / 15 Powder, For Solution In 1 Vial, Single-Dose","636","RC","16714-886-01","NDC","","","facility","both","1","EA","","27.67","27.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bleomycin: 1 Vial, Single-Dose In 1 Carton (16714-886-01)  / 15 Powder, For Solution In 1 Vial, Single-Dose","636","RC","16714-886-01","NDC","","","facility","both","1","EA","","33.24","33.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","19515-904-41","NDC","","","facility","both","1","EA","","24.3","24.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","19515-904-41","NDC","","","facility","both","1","EA","","24.3","24.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flulaval 2024/2025: 10 Syringe In 1 Carton (19515-810-52)  / .5 Ml In 1 Syringe (19515-810-41)","636","RC","19515-810-52","NDC","","","facility","both","1","EA","","26.19","26.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","19515-810-41","NDC","","","facility","both","1","EA","","26.15","26.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","19515-810-41","NDC","","","facility","both","1","EA","","26.19","26.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","19515-810-41","NDC","","","facility","both","1","EA","","26.19","26.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hylenex Recombinant: 4 Box In 1 Carton (18657-117-04)  / 1 Vial In 1 Box (18657-117-02)  / 1 Ml In 1 Vial (18657-117-01)","636","RC","18657-117-04","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","19515-904-41","NDC","","","facility","both","1","EA","","24.3","24.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","18657-117-01","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","18657-117-02","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flulaval 2025/2026: 10 Syringe In 1 Carton (19515-904-52)  / .5 Ml In 1 Syringe (19515-904-41)","636","RC","19515-904-52","NDC","","","facility","both","1","EA","","24.3","24.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 25 Vial In 1 Carton (23155-240-41)  / 2 Ml In 1 Vial (23155-240-31)","636","RC","23155-240-41","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-240-31","NDC","","","facility","both","1","EA","","1.58","1.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cidofovir Dihydrate: 5 Ml In 1 Vial, Glass (23155-216-31)","636","RC","23155-216-31","NDC","","","facility","both","1","EA","","265.23","265.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cidofovir Dihydrate: 5 Ml In 1 Vial, Glass (23155-216-31)","636","RC","23155-216-31","NDC","","","facility","both","1","EA","","567.49","567.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 250 Ml In 1 Bag (17271-701-05)","636","RC","17271-701-05","NDC","","","facility","both","1","EA","","3.03","3.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 1 Vial, Single-Dose In 1 Carton (16729-526-63)  / 1 Ml In 1 Vial, Single-Dose","636","RC","16729-526-63","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16729-502-03","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16729-502-03","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16729-502-03","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenylephrine hydrochloride: 10 CARTON in 1 CARTON (16729-465-03)  / 1 VIAL, PHARMACY BULK PACKAGE in 1 CARTON (16729-465-31)  / 5 mL in 1 VIAL, PHARMACY BULK PACKAGE","636","RC","16729-465-03","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 500 Ml In 1 Bag (17271-701-06)","636","RC","17271-701-06","NDC","","","facility","both","1","EA","","5.23","5.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adenosine: 10 Vial In 1 Carton (17478-542-02)  / 2 Ml In 1 Vial","636","RC","17478-542-02","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"FENTANYL CITRATE: 10 AMPULE in 1 CARTON (17478-030-05)  / 5 mL in 1 AMPULE","636","RC","17478-030-05","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 20 Bag In 1 Case (17271-720-06)  / 500 Ml In 1 Bag","636","RC","17271-720-06","NDC","","","facility","both","1","EA","","6.3","6.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 30 Bag In 1 Case (17271-720-05)  / 250 Ml In 1 Bag","636","RC","17271-720-05","NDC","","","facility","both","1","EA","","5.43","5.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1000 Ml In 1 Bag (17271-701-07)","636","RC","17271-701-07","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-08","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (16714-159-01)","636","RC","16714-159-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Vial In 1 Carton (16714-140-01)  / 5 Ml In 1 Vial","636","RC","16714-140-01","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irinotecan Hydrochloride: 1 Vial, Single-Dose In 1 Carton (16714-131-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","16714-131-01","NDC","","","facility","both","1","EA","","2.9","2.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (16714-160-01)","636","RC","16714-160-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irinotecan Hydrochloride: 1 Vial, Single-Dose In 1 Carton (16714-131-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","16714-131-01","NDC","","","facility","both","1","EA","","2.91","2.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Vial In 1 Carton (16714-130-01)  / 1 Ml In 1 Vial","636","RC","16714-130-01","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulvestrant: 2 Syringe, Glass In 1 Carton (16714-070-02)  / 5 Ml In 1 Syringe, Glass (16714-070-01)","636","RC","16714-070-02","NDC","","","facility","both","1","EA","","12.58","12.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16714-066-01","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (16714-056-10)  / .8 Ml In 1 Syringe (16714-056-01)","636","RC","16714-056-10","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irinotecan Hydrochloride: 1 Vial, Single-Dose In 1 Carton (16714-131-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","16714-131-01","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Granisetron Hydrochloride: 2 BLISTER PACK in 1 CARTON (16714-221-32)  / 10 TABLET, FILM COATED in 1 BLISTER PACK (16714-221-12) ","636","RC","16714-221-32","NDC","","","facility","both","1","EA","","13.89","13.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 3 Blister Pack In 1 Carton (16714-201-30)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","636","RC","16714-201-30","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 1 Blister Pack In 1 Carton (16714-201-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","636","RC","16714-201-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 3 Blister Pack In 1 Carton (16714-200-30)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack (16714-200-10)","636","RC","16714-200-30","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16714-200-10","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16714-056-01","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (16714-046-10)  / 1 Ml In 1 Syringe (16714-046-01)","636","RC","16714-046-10","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16714-046-01","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (16714-036-10)  / .8 Ml In 1 Syringe (16714-036-01)","636","RC","16714-036-10","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16714-036-01","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (16714-026-10)  / .6 Ml In 1 Syringe (16714-026-01)","636","RC","16714-026-10","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16714-026-01","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16714-016-01","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16714-006-01","NDC","","","facility","both","1","EA","","1.23","1.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosaprepitant: 1 Vial, Single-Dose In 1 Carton (16714-248-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","16714-248-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosaprepitant: 1 Vial, Single-Dose In 1 Carton (16714-248-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","16714-248-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16714-644-01","NDC","","","facility","both","1","EA","","25.41","25.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 1 Bottle, Plastic In 1 Carton (16714-671-02)  / 50 Ml In 1 Bottle, Plastic","636","RC","16714-671-02","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 1 Vial In 1 Carton (16714-620-01)  / 2 Ml In 1 Vial","636","RC","16714-620-01","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 1 Vial In 1 Carton (16714-620-01)  / 2 Ml In 1 Vial","636","RC","16714-620-01","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","16714-301-01","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 1 Vial In 1 Carton (16714-536-01)  / 1 Ml In 1 Vial","636","RC","16714-536-01","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 1 Vial In 1 Carton (16714-536-01)  / 1 Ml In 1 Vial","636","RC","16714-536-01","NDC","","","facility","both","1","EA","","2.33","2.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 1 Vial In 1 Carton (16714-536-01)  / 1 Ml In 1 Vial","636","RC","16714-536-01","NDC","","","facility","both","1","EA","","2.55","2.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (16714-517-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Pharmacy Bulk Package","636","RC","16714-517-01","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-08","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 100 Blister Pack In 1 Carton (0904-6552-61)  / 1 Tablet, Film Coated In 1 Blister Pack","636","RC","0904-6552-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 100 Blister Pack In 1 Carton (0904-6551-61)  / 1 Tablet, Film Coated In 1 Blister Pack","636","RC","0904-6551-61","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Perphenazine: 100 Blister Pack In 1 Carton (0904-6599-61)  / 1 Tablet, Film Coated In 1 Blister Pack","636","RC","0904-6599-61","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6461-61)  / 1 Tablet In 1 Blister Pack","636","RC","0904-6461-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Perphenazine: 100 Blister Pack In 1 Carton (0904-6600-61)  / 1 Tablet, Film Coated In 1 Blister Pack","636","RC","0904-6600-61","NDC","","","facility","both","1","EA","","1.58","1.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Blister Pack In 1 Carton (0904-6624-61)  / 1 Capsule In 1 Blister Pack","636","RC","0904-6624-61","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Blister Pack In 1 Carton (0904-6623-61)  / 1 Capsule In 1 Blister Pack","636","RC","0904-6623-61","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Box (0904-2056-61)  / 10 Capsule In 1 Blister Pack","636","RC","0904-2056-61","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0832-6020-89","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0832-6020-00)","636","RC","0832-6020-00","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0832-6019-89","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-9213-90","NDC","","","facility","both","1","EA","","1.7","1.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-7515-14","NDC","","","facility","both","1","EA","","4.72","4.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin G Sodium: 10 Vial In 1 Carton (0781-6153-95)  / 1 Injection, Powder, For Solution In 1 Vial (0781-6153-94)","636","RC","0781-6153-95","NDC","","","facility","both","1","EA","","7.48","7.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-6153-94","NDC","","","facility","both","1","EA","","7.41","7.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin G Potassium: 10 Vial In 1 Carton (0781-6135-95)  / 1 Injection, Powder, For Solution In 1 Vial (0781-6135-94)","636","RC","0781-6135-95","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Banophen: 1 Bottle, Plastic In 1 Carton (0904-5551-59)  / 100 Tablet, Film Coated In 1 Bottle, Plastic","636","RC","0904-5551-59","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Banophen: 1 Bottle, Plastic In 1 Carton (0904-5551-59)  / 100 Tablet, Film Coated In 1 Bottle, Plastic","636","RC","0904-5551-59","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Maleate: 50 Blister Pack In 1 Carton (0904-7382-06)  / 1 Tablet In 1 Blister Pack","636","RC","0904-7382-06","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0904-7266-61)  / 1 Tablet In 1 Blister Pack","636","RC","0904-7266-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7304-61)  / 1 Tablet In 1 Blister Pack","636","RC","0904-7304-61","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-02)  / 10 Ml In 1 Bottle, Glass (0944-2700-08)","636","RC","0944-2700-02","NDC","","","facility","both","1","EA","","98.73","98.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-02)  / 10 Ml In 1 Bottle, Glass (0944-2700-08)","636","RC","0944-2700-02","NDC","","","facility","both","1","EA","","98.73","98.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2659-08","NDC","","","facility","both","1","EA","","135.21","135.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard S/D: 1 Kit In 1 Carton (0944-2658-04)  *  192 Ml In 1 Bottle (0338-0001-37)  *  192 Ml In 1 Bottle (64764-511-92)  *  200 Ml In 1 Bottle (0944-2659-08)","636","RC","0944-2658-04","NDC","","","facility","both","1","EA","","135.12","135.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2657-07","NDC","","","facility","both","1","EA","","135.53","135.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard S/D: 1 Kit In 1 Carton (0944-2656-03)  *  96 Ml In 1 Bottle (0338-0001-77)  *  96 Ml In 1 Bottle (64764-512-96)  *  100 Ml In 1 Bottle (0944-2657-07)","636","RC","0944-2656-03","NDC","","","facility","both","1","EA","","133.53","133.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-0495-06","NDC","","","facility","both","1","EA","","13.08","13.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-02)  / 10 Ml In 1 Bottle, Glass (0944-2700-08)","636","RC","0944-2700-02","NDC","","","facility","both","1","EA","","70.38","70.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-0495-06","NDC","","","facility","both","1","EA","","27.5","27.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 2 Bag In 1 Carton (0944-0495-05)  / 250 Ml In 1 Bag (0944-0495-06)","636","RC","0944-0495-05","NDC","","","facility","both","1","EA","","13.03","13.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 2 Bag In 1 Carton (0944-0495-05)  / 250 Ml In 1 Bag (0944-0495-06)","636","RC","0944-0495-05","NDC","","","facility","both","1","EA","","27.05","27.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 2 Bag In 1 Carton (0944-0495-05)  / 250 Ml In 1 Bag (0944-0495-06)","636","RC","0944-0495-05","NDC","","","facility","both","1","EA","","27.95","27.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-0493-04","NDC","","","facility","both","1","EA","","54.98","54.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-0493-04","NDC","","","facility","both","1","EA","","56.45","56.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-0493-04","NDC","","","facility","both","1","EA","","58.95","58.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-0495-06","NDC","","","facility","both","1","EA","","27.76","27.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-02)  / 10 Ml In 1 Bottle, Glass (0944-2700-08)","636","RC","0944-2700-02","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-03)  / 25 Ml In 1 Bottle, Glass (0944-2700-09)","636","RC","0944-2700-03","NDC","","","facility","both","1","EA","","98.73","98.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-08","NDC","","","facility","both","1","EA","","70.38","70.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-08","NDC","","","facility","both","1","EA","","97.57","97.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06)  / 200 Ml In 1 Bottle, Glass (0944-2700-12)","636","RC","0944-2700-06","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06)  / 200 Ml In 1 Bottle, Glass (0944-2700-12)","636","RC","0944-2700-06","NDC","","","facility","both","1","EA","","70.38","70.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06)  / 200 Ml In 1 Bottle, Glass (0944-2700-12)","636","RC","0944-2700-06","NDC","","","facility","both","1","EA","","70.38","70.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06)  / 200 Ml In 1 Bottle, Glass (0944-2700-12)","636","RC","0944-2700-06","NDC","","","facility","both","1","EA","","97.24","97.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-06)  / 200 Ml In 1 Bottle, Glass (0944-2700-12)","636","RC","0944-2700-06","NDC","","","facility","both","1","EA","","98.73","98.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-05)  / 100 Ml In 1 Bottle, Glass (0944-2700-11)","636","RC","0944-2700-05","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-05)  / 100 Ml In 1 Bottle, Glass (0944-2700-11)","636","RC","0944-2700-05","NDC","","","facility","both","1","EA","","70.38","70.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-05)  / 100 Ml In 1 Bottle, Glass (0944-2700-11)","636","RC","0944-2700-05","NDC","","","facility","both","1","EA","","98.73","98.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-05)  / 100 Ml In 1 Bottle, Glass (0944-2700-11)","636","RC","0944-2700-05","NDC","","","facility","both","1","EA","","98.73","98.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04)  / 50 Ml In 1 Bottle, Glass (0944-2700-10)","636","RC","0944-2700-04","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04)  / 50 Ml In 1 Bottle, Glass (0944-2700-10)","636","RC","0944-2700-04","NDC","","","facility","both","1","EA","","70.38","70.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04)  / 50 Ml In 1 Bottle, Glass (0944-2700-10)","636","RC","0944-2700-04","NDC","","","facility","both","1","EA","","70.38","70.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04)  / 50 Ml In 1 Bottle, Glass (0944-2700-10)","636","RC","0944-2700-04","NDC","","","facility","both","1","EA","","96.76","96.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04)  / 50 Ml In 1 Bottle, Glass (0944-2700-10)","636","RC","0944-2700-04","NDC","","","facility","both","1","EA","","98.73","98.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-04)  / 50 Ml In 1 Bottle, Glass (0944-2700-10)","636","RC","0944-2700-04","NDC","","","facility","both","1","EA","","98.73","98.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gammagard Liquid: 1 Bottle, Glass In 1 Carton (0944-2700-03)  / 25 Ml In 1 Bottle, Glass (0944-2700-09)","636","RC","0944-2700-03","NDC","","","facility","both","1","EA","","70.38","70.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-0493-03","NDC","","","facility","both","1","EA","","48.04","48.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-0493-03","NDC","","","facility","both","1","EA","","55.1","55.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-0493-03","NDC","","","facility","both","1","EA","","56.65","56.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 6 Bag In 1 Carton (0944-0493-02)  / 100 Ml In 1 Bag (0944-0493-04)","636","RC","0944-0493-02","NDC","","","facility","both","1","EA","","52.93","52.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 6 Bag In 1 Carton (0944-0493-02)  / 100 Ml In 1 Bag (0944-0493-04)","636","RC","0944-0493-02","NDC","","","facility","both","1","EA","","56.66","56.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 12 Bag In 1 Carton (0944-0493-01)  / 50 Ml In 1 Bag (0944-0493-03)","636","RC","0944-0493-01","NDC","","","facility","both","1","EA","","56.73","56.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flexbumin: 12 Bag In 1 Carton (0944-0493-01)  / 50 Ml In 1 Bag (0944-0493-03)","636","RC","0944-0493-01","NDC","","","facility","both","1","EA","","57.02","57.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0944-2700-08","NDC","","","facility","both","1","EA","","65.79","65.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hcl: 118 Ml In 1 Bottle, Plastic (0904-6985-20)","636","RC","0904-6985-20","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone: 100 Blister Pack In 1 Carton (0904-6914-61)  / 1 Tablet In 1 Blister Pack","636","RC","0904-6914-61","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abiraterone Acetate: 30 Blister Pack In 1 Carton (0904-6948-04)  / 1 Tablet In 1 Blister Pack","636","RC","0904-6948-04","NDC","","","facility","both","1","EA","","4.9","4.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Blister Pack In 1 Carton (0904-6923-61)  / 1 Tablet In 1 Blister Pack","636","RC","0904-6923-61","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine: 30 Blister Pack In 1 Carton (0904-7154-04)  / 1 Tablet In 1 Blister Pack","636","RC","0904-7154-04","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dronabinol: 30 Blister Pack In 1 Carton (0904-7145-04)  / 1 Capsule In 1 Blister Pack","636","RC","0904-7145-04","NDC","","","facility","both","1","EA","","9.39","9.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 20 Blister Pack In 1 Carton (0904-7141-10)  / 1 Tablet In 1 Blister Pack","636","RC","0904-7141-10","NDC","","","facility","both","1","EA","","3.79","3.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7132-61)  / 1 Tablet, Film Coated In 1 Blister Pack","636","RC","0904-7132-61","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7131-61)  / 1 Tablet, Film Coated In 1 Blister Pack","636","RC","0904-7131-61","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7130-61)  / 1 Tablet, Film Coated In 1 Blister Pack","636","RC","0904-7130-61","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dronabinol: 100 Blister Pack In 1 Carton (0904-7144-61)  / 1 Capsule In 1 Blister Pack","636","RC","0904-7144-61","NDC","","","facility","both","1","EA","","7.85","7.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7129-61)  / 1 Tablet, Film Coated In 1 Blister Pack","636","RC","0904-7129-61","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 100 Blister Pack In 1 Capsule (0904-7078-61)  / 1 Tablet, Film Coated In 1 Blister Pack","636","RC","0904-7078-61","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Pamoate: 100 Blister Pack In 1 Carton (0904-7065-61)  / 1 Capsule In 1 Blister Pack","636","RC","0904-7065-61","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Blister Pack In 1 Carton (0904-7097-61)  / 1 Capsule In 1 Blister Pack","636","RC","0904-7097-61","NDC","","","facility","both","1","EA","","1.72","1.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Blister Pack In 1 Carton (0904-7127-61)  / 1 Tablet In 1 Blister Pack","636","RC","0904-7127-61","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adenosine: 1 Vial In 1 Carton (23155-258-31)  / 20 Ml In 1 Vial","636","RC","23155-258-31","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adenosine: 1 Vial In 1 Carton (23155-258-31)  / 20 Ml In 1 Vial","636","RC","23155-258-31","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone: 25 Vial In 1 Carton (44567-702-25)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-702-25","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate In Sodium Chloride: 24 Pouch In 1 Carton (44567-621-24)  / 1 Bag In 1 Pouch (44567-621-01)  / 100 Ml In 1 Bag","636","RC","44567-621-24","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44567-621-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44567-621-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone: 1 Vial In 1 Carton (44567-703-01)  / 100 Ml In 1 Vial","636","RC","44567-703-01","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate In Sodium Chloride: 24 Pouch In 1 Carton (44567-620-24)  / 1 Bag In 1 Pouch (44567-620-01)  / 50 Ml In 1 Bag","636","RC","44567-620-24","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44567-620-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44567-620-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam In Sodium Chloride: 10 Bag In 1 Carton (44567-611-10)  / 100 Ml In 1 Bag (44567-611-01)","636","RC","44567-611-10","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44567-611-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44567-503-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44567-451-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44567-705-01","NDC","","","facility","both","1","EA","","18.49","18.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ertapenem: 10 Vial, Single-Dose In 1 Carton (44567-820-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose (44567-820-01)","636","RC","44567-820-10","NDC","","","facility","both","1","EA","","13.92","13.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44567-820-01","NDC","","","facility","both","1","EA","","13.05","13.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial In 1 Box (44567-803-10)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-803-10","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial In 1 Box (44567-801-10)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-801-10","NDC","","","facility","both","1","EA","","2.06","2.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 10 Vial In 1 Carton (44567-708-10)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-708-10","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 25 Vial In 1 Carton (44567-707-25)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-707-25","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44567-450-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 24 Pouch In 1 Carton (44567-435-24)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag","636","RC","44567-435-24","NDC","","","facility","both","1","EA","","6.69","6.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (44567-210-10)  / 10 Ml In 1 Vial","636","RC","44567-210-10","NDC","","","facility","both","1","EA","","3.56","3.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial In 1 Tray (44567-103-10)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-103-10","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial In 1 Tray (44567-101-10)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-101-10","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hizentra: 1 Syringe In 1 Carton (44206-458-24)  / 20 Ml In 1 Syringe (44206-458-96)","636","RC","44206-458-24","NDC","","","facility","both","1","EA","","24.69","24.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hizentra: 1 Syringe In 1 Carton (44206-458-24)  / 20 Ml In 1 Syringe (44206-458-96)","636","RC","44206-458-24","NDC","","","facility","both","1","EA","","24.69","24.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hizentra: 1 Syringe In 1 Carton (44206-457-22)  / 10 Ml In 1 Syringe (44206-457-95)","636","RC","44206-457-22","NDC","","","facility","both","1","EA","","24.69","24.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44206-454-92","NDC","","","facility","both","1","EA","","23.74","23.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (44567-211-10)  / 20 Ml In 1 Vial","636","RC","44567-211-10","NDC","","","facility","both","1","EA","","2.94","2.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 1 Vial In 1 Carton (44567-212-01)  / 100 Ml In 1 Vial","636","RC","44567-212-01","NDC","","","facility","both","1","EA","","1.88","1.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Pouch In 1 Carton (44567-421-24)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","44567-421-24","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Pouch In 1 Carton (44567-420-24)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag","636","RC","44567-420-24","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44567-420-00","NDC","","","facility","both","1","EA","","1.76","1.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44567-312-01","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin G Potassium: 10 Vial In 1 Tray (44567-311-10)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-311-10","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefoxitin: 25 Vial In 1 Carton (44567-246-25)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-246-25","NDC","","","facility","both","1","EA","","4.49","4.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefoxitin: 25 Vial In 1 Carton (44567-245-25)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-245-25","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 10 Vial In 1 Carton (44567-241-10)  / 20 Ml In 1 Vial","636","RC","44567-241-10","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 10 Vial In 1 Carton (44567-240-10)  / 20 Ml In 1 Vial","636","RC","44567-240-10","NDC","","","facility","both","1","EA","","2.43","2.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftazidime: 6 Vial In 1 Carton (44567-237-06)  / 100 Ml In 1 Vial","636","RC","44567-237-06","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftazidime: 10 Vial In 1 Carton (44567-236-10)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-236-10","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftazidime: 25 Vial In 1 Carton (44567-235-25)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-235-25","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftazidime: 25 Vial In 1 Carton (44567-235-25)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","44567-235-25","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nafcillin: 10 Vial In 1 Carton (44567-222-10)  / 1 Powder, For Solution In 1 Vial","636","RC","44567-222-10","NDC","","","facility","both","1","EA","","10.68","10.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludarabine Phosphate: 1 Vial, Glass In 1 Carton (45963-609-55)  / 2 Ml In 1 Vial, Glass","636","RC","45963-609-55","NDC","","","facility","both","1","EA","","103.15","103.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludarabine Phosphate: 1 Vial, Glass In 1 Carton (45963-609-55)  / 2 Ml In 1 Vial, Glass","636","RC","45963-609-55","NDC","","","facility","both","1","EA","","108.12","108.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vinorelbine: 1 Vial, Single-Dose In 1 Carton (45963-607-56)  / 5 Ml In 1 Vial, Single-Dose","636","RC","45963-607-56","NDC","","","facility","both","1","EA","","28.18","28.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vinorelbine: 1 Vial, Single-Dose In 1 Carton (45963-607-56)  / 5 Ml In 1 Vial, Single-Dose","636","RC","45963-607-56","NDC","","","facility","both","1","EA","","29.13","29.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","45802-759-00","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 12 Blister Pack In 1 Carton (45802-758-30)  / 1 Suppository In 1 Blister Pack (45802-758-00)","636","RC","45802-758-30","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","45802-758-00","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 12 Blister Pack In 1 Carton (45802-759-30)  / 1 Suppository In 1 Blister Pack (45802-759-00)","636","RC","45802-759-30","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide Sodium: 1 Vial, Single-Dose In 1 Carton (47335-330-40)  / 18 Ml In 1 Vial, Single-Dose","636","RC","47335-330-40","NDC","","","facility","both","1","EA","","21.58","21.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide Sodium: 1 Vial, Single-Dose In 1 Carton (47335-330-40)  / 18 Ml In 1 Vial, Single-Dose","636","RC","47335-330-40","NDC","","","facility","both","1","EA","","60.31","60.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ilumya: 1 Ml In 1 Carton (47335-177-95)","636","RC","47335-177-95","NDC","","","facility","both","1","EA","","210.89","210.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ilumya: 1 Ml In 1 Carton (47335-177-95)","636","RC","47335-177-95","NDC","","","facility","both","1","EA","","210.7","210.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44206-438-92","NDC","","","facility","both","1","EA","","73.01","73.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Privigen: 1 Vial, Glass In 1 Carton (44206-438-20)  / 200 Ml In 1 Vial, Glass (44206-438-92)","636","RC","44206-438-20","NDC","","","facility","both","1","EA","","76.41","76.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Privigen: 1 Vial, Glass In 1 Carton (44206-438-20)  / 200 Ml In 1 Vial, Glass (44206-438-92)","636","RC","44206-438-20","NDC","","","facility","both","1","EA","","76.41","76.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-106-11","NDC","","","facility","both","1","EA","","7.21","7.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 10 Syringe, Glass In 1 Carton (43598-106-10)  / 2 Ml In 1 Syringe, Glass (43598-106-11)","636","RC","43598-106-10","NDC","","","facility","both","1","EA","","8.25","8.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 10 Syringe, Glass In 1 Carton (43598-106-10)  / 2 Ml In 1 Syringe, Glass (43598-106-11)","636","RC","43598-106-10","NDC","","","facility","both","1","EA","","17","17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-085-11","NDC","","","facility","both","1","EA","","146.91","146.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 1 Vial In 1 Carton (43598-053-11)  / 10 Ml In 1 Vial","636","RC","43598-053-11","NDC","","","facility","both","1","EA","","5.2","5.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Vial, Multi-Dose In 1 Carton (43598-128-11)  / 8 Ml In 1 Vial, Multi-Dose","636","RC","43598-128-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-050-11","NDC","","","facility","both","1","EA","","2.76","2.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (43598-051-11)  / 2 Ml In 1 Vial, Multi-Dose","636","RC","43598-051-11","NDC","","","facility","both","1","EA","","906.69","906.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Vial, Multi-Dose In 1 Carton (43598-128-11)  / 8 Ml In 1 Vial, Multi-Dose","636","RC","43598-128-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Vial, Multi-Dose In 1 Carton (43598-130-74)  / 16 Ml In 1 Vial, Multi-Dose","636","RC","43598-130-74","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pemetrexed Disodium: 1 Vial, Single-Dose In 1 Carton (43598-386-62)  / 4 Ml In 1 Vial, Single-Dose","636","RC","43598-386-62","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulvestrant: 2 Syringe, Glass In 1 Carton (43598-262-23)  / 5 Ml In 1 Syringe, Glass (43598-262-11)","636","RC","43598-262-23","NDC","","","facility","both","1","EA","","11.62","11.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulvestrant: 2 Syringe, Glass In 1 Carton (43598-262-23)  / 5 Ml In 1 Syringe, Glass (43598-262-11)","636","RC","43598-262-23","NDC","","","facility","both","1","EA","","11.62","11.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial In 1 Carton (43598-171-11)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","43598-171-11","NDC","","","facility","both","1","EA","","47","47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-169-11","NDC","","","facility","both","1","EA","","10.82","10.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nelarabine: 1 Vial, Single-Dose In 1 Carton (43598-142-11)  / 50 Ml In 1 Vial, Single-Dose","636","RC","43598-142-11","NDC","","","facility","both","1","EA","","73.48","73.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Vial, Multi-Dose In 1 Carton (43598-130-74)  / 16 Ml In 1 Vial, Multi-Dose","636","RC","43598-130-74","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43528-003-01","NDC","","","facility","both","1","EA","","235.43","235.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43547-543-01","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phytonadione Phytonadione: 25 Ampule In 1 Carton (43598-405-16)  / 1 Ml In 1 Ampule (43598-405-11)","636","RC","43598-405-16","NDC","","","facility","both","1","EA","","2.81","2.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosaprepitant: 1 Vial In 1 Carton (43598-948-11)  / 1 Ml In 1 Vial","636","RC","43598-948-11","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosaprepitant: 1 Vial In 1 Carton (43598-948-11)  / 1 Ml In 1 Vial","636","RC","43598-948-11","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-931-11","NDC","","","facility","both","1","EA","","8.93","8.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-931-11","NDC","","","facility","both","1","EA","","10.73","10.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin: 25 Vial In 1 Carton (43598-914-25)  / 1 Ml In 1 Vial (43598-914-11)","636","RC","43598-914-25","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-914-11","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin: 25 Vial In 1 Carton (43598-914-06)  / 1 Ml In 1 Vial (43598-914-11)","636","RC","43598-914-06","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ertapenem Sodium: 10 Vial, Single-Dose In 1 Carton (43598-901-58)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose (43598-901-11)","636","RC","43598-901-58","NDC","","","facility","both","1","EA","","13.3","13.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-901-11","NDC","","","facility","both","1","EA","","13.31","13.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-861-11","NDC","","","facility","both","1","EA","","579.38","579.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rhophylac: 1 Syringe, Glass In 1 Carton (44206-300-01)  / 2 Ml In 1 Syringe, Glass (44206-300-90)","636","RC","44206-300-01","NDC","","","facility","both","1","EA","","130.59","130.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Privigen: 1 Vial, Glass In 1 Carton (44206-438-20)  / 200 Ml In 1 Vial, Glass (44206-438-92)","636","RC","44206-438-20","NDC","","","facility","both","1","EA","","76.41","76.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Privigen: 1 Vial, Glass In 1 Carton (44206-438-20)  / 200 Ml In 1 Vial, Glass (44206-438-92)","636","RC","44206-438-20","NDC","","","facility","both","1","EA","","76.41","76.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44206-437-91","NDC","","","facility","both","1","EA","","73.01","73.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Privigen: 1 Vial, Glass In 1 Carton (44206-437-10)  / 100 Ml In 1 Vial, Glass (44206-437-91)","636","RC","44206-437-10","NDC","","","facility","both","1","EA","","76.41","76.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Privigen: 1 Vial, Glass In 1 Carton (44206-437-10)  / 100 Ml In 1 Vial, Glass (44206-437-91)","636","RC","44206-437-10","NDC","","","facility","both","1","EA","","76.41","76.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Privigen: 1 Vial, Glass In 1 Carton (44206-437-10)  / 100 Ml In 1 Vial, Glass (44206-437-91)","636","RC","44206-437-10","NDC","","","facility","both","1","EA","","76.41","76.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Privigen: 1 Vial, Glass In 1 Carton (44206-437-10)  / 100 Ml In 1 Vial, Glass (44206-437-91)","636","RC","44206-437-10","NDC","","","facility","both","1","EA","","76.41","76.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Privigen: 1 Vial, Glass In 1 Carton (44206-436-05)  / 50 Ml In 1 Vial, Glass (44206-436-90)","636","RC","44206-436-05","NDC","","","facility","both","1","EA","","76.41","76.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Privigen: 1 Vial, Glass In 1 Carton (44206-436-05)  / 50 Ml In 1 Vial, Glass (44206-436-90)","636","RC","44206-436-05","NDC","","","facility","both","1","EA","","76.41","76.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44206-310-91","NDC","","","facility","both","1","EA","","11.86","11.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44206-310-91","NDC","","","facility","both","1","EA","","11.9","11.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44206-310-91","NDC","","","facility","both","1","EA","","13.14","13.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alburx: 1 Vial, Glass In 1 Carton (44206-310-50)  / 500 Ml In 1 Vial, Glass (44206-310-91)","636","RC","44206-310-50","NDC","","","facility","both","1","EA","","11.85","11.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alburx: 1 Vial, Glass In 1 Carton (44206-310-50)  / 500 Ml In 1 Vial, Glass (44206-310-91)","636","RC","44206-310-50","NDC","","","facility","both","1","EA","","11.96","11.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alburx: 1 Vial, Glass In 1 Carton (44206-310-50)  / 500 Ml In 1 Vial, Glass (44206-310-91)","636","RC","44206-310-50","NDC","","","facility","both","1","EA","","13.14","13.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","44206-300-90","NDC","","","facility","both","1","EA","","129.92","129.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rhophylac: 1 Syringe, Glass In 1 Carton (44206-300-01)  / 2 Ml In 1 Syringe, Glass (44206-300-90)","636","RC","44206-300-01","NDC","","","facility","both","1","EA","","130.09","130.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-839-11","NDC","","","facility","both","1","EA","","4.4","4.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-839-11","NDC","","","facility","both","1","EA","","4.76","4.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 10 Syringe In 1 Box (43598-750-58)  / 2 Ml In 1 Syringe","636","RC","43598-750-58","NDC","","","facility","both","1","EA","","12.24","12.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bortezomib: 1 Vial, Single-Dose In 1 Carton (43598-426-60)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","43598-426-60","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bortezomib: 1 Vial, Single-Dose In 1 Carton (43598-426-60)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","43598-426-60","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bortezomib: 1 Vial, Single-Dose In 1 Carton (43598-426-60)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","43598-426-60","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bortezomib: 1 Vial, Single-Dose In 1 Carton (43598-426-60)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","43598-426-60","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (43598-413-11)  / 10 Ml In 1 Vial, Single-Dose","636","RC","43598-413-11","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (43598-413-11)  / 10 Ml In 1 Vial, Single-Dose","636","RC","43598-413-11","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (43598-541-25)  / 25 Ml In 1 Vial, Single-Dose","636","RC","43598-541-25","NDC","","","facility","both","1","EA","","384.77","384.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 1 Syringe In 1 Box (43598-750-11)  / 2 Ml In 1 Syringe","636","RC","43598-750-11","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 10 Syringe In 1 Box (43598-750-10)  / 2 Ml In 1 Syringe","636","RC","43598-750-10","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial In 1 Carton (43598-650-11)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","43598-650-11","NDC","","","facility","both","1","EA","","36.99","36.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-637-52","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43598-636-52","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (43598-541-25)  / 25 Ml In 1 Vial, Single-Dose","636","RC","43598-541-25","NDC","","","facility","both","1","EA","","373.45","373.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","47335-890-60","NDC","","","facility","both","1","EA","","3.12","3.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Temozolomide: 15 Blister Pack In 1 Carton (47335-890-72)  / 1 Capsule In 1 Blister Pack","636","RC","47335-890-72","NDC","","","facility","both","1","EA","","3.11","3.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial","636","RC","50242-041-64","NDC","","","facility","both","1","EA","","160","160","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial","636","RC","50242-041-64","NDC","","","facility","both","1","EA","","160.3","160.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cathflo Activase: 1 Vial In 1 Carton (50242-041-64)  / 2 Ml In 1 Vial","636","RC","50242-041-64","NDC","","","facility","both","1","EA","","176.74","176.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xolair: 1 Vial, Single-Use In 1 Carton (50242-040-62)  / 1.2 Ml In 1 Vial, Single-Use","636","RC","50242-040-62","NDC","","","facility","both","1","EA","","83.65","83.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xolair: 1 Vial, Single-Use In 1 Carton (50242-040-62)  / 1.2 Ml In 1 Vial, Single-Use","636","RC","50242-040-62","NDC","","","facility","both","1","EA","","85.92","85.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50242-037-06","NDC","","","facility","both","1","EA","","285.15","285.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50242-037-06","NDC","","","facility","both","1","EA","","289.14","289.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50242-037-06","NDC","","","facility","both","1","EA","","289.74","289.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50242-044-06","NDC","","","facility","both","1","EA","","153.65","153.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01)  / 40 Ml In 1 Vial, Single-Use","636","RC","50242-070-01","NDC","","","facility","both","1","EA","","135.52","135.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01)  / 40 Ml In 1 Vial, Single-Use","636","RC","50242-070-01","NDC","","","facility","both","1","EA","","136.52","136.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01)  / 40 Ml In 1 Vial, Single-Use","636","RC","50242-070-01","NDC","","","facility","both","1","EA","","139.77","139.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01)  / 40 Ml In 1 Vial, Single-Use","636","RC","50242-070-01","NDC","","","facility","both","1","EA","","141.24","141.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avastin: 1 Vial, Single-Use In 1 Carton (50242-061-01)  / 16 Ml In 1 Vial, Single-Use","636","RC","50242-061-01","NDC","","","facility","both","1","EA","","123.48","123.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avastin: 1 Vial, Single-Use In 1 Carton (50242-060-01)  / 4 Ml In 1 Vial, Single-Use","636","RC","50242-060-01","NDC","","","facility","both","1","EA","","10.1","10.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avastin: 1 Vial, Single-Use In 1 Carton (50242-060-01)  / 4 Ml In 1 Vial, Single-Use","636","RC","50242-060-01","NDC","","","facility","both","1","EA","","33.59","33.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50242-044-06","NDC","","","facility","both","1","EA","","152.09","152.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avastin: 1 Vial, Single-Use In 1 Carton (50242-060-01)  / 4 Ml In 1 Vial, Single-Use","636","RC","50242-060-01","NDC","","","facility","both","1","EA","","44.06","44.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-053-06)  / 50 Ml In 1 Vial, Single-Use","636","RC","50242-053-06","NDC","","","facility","both","1","EA","","80.75","80.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-053-06)  / 50 Ml In 1 Vial, Single-Use","636","RC","50242-053-06","NDC","","","facility","both","1","EA","","83.85","83.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-053-06)  / 50 Ml In 1 Vial, Single-Use","636","RC","50242-053-06","NDC","","","facility","both","1","EA","","130.89","130.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-051-21)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-051-21","NDC","","","facility","both","1","EA","","100.93","100.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-051-21)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-051-21","NDC","","","facility","both","1","EA","","143.75","143.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-051-21)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-051-21","NDC","","","facility","both","1","EA","","143.75","143.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-051-21)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-051-21","NDC","","","facility","both","1","EA","","146.98","146.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Activase: 1 Kit In 1 Carton (50242-044-13)  *  50 Ml In 1 Vial, Single-Use *  50 Ml In 1 Vial, Single-Use","636","RC","50242-044-13","NDC","","","facility","both","1","EA","","146.86","146.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Activase: 1 Kit In 1 Carton (50242-044-13)  *  50 Ml In 1 Vial, Single-Use *  50 Ml In 1 Vial, Single-Use","636","RC","50242-044-13","NDC","","","facility","both","1","EA","","153.65","153.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rituxan: 1 Vial, Single-Use In 1 Carton (50242-053-06)  / 50 Ml In 1 Vial, Single-Use","636","RC","50242-053-06","NDC","","","facility","both","1","EA","","57.5","57.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Everolimus: 6 Blister Pack In 1 Carton (49884-283-02)  / 10 Tablet In 1 Blister Pack (49884-283-52)","636","RC","49884-283-02","NDC","","","facility","both","1","EA","","4.36","4.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49884-160-52","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49884-159-52","NDC","","","facility","both","1","EA","","3.64","3.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Everolimus: 6 Blister Pack In 1 Carton (49884-159-02)  / 10 Tablet In 1 Blister Pack (49884-159-52)","636","RC","49884-159-02","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49884-283-52","NDC","","","facility","both","1","EA","","4.36","4.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dronabinol: 60 CAPSULE in 1 BOTTLE (49884-868-02) ","636","RC","49884-868-02","NDC","","","facility","both","1","EA","","5.39","5.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Tablet, Film Coated In 1 Bottle (50111-789-10)","636","RC","50111-789-10","NDC","","","facility","both","1","EA","","7.65","7.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Tablet, Film Coated In 1 Bottle (50111-787-10)","636","RC","50111-787-10","NDC","","","facility","both","1","EA","","2.83","2.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nutropin Aq Nuspin 10: 1 Cartridge In 1 Carton (50242-074-01)  / 2 Ml In 1 Cartridge","636","RC","50242-074-01","NDC","","","facility","both","1","EA","","212.95","212.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Susvimo: 1 Vial In 1 Carton (50242-078-12)  / 1 Ml In 1 Vial","636","RC","50242-078-12","NDC","","","facility","both","1","EA","","144","144","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Susvimo: 1 Vial In 1 Carton (50242-078-55)  / 1 Ml In 1 Vial","636","RC","50242-078-55","NDC","","","facility","both","1","EA","","144","144","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Susvimo: 1 Vial In 1 Carton (50242-078-55)  / 1 Ml In 1 Vial","636","RC","50242-078-55","NDC","","","facility","both","1","EA","","144","144","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-260-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","50242-260-01","NDC","","","facility","both","1","EA","","127.93","127.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-260-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","50242-260-01","NDC","","","facility","both","1","EA","","130.26","130.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-260-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","50242-260-01","NDC","","","facility","both","1","EA","","130.89","130.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-245-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","50242-245-01","NDC","","","facility","both","1","EA","","115.27","115.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-245-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","50242-245-01","NDC","","","facility","both","1","EA","","116.31","116.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-245-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","50242-245-01","NDC","","","facility","both","1","EA","","116.73","116.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xolair: 1 Syringe, Glass In 1 Carton (50242-227-01)  / 2 Ml In 1 Syringe, Glass","636","RC","50242-227-01","NDC","","","facility","both","1","EA","","84.97","84.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-215-03)  / 1 Ml In 1 Syringe, Glass","636","RC","50242-215-03","NDC","","","facility","both","1","EA","","84.97","84.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xolair Pfs: 1 Syringe, Glass In 1 Carton (50242-215-01)  / 1 Ml In 1 Syringe, Glass","636","RC","50242-215-01","NDC","","","facility","both","1","EA","","83.1","83.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lunsumio: 1 Vial In 1 Carton (50242-159-01)  / 1 Ml In 1 Vial","636","RC","50242-159-01","NDC","","","facility","both","1","EA","","1101.62","1101.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phesgo: 1 Vial, Single-Dose In 1 Carton (50242-260-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","50242-260-01","NDC","","","facility","both","1","EA","","127.72","127.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lunsumio: 1 Vial In 1 Carton (50242-159-01)  / 1 Ml In 1 Vial","636","RC","50242-159-01","NDC","","","facility","both","1","EA","","1114.21","1114.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ocrevus: 1 Vial, Single-Use In 1 Carton (50242-150-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-150-01","NDC","","","facility","both","1","EA","","73.92","73.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ocrevus: 1 Vial, Single-Use In 1 Carton (50242-150-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-150-01","NDC","","","facility","both","1","EA","","78.95","78.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ocrevus: 1 Vial, Single-Use In 1 Carton (50242-150-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-150-01","NDC","","","facility","both","1","EA","","79.67","79.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01)  / 14 Ml In 1 Vial, Single-Use","636","RC","50242-145-01","NDC","","","facility","both","1","EA","","28.15","28.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01)  / 14 Ml In 1 Vial, Single-Use","636","RC","50242-145-01","NDC","","","facility","both","1","EA","","28.39","28.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01)  / 14 Ml In 1 Vial, Single-Use","636","RC","50242-145-01","NDC","","","facility","both","1","EA","","29.17","29.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01)  / 14 Ml In 1 Vial, Single-Use","636","RC","50242-145-01","NDC","","","facility","both","1","EA","","29.23","29.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01)  / 14 Ml In 1 Vial, Single-Use","636","RC","50242-145-01","NDC","","","facility","both","1","EA","","29.23","29.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Perjeta: 1 Vial, Single-Use In 1 Carton (50242-145-01)  / 14 Ml In 1 Vial, Single-Use","636","RC","50242-145-01","NDC","","","facility","both","1","EA","","29.23","29.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lunsumio: 1 Vial In 1 Carton (50242-142-01)  / 30 Ml In 1 Vial","636","RC","50242-142-01","NDC","","","facility","both","1","EA","","839.33","839.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ocrevus: 1 Vial, Single-Use In 1 Carton (50242-150-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-150-01","NDC","","","facility","both","1","EA","","66.9","66.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ocrevus Zunovo: 1 Vial, Single-Use In 1 Carton (50242-554-01)  / 23 Ml In 1 Vial, Single-Use","636","RC","50242-554-01","NDC","","","facility","both","1","EA","","53.57","53.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ocrevus Zunovo: 1 Vial, Single-Use In 1 Carton (50242-554-01)  / 23 Ml In 1 Vial, Single-Use","636","RC","50242-554-01","NDC","","","facility","both","1","EA","","35.71","35.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","50242-917-01","NDC","","","facility","both","1","EA","","158.41","158.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","50242-917-01","NDC","","","facility","both","1","EA","","158.46","158.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","50242-917-01","NDC","","","facility","both","1","EA","","161.38","161.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","50242-917-01","NDC","","","facility","both","1","EA","","161.52","161.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecentriq: 1 Vial, Single-Use In 1 Carton (50242-917-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","50242-917-01","NDC","","","facility","both","1","EA","","168.78","168.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lunsumio: 1 Vial In 1 Carton (50242-142-01)  / 30 Ml In 1 Vial","636","RC","50242-142-01","NDC","","","facility","both","1","EA","","870.7","870.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","50242-137-01","NDC","","","facility","both","1","EA","","11.59","11.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polivy: 1 Vial, Single-Dose In 1 Carton (50242-105-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","50242-105-01","NDC","","","facility","both","1","EA","","193.85","193.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polivy: 1 Vial In 1 Carton (50242-103-01)  / 6 Ml In 1 Vial","636","RC","50242-103-01","NDC","","","facility","both","1","EA","","208.19","208.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polivy: 1 Vial In 1 Carton (50242-103-01)  / 6 Ml In 1 Vial","636","RC","50242-103-01","NDC","","","facility","both","1","EA","","211.44","211.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polivy: 1 Vial In 1 Carton (50242-103-01)  / 6 Ml In 1 Vial","636","RC","50242-103-01","NDC","","","facility","both","1","EA","","217.48","217.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polivy: 1 Vial In 1 Carton (50242-103-01)  / 6 Ml In 1 Vial","636","RC","50242-103-01","NDC","","","facility","both","1","EA","","226.41","226.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pulmozyme: 5 Pouch In 1 Carton (50242-100-40)  / 6 Ampule In 1 Pouch (50242-100-39)  / 2.5 Ml In 1 Ampule","636","RC","50242-100-40","NDC","","","facility","both","1","EA","","81.96","81.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50242-100-39","NDC","","","facility","both","1","EA","","78.49","78.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","50242-088-01","NDC","","","facility","both","1","EA","","49.92","49.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polivy: 1 Vial, Single-Dose In 1 Carton (50242-105-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","50242-105-01","NDC","","","facility","both","1","EA","","190.82","190.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","50242-088-01","NDC","","","facility","both","1","EA","","49.92","49.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","50242-088-01","NDC","","","facility","both","1","EA","","49.92","49.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01)  / 8 Ml In 1 Vial, Single-Use","636","RC","50242-087-01","NDC","","","facility","both","1","EA","","49.67","49.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01)  / 8 Ml In 1 Vial, Single-Use","636","RC","50242-087-01","NDC","","","facility","both","1","EA","","49.92","49.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01)  / 8 Ml In 1 Vial, Single-Use","636","RC","50242-087-01","NDC","","","facility","both","1","EA","","49.92","49.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-087-01)  / 8 Ml In 1 Vial, Single-Use","636","RC","50242-087-01","NDC","","","facility","both","1","EA","","49.92","49.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Activase: 1 Kit In 1 Carton (50242-085-27)  *  100 Ml In 1 Vial, Single-Use *  100 Ml In 1 Vial, Single-Use","636","RC","50242-085-27","NDC","","","facility","both","1","EA","","140.18","140.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50242-085-25","NDC","","","facility","both","1","EA","","106.68","106.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Susvimo: 1 Vial In 1 Carton (50242-078-55)  / 1 Ml In 1 Vial","636","RC","50242-078-55","NDC","","","facility","both","1","EA","","144","144","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kadcyla: 1 Vial, Single-Use In 1 Carton (50242-088-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","50242-088-01","NDC","","","facility","both","1","EA","","49.92","49.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polivy: 1 Vial, Single-Dose In 1 Carton (50242-105-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","50242-105-01","NDC","","","facility","both","1","EA","","190.07","190.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polivy: 1 Vial, Single-Dose In 1 Carton (50242-105-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","50242-105-01","NDC","","","facility","both","1","EA","","180","180","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","50242-137-01","NDC","","","facility","both","1","EA","","11.59","11.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","50242-137-01","NDC","","","facility","both","1","EA","","11.59","11.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","50242-137-01","NDC","","","facility","both","1","EA","","11.62","11.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-137-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","50242-137-01","NDC","","","facility","both","1","EA","","11.65","11.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-136-01","NDC","","","facility","both","1","EA","","11.58","11.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-136-01","NDC","","","facility","both","1","EA","","11.59","11.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-136-01","NDC","","","facility","both","1","EA","","11.59","11.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-136-01","NDC","","","facility","both","1","EA","","11.59","11.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","50242-136-01","NDC","","","facility","both","1","EA","","11.64","11.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-135-01)  / 4 Ml In 1 Vial, Single-Use","636","RC","50242-135-01","NDC","","","facility","both","1","EA","","11.56","11.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-135-01)  / 4 Ml In 1 Vial, Single-Use","636","RC","50242-135-01","NDC","","","facility","both","1","EA","","11.57","11.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-135-01)  / 4 Ml In 1 Vial, Single-Use","636","RC","50242-135-01","NDC","","","facility","both","1","EA","","11.59","11.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-135-01)  / 4 Ml In 1 Vial, Single-Use","636","RC","50242-135-01","NDC","","","facility","both","1","EA","","11.61","11.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actemra: 1 Vial, Single-Use In 1 Box (50242-135-01)  / 4 Ml In 1 Vial, Single-Use","636","RC","50242-135-01","NDC","","","facility","both","1","EA","","11.71","11.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Herceptin: 1 Vial, Single-Dose In 1 Carton (50242-132-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","50242-132-01","NDC","","","facility","both","1","EA","","157.58","157.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Herceptin: 1 Vial, Single-Dose In 1 Carton (50242-132-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","50242-132-01","NDC","","","facility","both","1","EA","","158.17","158.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Herceptin: 1 Vial, Single-Dose In 1 Carton (50242-132-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","50242-132-01","NDC","","","facility","both","1","EA","","158.96","158.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Herceptin: 1 Vial, Single-Dose In 1 Carton (50242-132-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","50242-132-01","NDC","","","facility","both","1","EA","","159.97","159.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Beyfortus: 5 Syringe In 1 Carton (49281-575-15)  / .5 Ml In 1 Syringe","636","RC","49281-575-15","NDC","","","facility","both","1","EA","","951.59","951.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Beyfortus: 1 Syringe In 1 Carton (49281-575-00)  / .5 Ml In 1 Syringe","636","RC","49281-575-00","NDC","","","facility","both","1","EA","","948.91","948.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Beyfortus: 1 Syringe In 1 Carton (49281-574-88)  / 1 Ml In 1 Syringe","636","RC","49281-574-88","NDC","","","facility","both","1","EA","","936.39","936.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49281-423-88","NDC","","","facility","both","1","EA","","34.82","34.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49281-422-88","NDC","","","facility","both","1","EA","","29.37","29.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49281-286-58","NDC","","","facility","both","1","EA","","50.75","50.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49281-215-88","NDC","","","facility","both","1","EA","","64.87","64.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49281-215-88","NDC","","","facility","both","1","EA","","68.69","68.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49281-125-88","NDC","","","facility","both","1","EA","","93.19","93.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluzone High Dose Northern Hemisphere: 5 Syringe, Glass In 1 Package (49281-125-65)  / .5 Ml In 1 Syringe, Glass (49281-125-88)","636","RC","49281-125-65","NDC","","","facility","both","1","EA","","93.19","93.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49281-124-88","NDC","","","facility","both","1","EA","","119.04","119.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49281-124-88","NDC","","","facility","both","1","EA","","122.63","122.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluzone High Dose Northern Hemisphere: 5 Syringe, Glass In 1 Package (49281-124-65)  / .5 Ml In 1 Syringe, Glass (49281-124-88)","636","RC","49281-124-65","NDC","","","facility","both","1","EA","","119.04","119.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinvanti: 1 Vial, Glass In 1 Carton (47426-201-01)  / 18 Ml In 1 Vial, Glass","636","RC","47426-201-01","NDC","","","facility","both","1","EA","","2.86","2.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinvanti: 1 Vial, Glass In 1 Carton (47426-201-01)  / 18 Ml In 1 Vial, Glass","636","RC","47426-201-01","NDC","","","facility","both","1","EA","","2.94","2.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 1 Bag In 1 Pouch (47335-993-01)  / 100 Ml In 1 Bag","636","RC","47335-993-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 1 Bag In 1 Pouch (47335-993-01)  / 100 Ml In 1 Bag","636","RC","47335-993-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 24 Pouch In 1 Case (47335-992-02)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","47335-992-02","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 24 Pouch In 1 Case (47335-992-01)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag","636","RC","47335-992-01","NDC","","","facility","both","1","EA","","4.92","4.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leuprolide Acetate: 1 Kit In 1 Carton (47335-936-40)  *  1 Vial, Multi-Dose In 1 Carton / 2.8 Ml In 1 Vial, Multi-Dose *  1 Ml In 1 Packet","636","RC","47335-936-40","NDC","","","facility","both","1","EA","","41.83","41.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","47335-931-40","NDC","","","facility","both","1","EA","","27.36","27.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","47335-930-60","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Temozolomide: 5 Blister Pack In 1 Carton (47335-893-74)  / 1 Capsule In 1 Blister Pack","636","RC","47335-893-74","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","47335-893-60","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Temozolomide: 15 Blister Pack In 1 Carton (47335-892-72)  / 1 Capsule In 1 Blister Pack","636","RC","47335-892-72","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","47335-892-60","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Temozolomide: 15 Blister Pack In 1 Carton (47335-891-72)  / 1 Capsule In 1 Blister Pack","636","RC","47335-891-72","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","47335-891-60","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","47335-932-40","NDC","","","facility","both","1","EA","","94.06","94.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","47781-355-11","NDC","","","facility","both","1","EA","","3.01","3.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Menquadfi: 10 Vial, Single-Dose In 1 Carton (49281-590-10)  / .5 Ml In 1 Vial, Single-Dose (49281-590-58)","636","RC","49281-590-10","NDC","","","facility","both","1","EA","","269.97","269.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49281-590-58","NDC","","","facility","both","1","EA","","271.33","271.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytogam: 1 Vial, Glass In 1 Carton (49591-532-51)  / 50 Ml In 1 Vial, Glass (49591-532-50)","636","RC","49591-532-51","NDC","","","facility","both","1","EA","","1556.32","1556.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytogam: 1 Vial, Glass In 1 Carton (49591-532-51)  / 50 Ml In 1 Vial, Glass (49591-532-50)","636","RC","49591-532-51","NDC","","","facility","both","1","EA","","2383.12","2383.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Varizig: 1 Vial, Glass In 1 Carton (49591-126-51)  / 1.2 Ml In 1 Vial, Glass (49591-126-11)","636","RC","49591-126-51","NDC","","","facility","both","1","EA","","3858.74","3858.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49591-126-11","NDC","","","facility","both","1","EA","","4010.95","4010.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hepagam B: 1 Vial, Glass In 1 Carton (49591-052-51)  / 1 Ml In 1 Vial, Glass (49591-052-11)","636","RC","49591-052-51","NDC","","","facility","both","1","EA","","106.5","106.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49591-052-11","NDC","","","facility","both","1","EA","","106.5","106.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hepagam B: 1 Vial, Glass In 1 Carton (49591-051-51)  / 5 Ml In 1 Vial, Glass (49591-051-05)","636","RC","49591-051-51","NDC","","","facility","both","1","EA","","95.42","95.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 2 Container In 1 Carton (49502-102-02)  / 1 Syringe, Glass In 1 Container (49502-102-01)  / .3 Ml In 1 Syringe, Glass","636","RC","49502-102-02","NDC","","","facility","both","1","EA","","78.84","78.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49591-052-11","NDC","","","facility","both","1","EA","","106.5","106.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49702-213-01","NDC","","","facility","both","1","EA","","2.42","2.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Apretude: 1 Kit In 1 Carton (49702-264-23)  *  3 Ml In 1 Vial (49702-238-03)","636","RC","49702-264-23","NDC","","","facility","both","1","EA","","12.12","12.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabenuva: 1 Kit In 1 Carton (49702-253-15)  *  2 Ml In 1 Vial (49702-245-01)  *  2 Ml In 1 Vial (49702-249-02)","636","RC","49702-253-15","NDC","","","facility","both","1","EA","","40.05","40.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabenuva: 1 Kit In 1 Carton (49702-253-15)  *  2 Ml In 1 Vial (49702-245-01)  *  2 Ml In 1 Vial (49702-249-02)","636","RC","49702-253-15","NDC","","","facility","both","1","EA","","40.07","40.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabenuva: 1 Kit In 1 Carton (49702-253-15)  *  2 Ml In 1 Vial (49702-245-01)  *  2 Ml In 1 Vial (49702-249-02)","636","RC","49702-253-15","NDC","","","facility","both","1","EA","","41.1","41.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabenuva: 1 Kit In 1 Carton (49702-253-15)  *  2 Ml In 1 Vial (49702-245-01)  *  2 Ml In 1 Vial (49702-249-02)","636","RC","49702-253-15","NDC","","","facility","both","1","EA","","41.2","41.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabenuva: 1 Kit In 1 Carton (49702-240-15)  *  3 Ml In 1 Vial (49702-238-01)  *  3 Ml In 1 Vial (49702-243-02)","636","RC","49702-240-15","NDC","","","facility","both","1","EA","","59.83","59.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabenuva: 1 Kit In 1 Carton (49702-240-15)  *  3 Ml In 1 Vial (49702-238-01)  *  3 Ml In 1 Vial (49702-243-02)","636","RC","49702-240-15","NDC","","","facility","both","1","EA","","60.07","60.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabenuva: 1 Kit In 1 Carton (49702-240-15)  *  3 Ml In 1 Vial (49702-238-01)  *  3 Ml In 1 Vial (49702-243-02)","636","RC","49702-240-15","NDC","","","facility","both","1","EA","","60.73","60.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabenuva: 1 Kit In 1 Carton (49702-240-15)  *  3 Ml In 1 Vial (49702-238-01)  *  3 Ml In 1 Vial (49702-243-02)","636","RC","49702-240-15","NDC","","","facility","both","1","EA","","61.3","61.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retrovir: 5 Vial, Single-Use In 1 Carton (49702-213-26)  / 20 Ml In 1 Vial, Single-Use (49702-213-01)","636","RC","49702-213-26","NDC","","","facility","both","1","EA","","2.42","2.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49502-102-01","NDC","","","facility","both","1","EA","","78.84","78.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 2 Container In 1 Carton (49502-101-02)  / 1 Syringe, Glass In 1 Container (49502-101-01)  / .3 Ml In 1 Syringe, Glass","636","RC","49502-101-02","NDC","","","facility","both","1","EA","","118.26","118.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Allergy Relief: 1 BOTTLE in 1 CARTON (49348-045-34)  / 118 mL in 1 BOTTLE","636","RC","49348-045-34","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49281-860-78","NDC","","","facility","both","1","EA","","74.36","74.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipol: 1 Vial, Multi-Dose In 1 Package (49281-860-10)  / 5 Ml In 1 Vial, Multi-Dose (49281-860-78)","636","RC","49281-860-10","NDC","","","facility","both","1","EA","","75.14","75.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","49502-101-01","NDC","","","facility","both","1","EA","","118.26","118.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benlysta: 1 Vial In 1 Carton (49401-102-01)  / 5 Ml In 1 Vial","636","RC","49401-102-01","NDC","","","facility","both","1","EA","","92.9","92.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benlysta: 1 Vial In 1 Carton (49401-102-01)  / 5 Ml In 1 Vial","636","RC","49401-102-01","NDC","","","facility","both","1","EA","","93.26","93.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benlysta: 1 Vial In 1 Carton (49401-102-01)  / 5 Ml In 1 Vial","636","RC","49401-102-01","NDC","","","facility","both","1","EA","","95.56","95.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benlysta: 1 Vial In 1 Carton (49401-102-01)  / 5 Ml In 1 Vial","636","RC","49401-102-01","NDC","","","facility","both","1","EA","","95.67","95.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benlysta: 1 Vial In 1 Carton (49401-102-01)  / 5 Ml In 1 Vial","636","RC","49401-102-01","NDC","","","facility","both","1","EA","","96.54","96.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benlysta: 1 Vial In 1 Carton (49401-102-01)  / 5 Ml In 1 Vial","636","RC","49401-102-01","NDC","","","facility","both","1","EA","","100","100","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benlysta: 1 Vial In 1 Carton (49401-101-01)  / 1.5 Ml In 1 Vial","636","RC","49401-101-01","NDC","","","facility","both","1","EA","","91.87","91.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benlysta: 1 Vial In 1 Carton (49401-101-01)  / 1.5 Ml In 1 Vial","636","RC","49401-101-01","NDC","","","facility","both","1","EA","","92.34","92.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benlysta: 1 Vial In 1 Carton (49401-101-01)  / 1.5 Ml In 1 Vial","636","RC","49401-101-01","NDC","","","facility","both","1","EA","","94.48","94.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benlysta: 1 Vial In 1 Carton (49401-101-01)  / 1.5 Ml In 1 Vial","636","RC","49401-101-01","NDC","","","facility","both","1","EA","","96.48","96.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benlysta: 1 Vial In 1 Carton (49401-101-01)  / 1.5 Ml In 1 Vial","636","RC","49401-101-01","NDC","","","facility","both","1","EA","","103.59","103.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allergy Relief: 1 BOTTLE in 1 BOX (49348-983-10)  / 100 TABLET in 1 BOTTLE","636","RC","49348-983-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nexterone: 200 Ml In 1 Bag (43066-360-20)","636","RC","43066-360-20","NDC","","","facility","both","1","EA","","3.55","3.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"zoledronic acid: 1 VIAL in 1 CARTON (25021-801-66)  / 5 mL in 1 VIAL","636","RC","25021-801-66","NDC","","","facility","both","1","EA","","20","20","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 10 Vial In 1 Carton (25021-798-10)  / 10 Ml In 1 Vial","636","RC","25021-798-10","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 25 Vial In 1 Carton (25021-798-02)  / 2 Ml In 1 Vial","636","RC","25021-798-02","NDC","","","facility","both","1","EA","","2.67","2.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide: 10 Vial, Glass In 1 Carton (25021-791-20)  / 20 Ml In 1 Vial, Glass","636","RC","25021-791-20","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide: 10 Vial, Glass In 1 Carton (25021-791-20)  / 20 Ml In 1 Vial, Glass","636","RC","25021-791-20","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Edisylate: 10 Vial In 1 Carton (25021-790-02)  / 2 Ml In 1 Vial","636","RC","25021-790-02","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"zoledronic acid: 1 VIAL in 1 CARTON (25021-801-66)  / 5 mL in 1 VIAL","636","RC","25021-801-66","NDC","","","facility","both","1","EA","","19.43","19.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 10 Vial In 1 Carton (25021-751-10)  / 10 Ml In 1 Vial","636","RC","25021-751-10","NDC","","","facility","both","1","EA","","2.44","2.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (25021-701-01)  / 1 Ml In 1 Vial","636","RC","25021-701-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (25021-701-01)  / 1 Ml In 1 Vial","636","RC","25021-701-01","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (25021-700-01)  / 1 Ml In 1 Vial","636","RC","25021-700-01","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (25021-700-01)  / 1 Ml In 1 Vial","636","RC","25021-700-01","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam In Sodium Chloride: 20 Bag In 1 Carton (25021-688-87)  / 100 Ml In 1 Bag","636","RC","25021-688-87","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 25 Vial In 1 Carton (25021-777-02)  / 2 Ml In 1 Vial","636","RC","25021-777-02","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Soliris: 1 Vial In 1 Carton (25682-001-01)  / 30 Ml In 1 Vial","636","RC","25682-001-01","NDC","","","facility","both","1","EA","","73.72","73.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Soliris: 1 Vial In 1 Carton (25682-001-01)  / 30 Ml In 1 Vial","636","RC","25682-001-01","NDC","","","facility","both","1","EA","","100.26","100.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Soliris: 1 Vial In 1 Carton (25682-001-01)  / 30 Ml In 1 Vial","636","RC","25682-001-01","NDC","","","facility","both","1","EA","","284.1","284.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Soliris: 1 Vial In 1 Carton (25682-001-01)  / 30 Ml In 1 Vial","636","RC","25682-001-01","NDC","","","facility","both","1","EA","","306.32","306.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Soliris: 1 Vial In 1 Carton (25682-001-01)  / 30 Ml In 1 Vial","636","RC","25682-001-01","NDC","","","facility","both","1","EA","","306.32","306.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Decanoate: 1 Vial In 1 Carton (25021-838-05)  / 5 Ml In 1 Vial","636","RC","25021-838-05","NDC","","","facility","both","1","EA","","37.04","37.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoledronic Acid: 1 Bag In 1 Carton (25021-830-82)  / 100 Ml In 1 Bag","636","RC","25021-830-82","NDC","","","facility","both","1","EA","","12.46","12.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fomepizole: 1 Vial In 1 Carton (25021-829-02)  / 1.5 Ml In 1 Vial","636","RC","25021-829-02","NDC","","","facility","both","1","EA","","7.92","7.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 10 Vial In 1 Carton (25021-806-01)  / 1 Ml In 1 Vial","636","RC","25021-806-01","NDC","","","facility","both","1","EA","","6.47","6.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoledronic Acid: 1 Bag In 1 Carton (25021-826-82)  / 100 Ml In 1 Bag","636","RC","25021-826-82","NDC","","","facility","both","1","EA","","10.35","10.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial In 1 Carton (25021-816-30)  / 17.5 Ml In 1 Vial","636","RC","25021-816-30","NDC","","","facility","both","1","EA","","3.02","3.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial In 1 Carton (25021-816-30)  / 17.5 Ml In 1 Vial","636","RC","25021-816-30","NDC","","","facility","both","1","EA","","4.61","4.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial In 1 Carton (25021-815-30)  / 20 Ml In 1 Vial","636","RC","25021-815-30","NDC","","","facility","both","1","EA","","5.81","5.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial In 1 Carton (25021-815-30)  / 20 Ml In 1 Vial","636","RC","25021-815-30","NDC","","","facility","both","1","EA","","5.81","5.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial In 1 Carton (25021-814-30)  / 10 Ml In 1 Vial","636","RC","25021-814-30","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial In 1 Carton (25021-814-30)  / 10 Ml In 1 Vial","636","RC","25021-814-30","NDC","","","facility","both","1","EA","","3.48","3.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 4 Vial In 1 Carton (25021-812-30)  / 30 Ml In 1 Vial","636","RC","25021-812-30","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 4 Vial In 1 Carton (25021-812-30)  / 30 Ml In 1 Vial","636","RC","25021-812-30","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoledronic Acid: 1 Bag In 1 Carton (25021-826-82)  / 100 Ml In 1 Bag","636","RC","25021-826-82","NDC","","","facility","both","1","EA","","10.35","10.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vecuronium Bromide: 10 Vial In 1 Carton (25021-686-20)  / 20 Ml In 1 Vial","636","RC","25021-686-20","NDC","","","facility","both","1","EA","","45.87","45.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vecuronium Bromide: 10 Vial In 1 Carton (25021-685-10)  / 10 Ml In 1 Vial","636","RC","25021-685-10","NDC","","","facility","both","1","EA","","4.15","4.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial In 1 Carton (25021-321-10)  / 10 Ml In 1 Vial","636","RC","25021-321-10","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial In 1 Carton (25021-321-10)  / 10 Ml In 1 Vial","636","RC","25021-321-10","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial In 1 Carton (25021-321-04)  / 4 Ml In 1 Vial","636","RC","25021-321-04","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial In 1 Carton (25021-321-04)  / 4 Ml In 1 Vial","636","RC","25021-321-04","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Carton (25021-320-04)  / 4 Ml In 1 Vial","636","RC","25021-320-04","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Carton (25021-320-04)  / 4 Ml In 1 Vial","636","RC","25021-320-04","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Carton (25021-320-04)  / 4 Ml In 1 Vial","636","RC","25021-320-04","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial In 1 Carton (25021-321-10)  / 10 Ml In 1 Vial","636","RC","25021-321-10","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adenosine: 10 Vial In 1 Carton (25021-318-02)  / 2 Ml In 1 Vial","636","RC","25021-318-02","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milrinone Lactate In Dextrose: 10 Bag In 1 Carton (25021-313-82)  / 100 Ml In 1 Bag","636","RC","25021-313-82","NDC","","","facility","both","1","EA","","3.11","3.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Carton (25021-311-02)  / 2 Ml In 1 Vial","636","RC","25021-311-02","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Carton (25021-311-02)  / 2 Ml In 1 Vial","636","RC","25021-311-02","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esmolol Hydrochloride: 10 Bag In 1 Carton (25021-308-84)  / 250 Ml In 1 Bag","636","RC","25021-308-84","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide Sodium: 1 Vial In 1 Carton (25021-305-20)  / 18 Ml In 1 Vial","636","RC","25021-305-20","NDC","","","facility","both","1","EA","","16.47","16.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide Sodium: 1 Vial In 1 Carton (25021-305-20)  / 18 Ml In 1 Vial","636","RC","25021-305-20","NDC","","","facility","both","1","EA","","50.68","50.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Carton (25021-401-02)  / 2 Ml In 1 Vial","636","RC","25021-401-02","NDC","","","facility","both","1","EA","","4.43","4.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Carton (25021-402-01)  / 1 Ml In 1 Vial","636","RC","25021-402-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pentobarbital Sodium: 1 Vial In 1 Carton (25021-676-50)  / 50 Ml In 1 Vial","636","RC","25021-676-50","NDC","","","facility","both","1","EA","","34.69","34.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pentobarbital Sodium: 1 Vial In 1 Carton (25021-676-20)  / 20 Ml In 1 Vial","636","RC","25021-676-20","NDC","","","facility","both","1","EA","","59.34","59.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 10 Bag In 1 Carton (25021-612-81)  / 50 Ml In 1 Bag","636","RC","25021-612-81","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Caffeine Citrate: 1 Vial In 1 Carton (25021-601-03)  / 3 Ml In 1 Vial","636","RC","25021-601-03","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Caffeine Citrate: 1 Vial In 1 Carton (25021-601-03)  / 3 Ml In 1 Vial","636","RC","25021-601-03","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyanocobalamin: 25 Vial In 1 Carton (25021-502-01)  / 1 Ml In 1 Vial","636","RC","25021-502-01","NDC","","","facility","both","1","EA","","3.99","3.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiamine Hydrochloride: 25 Vial In 1 Carton (25021-500-02)  / 2 Ml In 1 Vial","636","RC","25021-500-02","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulvestrant: 2 Syringe In 1 Carton (25021-471-74)  / 5 Ml In 1 Syringe","636","RC","25021-471-74","NDC","","","facility","both","1","EA","","8.96","8.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulvestrant: 2 Syringe In 1 Carton (25021-471-74)  / 5 Ml In 1 Syringe","636","RC","25021-471-74","NDC","","","facility","both","1","EA","","8.96","8.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 10 Vial In 1 Carton (25021-460-01)  / 1 Ml In 1 Vial","636","RC","25021-460-01","NDC","","","facility","both","1","EA","","20.98","20.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (25021-410-78)  / .8 Ml In 1 Syringe","636","RC","25021-410-78","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Soliris: 1 Vial In 1 Carton (25682-001-01)  / 30 Ml In 1 Vial","636","RC","25682-001-01","NDC","","","facility","both","1","EA","","62.47","62.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultomiris: 1 Vial, Glass In 1 Carton (25682-025-01)  / 3 Ml In 1 Vial, Glass","636","RC","25682-025-01","NDC","","","facility","both","1","EA","","38.42","38.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultomiris: 1 Vial, Glass In 1 Carton (25682-028-01)  / 11 Ml In 1 Vial, Glass","636","RC","25682-028-01","NDC","","","facility","both","1","EA","","391.93","391.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 2 Blister Pack In 1 Carton (31722-040-31)  / 6 Suppository In 1 Blister Pack","636","RC","31722-040-31","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Tartrate: 10 Vial In 1 Carton (25021-303-05)  / 5 Ml In 1 Vial","636","RC","25021-303-05","NDC","","","facility","both","1","EA","","4.74","4.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultomiris: 1 Vial, Glass In 1 Carton (25682-028-01)  / 11 Ml In 1 Vial, Glass","636","RC","25682-028-01","NDC","","","facility","both","1","EA","","173.43","173.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultomiris: 1 Vial, Glass In 1 Carton (25682-028-01)  / 11 Ml In 1 Vial, Glass","636","RC","25682-028-01","NDC","","","facility","both","1","EA","","191.13","191.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultomiris: 1 Vial, Glass In 1 Carton (25682-028-01)  / 11 Ml In 1 Vial, Glass","636","RC","25682-028-01","NDC","","","facility","both","1","EA","","238.98","238.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultomiris: 1 Vial, Glass In 1 Carton (25682-028-01)  / 11 Ml In 1 Vial, Glass","636","RC","25682-028-01","NDC","","","facility","both","1","EA","","242.36","242.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 1 Vial In 1 Carton (31722-308-01)  / 2 Ml In 1 Vial","636","RC","31722-308-01","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Carton (25021-251-50)  / 40 Ml In 1 Vial","636","RC","25021-251-50","NDC","","","facility","both","1","EA","","19.83","19.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabergoline: 8 Tablet In 1 Bottle (23155-823-73)","636","RC","23155-823-73","NDC","","","facility","both","1","EA","","1.69","1.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foscarnet Sodium: 1 Bottle, Glass In 1 Carton (23155-771-31)  / 250 Ml In 1 Bottle, Glass","636","RC","23155-771-31","NDC","","","facility","both","1","EA","","49.37","49.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foscarnet Sodium: 1 Bottle, Glass In 1 Carton (23155-771-31)  / 250 Ml In 1 Bottle, Glass","636","RC","23155-771-31","NDC","","","facility","both","1","EA","","51.11","51.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-689-31","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-688-31","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-687-31","NDC","","","facility","both","1","EA","","2.37","2.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-687-31","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-687-31","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 1 Bottle, Plastic In 1 Carton (23155-848-51)  / 225 Ml In 1 Bottle, Plastic","636","RC","23155-848-51","NDC","","","facility","both","1","EA","","3.07","3.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (24201-400-02)  / 2 Ml In 1 Vial, Multi-Dose","636","RC","24201-400-02","NDC","","","facility","both","1","EA","","717.28","717.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 24 Vial, Glass In 1 Carton (24201-100-24)  / 100 Ml In 1 Vial, Glass","636","RC","24201-100-24","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-839-11","NDC","","","facility","both","1","EA","","2.76","2.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","24201-100-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pentobarbital Sodium: 1 Vial In 1 Carton (24201-010-50)  / 50 Ml In 1 Vial","636","RC","24201-010-50","NDC","","","facility","both","1","EA","","33.34","33.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pentobarbital Sodium: 1 Vial In 1 Carton (24201-010-20)  / 20 Ml In 1 Vial","636","RC","24201-010-20","NDC","","","facility","both","1","EA","","54.98","54.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carmustine: 1 Kit In 1 Carton (23155-649-41)  *  3 Ml In 1 Vial (23155-648-31)  *  30 Ml In 1 Vial, Single-Dose (23155-647-31)","636","RC","23155-649-41","NDC","","","facility","both","1","EA","","305.74","305.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-647-31","NDC","","","facility","both","1","EA","","298.62","298.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-473-33","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-473-33","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-473-33","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-473-32","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-473-32","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-473-32","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-473-31","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-473-31","NDC","","","facility","both","1","EA","","1.2","1.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 5 Ml In 1 Vial, Glass (23155-313-31)","636","RC","23155-313-31","NDC","","","facility","both","1","EA","","19.97","19.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-294-31","NDC","","","facility","both","1","EA","","3.67","3.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-290-32","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-290-31","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-601-32","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-600-31","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (23155-594-31)  / 1 Injectable, Liposomal In 1 Vial, Single-Dose","636","RC","23155-594-31","NDC","","","facility","both","1","EA","","27.82","27.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (23155-594-31)  / 1 Injectable, Liposomal In 1 Vial, Single-Dose","636","RC","23155-594-31","NDC","","","facility","both","1","EA","","29.38","29.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 1 Vial In 1 Carton (23155-549-31)  / 20 Ml In 1 Vial","636","RC","23155-549-31","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 25 Vial In 1 Carton (23155-548-42)  / 2 Ml In 1 Vial (23155-548-31)","636","RC","23155-548-42","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 25 Vial In 1 Carton (23155-547-42)  / 2 Ml In 1 Vial (23155-547-31)","636","RC","23155-547-42","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","23155-547-31","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retisert: 1 Pouch In 1 Carton (24208-416-01)  / 1 Implant In 1 Pouch","636","RC","24208-416-01","NDC","","","facility","both","1","EA","","458.05","458.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retisert: 1 Pouch In 1 Carton (24208-416-01)  / 1 Implant In 1 Pouch","636","RC","24208-416-01","NDC","","","facility","both","1","EA","","458.05","458.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vinorelbine: 1 Vial In 1 Carton (25021-204-05)  / 5 Ml In 1 Vial","636","RC","25021-204-05","NDC","","","facility","both","1","EA","","10.26","10.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ertapenem: 10 Vial In 1 Carton (25021-199-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","25021-199-20","NDC","","","facility","both","1","EA","","13.81","13.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 24 Pouch In 1 Carton (25021-192-87)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag","636","RC","25021-192-87","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 24 Pouch In 1 Carton (25021-192-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","25021-192-82","NDC","","","facility","both","1","EA","","3.78","3.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial In 1 Carton (25021-191-10)  / 5 Ml In 1 Vial","636","RC","25021-191-10","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial In 1 Carton (25021-190-10)  / 5 Ml In 1 Vial","636","RC","25021-190-10","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vinorelbine: 1 Vial In 1 Carton (25021-204-05)  / 5 Ml In 1 Vial","636","RC","25021-204-05","NDC","","","facility","both","1","EA","","9.57","9.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foscarnet Sodium: 10 Bag In 1 Carton (25021-189-84)  / 250 Ml In 1 Bag","636","RC","25021-189-84","NDC","","","facility","both","1","EA","","62.29","62.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 10 Pouch In 1 Carton (25021-184-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","25021-184-82","NDC","","","facility","both","1","EA","","4.46","4.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 10 Pouch In 1 Carton (25021-184-67)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag","636","RC","25021-184-67","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 10 Pouch In 1 Carton (25021-184-66)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","25021-184-66","NDC","","","facility","both","1","EA","","3.33","3.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amikacin Sulfate: 10 Vial In 1 Carton (25021-173-02)  / 2 Ml In 1 Vial","636","RC","25021-173-02","NDC","","","facility","both","1","EA","","2.52","2.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxacillin: 10 Vial In 1 Carton (25021-162-24)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","25021-162-24","NDC","","","facility","both","1","EA","","1.87","1.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin: 1 Bottle In 1 Carton (25021-158-99)  / 100 Ml In 1 Bottle","636","RC","25021-158-99","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 10 Pouch In 1 Carton (25021-184-87)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag","636","RC","25021-184-87","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vinorelbine: 1 Vial In 1 Carton (25021-204-05)  / 5 Ml In 1 Vial","636","RC","25021-204-05","NDC","","","facility","both","1","EA","","9.46","9.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial In 1 Carton (25021-207-25)  / 25 Ml In 1 Vial","636","RC","25021-207-25","NDC","","","facility","both","1","EA","","2.65","2.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Carton (25021-250-20)  / 10 Ml In 1 Vial","636","RC","25021-250-20","NDC","","","facility","both","1","EA","","92.13","92.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial In 1 Carton (25021-249-51)  / 100 Ml In 1 Vial","636","RC","25021-249-51","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial In 1 Carton (25021-249-51)  / 100 Ml In 1 Vial","636","RC","25021-249-51","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial In 1 Carton (25021-248-51)  / 50 Ml In 1 Vial","636","RC","25021-248-51","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial In 1 Carton (25021-248-51)  / 50 Ml In 1 Vial","636","RC","25021-248-51","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial In 1 Carton (25021-246-02)  / 1.5 Ml In 1 Vial","636","RC","25021-246-02","NDC","","","facility","both","1","EA","","96.71","96.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docetaxel: 1 Vial In 1 Carton (25021-245-04)  / 4 Ml In 1 Vial","636","RC","25021-245-04","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docetaxel: 1 Vial In 1 Carton (25021-245-04)  / 4 Ml In 1 Vial","636","RC","25021-245-04","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docetaxel: 1 Vial In 1 Carton (25021-245-01)  / 1 Ml In 1 Vial","636","RC","25021-245-01","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Busulfan: 8 Vial In 1 Carton (25021-241-10)  / 10 Ml In 1 Vial","636","RC","25021-241-10","NDC","","","facility","both","1","EA","","13.83","13.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irinotecan Hydrochloride: 1 Vial In 1 Carton (25021-230-05)  / 5 Ml In 1 Vial","636","RC","25021-230-05","NDC","","","facility","both","1","EA","","10.18","10.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial In 1 Carton (25021-223-20)  / 20 Ml In 1 Vial","636","RC","25021-223-20","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial In 1 Carton (25021-223-20)  / 20 Ml In 1 Vial","636","RC","25021-223-20","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial In 1 Carton (25021-219-20)  / 20 Ml In 1 Vial","636","RC","25021-219-20","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial In 1 Carton (25021-219-20)  / 20 Ml In 1 Vial","636","RC","25021-219-20","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial In 1 Carton (25021-219-20)  / 20 Ml In 1 Vial","636","RC","25021-219-20","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial In 1 Carton (25021-207-51)  / 100 Ml In 1 Vial","636","RC","25021-207-51","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisplatin: 1 Vial In 1 Carton (25021-253-50)  / 50 Ml In 1 Vial","636","RC","25021-253-50","NDC","","","facility","both","1","EA","","2.46","2.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 1 Bottle In 1 Carton (25021-144-99)  / 100 Ml In 1 Bottle","636","RC","25021-144-99","NDC","","","facility","both","1","EA","","8.16","8.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miochol E: 1 Kit In 1 Blister Pack (24208-539-20)  *  2 Ml In 1 Vial *  2 Ml In 1 Ampule","636","RC","24208-539-20","NDC","","","facility","both","1","EA","","38.53","38.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 24 Pouch In 1 Carton (25021-132-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","25021-132-82","NDC","","","facility","both","1","EA","","6.7","6.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 24 Pouch In 1 Carton (25021-132-81)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag","636","RC","25021-132-81","NDC","","","facility","both","1","EA","","8.9","8.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 24 Pouch In 1 Carton (25021-131-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","25021-131-82","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftazidime: 25 Vial In 1 Carton (25021-127-20)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","25021-127-20","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin: 25 Vial In 1 Carton (25021-115-04)  / 4 Ml In 1 Vial","636","RC","25021-115-04","NDC","","","facility","both","1","EA","","3.17","3.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin: 25 Vial In 1 Carton (25021-115-02)  / 2 Ml In 1 Vial","636","RC","25021-115-02","NDC","","","facility","both","1","EA","","5.27","5.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 24 Pouch In 1 Carton (25021-114-87)  / 1 Bag In 1 Pouch / 200 Ml In 1 Bag","636","RC","25021-114-87","NDC","","","facility","both","1","EA","","2.81","2.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 24 Pouch In 1 Carton (25021-114-82)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","25021-114-82","NDC","","","facility","both","1","EA","","3.78","3.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (25021-052-05)  / 5 Ml In 1 Vial","636","RC","25021-052-05","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolic Acid: 120 Tablet, Delayed Release In 1 Bottle (24979-161-44)","636","RC","24979-161-44","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial In 1 Carton (25021-137-20)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","25021-137-20","NDC","","","facility","both","1","EA","","3.11","3.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 1 Vial In 1 Carton (31722-308-01)  / 2 Ml In 1 Vial","636","RC","31722-308-01","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital Sodium: 25 Vial In 1 Box, Unit-Dose (42494-416-25)  / 1 Ml In 1 Vial","636","RC","42494-416-25","NDC","","","facility","both","1","EA","","45.01","45.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital Sodium: 25 Vial In 1 Box, Unit-Dose (42494-415-25)  / 1 Ml In 1 Vial","636","RC","42494-415-25","NDC","","","facility","both","1","EA","","31.57","31.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","42494-415-01","NDC","","","facility","both","1","EA","","11.51","11.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","42494-416-01","NDC","","","facility","both","1","EA","","31.31","31.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adrenalin (Epinephrine In Sodium Chloride): 10 Bag In 1 Carton (42023-315-10)  / 250 Ml In 1 Bag (42023-315-01)","636","RC","42023-315-10","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","42023-315-01","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasostrict: 10 Vial In 1 Carton (42023-237-10)  / 100 Ml In 1 Vial (42023-237-01)","636","RC","42023-237-10","NDC","","","facility","both","1","EA","","3.64","3.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasostrict: 10 Vial In 1 Carton (42023-237-10)  / 100 Ml In 1 Vial (42023-237-01)","636","RC","42023-237-10","NDC","","","facility","both","1","EA","","3.74","3.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","42023-237-01","NDC","","","facility","both","1","EA","","3.64","3.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","42023-230-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","42023-230-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 1 Syringe, Glass In 1 Carton (42023-224-01)  / 2 Ml In 1 Syringe, Glass","636","RC","42023-224-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (42023-205-01)  / 2 Ml In 1 Vial, Multi-Dose","636","RC","42023-205-01","NDC","","","facility","both","1","EA","","846.49","846.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 1 Vial, Glass In 1 Carton (42023-195-01)  / 16.7 Ml In 1 Vial, Glass","636","RC","42023-195-01","NDC","","","facility","both","1","EA","","262.25","262.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasostrict: 1 Vial In 1 Carton (42023-190-01)  / 10 Ml In 1 Vial","636","RC","42023-190-01","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","42023-237-01","NDC","","","facility","both","1","EA","","3.74","3.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bivalirudin: 1 Vial, Single-Dose In 1 Carton (42023-622-01)  / 1 Injection, Solution In 1 Vial, Single-Dose","636","RC","42023-622-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bivalirudin: 10 Vial, Single-Dose In 1 Carton (42023-622-10)  / 1 Injection, Solution In 1 Vial, Single-Dose","636","RC","42023-622-10","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine: 30 Tablet In 1 Bottle (42858-501-03)","636","RC","42858-501-03","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nexterone: 100 Ml In 1 Bag (43066-150-10)","636","RC","43066-150-10","NDC","","","facility","both","1","EA","","8.28","8.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Edisylate: 25 Vial In 1 Carton (43066-090-25)  / 2 Ml In 1 Vial (43066-090-01)","636","RC","43066-090-25","NDC","","","facility","both","1","EA","","3.17","3.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","43066-090-01","NDC","","","facility","both","1","EA","","3.02","3.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dronabinol: 60 Capsule In 1 Bottle (42858-868-06)","636","RC","42858-868-06","NDC","","","facility","both","1","EA","","2.58","2.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dronabinol: 60 Capsule In 1 Bottle (42858-867-06)","636","RC","42858-867-06","NDC","","","facility","both","1","EA","","3.43","3.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine: 30 Tablet In 1 Bottle (42858-502-03)","636","RC","42858-502-03","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Poteligeo: 1 Vial, Glass In 1 Carton (42747-761-01)  / 5 Ml In 1 Vial, Glass","636","RC","42747-761-01","NDC","","","facility","both","1","EA","","306.78","306.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Poteligeo: 1 Vial, Glass In 1 Carton (42747-761-01)  / 5 Ml In 1 Vial, Glass","636","RC","42747-761-01","NDC","","","facility","both","1","EA","","333.87","333.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Poteligeo: 1 Vial, Glass In 1 Carton (42747-761-01)  / 5 Ml In 1 Vial, Glass","636","RC","42747-761-01","NDC","","","facility","both","1","EA","","334.85","334.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Poteligeo: 1 Vial, Glass In 1 Carton (42747-761-01)  / 5 Ml In 1 Vial, Glass","636","RC","42747-761-01","NDC","","","facility","both","1","EA","","335.15","335.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Poteligeo: 1 Vial, Glass In 1 Carton (42747-761-01)  / 5 Ml In 1 Vial, Glass","636","RC","42747-761-01","NDC","","","facility","both","1","EA","","419.91","419.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Poteligeo: 1 Vial, Glass In 1 Carton (42747-761-01)  / 5 Ml In 1 Vial, Glass","636","RC","42747-761-01","NDC","","","facility","both","1","EA","","441.8","441.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daunorubicin Hydrochloride: 10 Vial In 1 Carton (42658-021-02)  / 4 Ml In 1 Vial","636","RC","42658-021-02","NDC","","","facility","both","1","EA","","23.73","23.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daunorubicin Hydrochloride: 1 Vial In 1 Box (42658-021-01)  / 4 Ml In 1 Vial","636","RC","42658-021-01","NDC","","","facility","both","1","EA","","39.46","39.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daunorubicin Hydrochloride: 1 Vial In 1 Box (42658-021-01)  / 4 Ml In 1 Vial","636","RC","42658-021-01","NDC","","","facility","both","1","EA","","66.69","66.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cladribine: 1 Ml In 1 Vial, Single-Dose (42658-010-01)","636","RC","42658-010-01","NDC","","","facility","both","1","EA","","14.22","14.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cladribine: 1 Ml In 1 Vial, Single-Dose (42658-010-01)","636","RC","42658-010-01","NDC","","","facility","both","1","EA","","14.81","14.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dactinomycin: 1 Vial In 1 Carton (42658-008-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","42658-008-01","NDC","","","facility","both","1","EA","","452.42","452.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daunorubicin Hydrochloride: 1 Vial In 1 Box (42658-021-01)  / 4 Ml In 1 Vial","636","RC","42658-021-01","NDC","","","facility","both","1","EA","","41.41","41.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Ml In 1 Bottle, Plastic (42806-151-34)","636","RC","42806-151-34","NDC","","","facility","both","1","EA","","2.64","2.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisolone Sodium Phosphate: 237 Ml In 1 Bottle, Plastic (42799-815-01)","636","RC","42799-815-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 1 Vial In 1 Carton (31722-308-01)  / 2 Ml In 1 Vial","636","RC","31722-308-01","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","42023-179-01","NDC","","","facility","both","1","EA","","7.03","7.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 1 Bottle In 1 Carton (31722-878-01)  / 100 Capsule In 1 Bottle","636","RC","31722-878-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","36000-063-01","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","31722-394-31","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","31722-316-60","NDC","","","facility","both","1","EA","","6.15","6.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 100 Tablet In 1 Bottle (31722-777-01)","636","RC","31722-777-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 473 Ml In 1 Bottle (31722-681-47)","636","RC","31722-681-47","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 10 AMPULE in 1 BLISTER PACK (36000-092-10)  / 2 mL in 1 AMPULE","636","RC","36000-092-10","NDC","","","facility","both","1","EA","","1.89","1.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","36000-149-01","NDC","","","facility","both","1","EA","","14.71","14.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 1 Vial, Multi-Dose In 1 Carton (36000-242-01)  / 30 Ml In 1 Vial, Multi-Dose","636","RC","36000-242-01","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","39822-3030-1","NDC","","","facility","both","1","EA","","126.13","126.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dactinomycin: 1 Vial, Single-Dose In 1 Carton (39822-2100-2)  / 1 Ml In 1 Vial, Single-Dose (39822-2100-1)","636","RC","39822-2100-2","NDC","","","facility","both","1","EA","","563.77","563.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","39822-2100-1","NDC","","","facility","both","1","EA","","497.44","497.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine: 10 Ml In 1 Vial, Single-Dose (39822-2000-1)","636","RC","39822-2000-1","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folic Acid: 1 Vial, Multi-Dose In 1 Carton (39822-1100-1)  / 10 Ml In 1 Vial, Multi-Dose","636","RC","39822-1100-1","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 10 Ml In 1 Vial (39822-1055-5)","636","RC","39822-1055-5","NDC","","","facility","both","1","EA","","19.02","19.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","39822-1030-1","NDC","","","facility","both","1","EA","","235.09","235.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (39822-0260-1)  / 100 Ml In 1 Vial, Single-Dose","636","RC","39822-0260-1","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (39822-0260-1)  / 100 Ml In 1 Vial, Single-Dose","636","RC","39822-0260-1","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 1 Vial, Glass In 1 Carton (39822-0190-1)  / 5 Ml In 1 Vial, Glass","636","RC","39822-0190-1","NDC","","","facility","both","1","EA","","42.3","42.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 1 Vial, Glass In 1 Carton (39822-0190-1)  / 5 Ml In 1 Vial, Glass","636","RC","39822-0190-1","NDC","","","facility","both","1","EA","","44.51","44.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen Lysine: 3 Vial In 1 Carton (39822-1030-2)  / 2 Ml In 1 Vial (39822-1030-1)","636","RC","39822-1030-2","NDC","","","facility","both","1","EA","","140.18","140.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","39822-5525-2","NDC","","","facility","both","1","EA","","1.24","1.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ganciclovir: 25 Vial, Single-Dose In 1 Carton (42023-173-25)  / 10 Ml In 1 Vial, Single-Dose (42023-173-01)","636","RC","42023-173-25","NDC","","","facility","both","1","EA","","19.67","19.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 4 Vial In 1 Carton (42023-172-04)  / 20 Ml In 1 Vial","636","RC","42023-172-04","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adrenalin: 1 Vial In 1 Carton (42023-168-01)  / 30 Ml In 1 Vial","636","RC","42023-168-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasostrict: 25 Vial In 1 Carton (42023-164-25)  / 1 Ml In 1 Vial (42023-164-01)","636","RC","42023-164-25","NDC","","","facility","both","1","EA","","1.78","1.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","42023-164-01","NDC","","","facility","both","1","EA","","1.6","1.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adrenalin: 25 Vial In 1 Carton (42023-159-25)  / 1 Ml In 1 Vial (42023-159-01)","636","RC","42023-159-25","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","42023-159-01","NDC","","","facility","both","1","EA","","2.29","2.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pitocin: 25 Vial In 1 Tray (42023-116-25)  / 1 Ml In 1 Vial","636","RC","42023-116-25","NDC","","","facility","both","1","EA","","5.98","5.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pitocin: 25 Vial In 1 Carton (42023-116-02)  / 10 Ml In 1 Vial","636","RC","42023-116-02","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","40001-81332","NDC","","","facility","both","1","EA","","112.56","112.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","40001-81332","NDC","","","facility","both","1","EA","","185.97","185.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine Hydrochloride: 5 Vial In 1 Carton (42023-179-05)  / 1 Ml In 1 Vial","636","RC","42023-179-05","NDC","","","facility","both","1","EA","","7.15","7.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","36000-308-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 40 Bag In 1 Carton (36000-306-60)  / 100 Ml In 1 Bag","636","RC","36000-306-60","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose","636","RC","36000-284-25","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose","636","RC","36000-284-25","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-284-25)  / 10 Ml In 1 Vial, Single-Dose","636","RC","36000-284-25","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-283-25)  / 4 Ml In 1 Vial, Single-Dose","636","RC","36000-283-25","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-283-25)  / 4 Ml In 1 Vial, Single-Dose","636","RC","36000-283-25","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-283-25)  / 4 Ml In 1 Vial, Single-Dose","636","RC","36000-283-25","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-282-25)  / 2 Ml In 1 Vial, Single-Dose","636","RC","36000-282-25","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-282-25)  / 2 Ml In 1 Vial, Single-Dose","636","RC","36000-282-25","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Box (36000-282-25)  / 2 Ml In 1 Vial, Single-Dose","636","RC","36000-282-25","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","36000-244-01","NDC","","","facility","both","1","EA","","3.06","3.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 10 Vial, Single-Dose In 1 Carton (36000-308-10)  / 1 Ml In 1 Vial, Single-Dose (36000-308-01)","636","RC","36000-308-10","NDC","","","facility","both","1","EA","","1.24","1.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","36000-310-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","36000-354-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 1 Vial In 1 Carton (36000-324-02)  / 40 Ml In 1 Vial (36000-324-01)","636","RC","36000-324-02","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","36000-324-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 1 Vial In 1 Carton (36000-322-02)  / 20 Ml In 1 Vial (36000-322-01)","636","RC","36000-322-02","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","36000-322-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (36000-310-02)  / 10 Ml In 1 Vial, Multi-Dose (36000-310-01)","636","RC","36000-310-02","NDC","","","facility","both","1","EA","","13.9","13.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisplatin: 1 Vial, Multi-Dose In 1 Carton (0143-9504-01)  / 50 Ml In 1 Vial, Multi-Dose","636","RC","0143-9504-01","NDC","","","facility","both","1","EA","","4.4","4.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 1 Vial In 1 Box, Unit-Dose (0143-9503-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9503-01","NDC","","","facility","both","1","EA","","29.64","29.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9501-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meropenem: 10 Vial In 1 Carton (0143-9431-10)  / 30 Ml In 1 Vial (0143-9431-01)","636","RC","0143-9431-10","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9431-01","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9506-01","NDC","","","facility","both","1","EA","","2.53","2.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9387-01","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9386-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9398-01","NDC","","","facility","both","1","EA","","20.34","20.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (0143-9385-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","0143-9385-01","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daunorubicin Hydrochloride: 10 Vial In 1 Box (0143-9551-10)  / 4 Ml In 1 Vial (0143-9551-01)","636","RC","0143-9551-10","NDC","","","facility","both","1","EA","","43.62","43.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9551-01","NDC","","","facility","both","1","EA","","46.98","46.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9551-01","NDC","","","facility","both","1","EA","","47.89","47.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9551-01","NDC","","","facility","both","1","EA","","89.81","89.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Decanoate: 1 Vial, Multi-Dose In 1 Box (0143-9529-01)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","0143-9529-01","NDC","","","facility","both","1","EA","","15.46","15.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 10 Vial In 1 Carton (0143-9519-10)  / 2 Ml In 1 Vial","636","RC","0143-9519-10","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 10 Vial In 1 Carton (0143-9519-10)  / 2 Ml In 1 Vial","636","RC","0143-9519-10","NDC","","","facility","both","1","EA","","3.06","3.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9519-01","NDC","","","facility","both","1","EA","","1.69","1.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9507-01","NDC","","","facility","both","1","EA","","2.36","2.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9519-01","NDC","","","facility","both","1","EA","","2.14","2.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9514-01","NDC","","","facility","both","1","EA","","6.74","6.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial In 1 Box, Unit-Dose (0143-9512-01)  / 50 Ml In 1 Vial","636","RC","0143-9512-01","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial In 1 Box, Unit-Dose (0143-9511-01)  / 25 Ml In 1 Vial","636","RC","0143-9511-01","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial In 1 Box, Unit-Dose (0143-9510-01)  / 5 Ml In 1 Vial","636","RC","0143-9510-01","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (0143-9385-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","0143-9385-01","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (0143-9385-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","0143-9385-01","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9333-10)  / 30 Ml In 1 Vial, Single-Dose (0143-9333-01)","636","RC","0143-9333-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9333-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9331-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9330-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9315-01","NDC","","","facility","both","1","EA","","1.72","1.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial In 1 Box, Unit-Dose (0143-9292-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9292-01","NDC","","","facility","both","1","EA","","4.4","4.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial In 1 Box, Unit-Dose (0143-9292-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9292-01","NDC","","","facility","both","1","EA","","16.69","16.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Estradiol Valerate: 1 Vial In 1 Carton (0143-9291-01)  / 5 Ml In 1 Vial","636","RC","0143-9291-01","NDC","","","facility","both","1","EA","","10.23","10.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9284-01","NDC","","","facility","both","1","EA","","9.6","9.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Box, Unit-Dose (0143-9280-01)  / 80 Ml In 1 Vial","636","RC","0143-9280-01","NDC","","","facility","both","1","EA","","24.35","24.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Box, Unit-Dose (0143-9280-01)  / 80 Ml In 1 Vial","636","RC","0143-9280-01","NDC","","","facility","both","1","EA","","26.84","26.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9334-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9334-10)  / 30 Ml In 1 Vial, Single-Dose (0143-9334-01)","636","RC","0143-9334-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9384-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0143-9384-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosaprepitant Dimeglumine: 1 Vial, Single-Dose In 1 Carton (0143-9384-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0143-9384-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime Hydrochloride: 10 Vial In 1 Carton (0143-9383-10)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","0143-9383-10","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9383-01","NDC","","","facility","both","1","EA","","1.54","1.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9380-01","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial In 1 Carton (0143-9362-01)  / 5 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9362-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial In 1 Carton (0143-9361-01)  / 5 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9361-01","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Succinylcholine Chloride: 25 Vial In 1 Carton (0143-9338-25)  / 10 Ml In 1 Vial","636","RC","0143-9338-25","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9338-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9335-10)  / 30 Ml In 1 Vial, Single-Dose (0143-9335-01)","636","RC","0143-9335-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9335-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9335-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0143-9334-10)  / 30 Ml In 1 Vial, Single-Dose (0143-9334-01)","636","RC","0143-9334-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial In 1 Box, Unit-Dose (0143-9553-01)  / 20 Ml In 1 Vial","636","RC","0143-9553-01","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Box, Unit-Dose (0143-9280-01)  / 80 Ml In 1 Vial","636","RC","0143-9280-01","NDC","","","facility","both","1","EA","","27.18","27.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phentolamine Mesylate: 1 Vial In 1 Box (0143-9564-01)  / 1 Ml In 1 Vial","636","RC","0143-9564-01","NDC","","","facility","both","1","EA","","766.09","766.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Injection, Powder, For Solution In 1 Vial, Multi-Dose (0143-9851-01)","636","RC","0143-9851-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Injection, Powder, For Solution In 1 Vial, Multi-Dose (0143-9850-01)","636","RC","0143-9850-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Injection, Powder, For Solution In 1 Vial, Multi-Dose (0143-9850-01)","636","RC","0143-9850-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9787-01","NDC","","","facility","both","1","EA","","5.3","5.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9786-01","NDC","","","facility","both","1","EA","","13.88","13.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flumazenil: 10 Vial, Multi-Dose In 1 Box (0143-9784-10)  / 5 Ml In 1 Vial, Multi-Dose (0143-9784-01)","636","RC","0143-9784-10","NDC","","","facility","both","1","EA","","891","891","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9783-01","NDC","","","facility","both","1","EA","","10.69","10.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Testosterone Enanthate: 5 Ml In 1 Vial, Multi-Dose (0143-9750-01)","636","RC","0143-9750-01","NDC","","","facility","both","1","EA","","9.43","9.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Terbutaline Sulfate: 10 Vial In 1 Carton (0143-9746-10)  / 1 Ml In 1 Vial (0143-9746-01)","636","RC","0143-9746-10","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9746-01","NDC","","","facility","both","1","EA","","1.72","1.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9744-01","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 5 Ampule In 1 Carton (0143-9729-05)  / 2 Ml In 1 Ampule (0143-9729-01)","636","RC","0143-9729-05","NDC","","","facility","both","1","EA","","20.75","20.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 5 Ampule In 1 Carton (0143-9729-05)  / 2 Ml In 1 Ampule (0143-9729-01)","636","RC","0143-9729-05","NDC","","","facility","both","1","EA","","20.75","20.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9784-01","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9729-01","NDC","","","facility","both","1","EA","","13.15","13.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Injection, Powder, For Solution In 1 Vial, Multi-Dose (0143-9851-01)","636","RC","0143-9851-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Injection, Powder, For Solution In 1 Vial, Multi-Dose (0143-9851-01)","636","RC","0143-9851-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9875-01","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cladribine: 1 Vial In 1 Box, Unit-Dose (0143-9871-01)  / 10 Ml In 1 Vial","636","RC","0143-9871-01","NDC","","","facility","both","1","EA","","11.42","11.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cladribine: 1 Vial In 1 Box, Unit-Dose (0143-9871-01)  / 10 Ml In 1 Vial","636","RC","0143-9871-01","NDC","","","facility","both","1","EA","","11.7","11.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone: 25 Vial In 1 Box (0143-9856-25)  / 1 Injection, Powder, For Solution In 1 Vial (0143-9856-01)","636","RC","0143-9856-25","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9856-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levocarnitine: 10 Vial, Single-Use In 1 Carton (0143-9852-10)  / 5 Ml In 1 Vial, Single-Use (0143-9852-01)","636","RC","0143-9852-10","NDC","","","facility","both","1","EA","","29.46","29.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9852-01","NDC","","","facility","both","1","EA","","32.4","32.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9857-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9721-01","NDC","","","facility","both","1","EA","","2.61","2.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9720-01","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 1 Vial In 1 Box, Unit-Dose (0143-9622-01)  / 20 Ml In 1 Vial","636","RC","0143-9622-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Vial In 1 Carton (0143-9606-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9606-01","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Vial In 1 Carton (0143-9606-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9606-01","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Vial In 1 Carton (0143-9606-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9606-01","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9595-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Testosterone Cypionate: 1 Ml In 1 Vial (0143-9659-01)","636","RC","0143-9659-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (0143-9594-25)  / 5 Ml In 1 Vial, Single-Dose (0143-9594-01)","636","RC","0143-9594-25","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9577-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 10 Vial, Multi-Dose In 1 Package (0143-9575-10)  / 50 Ml In 1 Vial, Multi-Dose (0143-9575-01)","636","RC","0143-9575-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9575-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial In 1 Box, Unit-Dose (0143-9565-01)  / 1.5 Ml In 1 Vial","636","RC","0143-9565-01","NDC","","","facility","both","1","EA","","62.57","62.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial In 1 Box, Unit-Dose (0143-9565-01)  / 1.5 Ml In 1 Vial","636","RC","0143-9565-01","NDC","","","facility","both","1","EA","","198.28","198.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phentolamine Mesylate: 1 Vial In 1 Box (0143-9564-01)  / 1 Ml In 1 Vial","636","RC","0143-9564-01","NDC","","","facility","both","1","EA","","648.93","648.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9594-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone: 1 Injection, Powder, For Solution In 1 Carton (0143-9678-01)","636","RC","0143-9678-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9719-01","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9710-01","NDC","","","facility","both","1","EA","","3.21","3.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milrinone Lactate: 10 Vial In 1 Box (0143-9709-10)  / 20 Ml In 1 Vial (0143-9709-01)","636","RC","0143-9709-10","NDC","","","facility","both","1","EA","","2.01","2.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milrinone Lactate: 20 Ml In 1 Box (0143-9709-01)","636","RC","0143-9709-01","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milrinone Lactate: 50 Ml In 1 Box (0143-9708-01)","636","RC","0143-9708-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9682-01","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9682-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9682-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial In 1 Carton (0143-9681-25)  / 2 Ml In 1 Vial (0143-9681-01)","636","RC","0143-9681-25","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial In 1 Carton (0143-9681-25)  / 2 Ml In 1 Vial (0143-9681-01)","636","RC","0143-9681-25","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9681-01","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9681-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9681-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial In 1 Box (0143-9555-01)  / 5 Ml In 1 Vial","636","RC","0143-9555-01","NDC","","","facility","both","1","EA","","5.96","5.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Box, Unit-Dose (0143-9279-01)  / 40 Ml In 1 Vial","636","RC","0143-9279-01","NDC","","","facility","both","1","EA","","20.94","20.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Box, Unit-Dose (0143-9279-01)  / 40 Ml In 1 Vial","636","RC","0143-9279-01","NDC","","","facility","both","1","EA","","21.41","21.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Box, Unit-Dose (0143-9279-01)  / 40 Ml In 1 Vial","636","RC","0143-9279-01","NDC","","","facility","both","1","EA","","29.08","29.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 10 Tray In 1 Case (0121-1576-10)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose","636","RC","0121-1576-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisolone: 480 Ml In 1 Bottle (0121-0885-16)","636","RC","0121-0885-16","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisolone Sodium Phosphate: 237 Ml In 1 Bottle (0121-0759-08)","636","RC","0121-0759-08","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0121-0978-10","NDC","","","facility","both","1","EA","","7.53","7.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hydrochloride: 10 Tray In 1 Case (0121-0978-00)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose (0121-0978-10)","636","RC","0121-0978-00","NDC","","","facility","both","1","EA","","7.77","7.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0121-0977-55","NDC","","","facility","both","1","EA","","30.91","30.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foscarnet Sodium: 10 Carton In 1 Case (0143-9192-01)  / 1 Bottle In 1 Carton / 250 Ml In 1 Bottle","636","RC","0143-9192-01","NDC","","","facility","both","1","EA","","42.79","42.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foscarnet Sodium: 10 Carton In 1 Case (0143-9192-01)  / 1 Bottle In 1 Carton / 250 Ml In 1 Bottle","636","RC","0143-9192-01","NDC","","","facility","both","1","EA","","55.97","55.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9180-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9172-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (0143-9167-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","0143-9167-01","NDC","","","facility","both","1","EA","","99.59","99.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (0143-9167-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","0143-9167-01","NDC","","","facility","both","1","EA","","99.59","99.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0143-9164-01)  / 10.25 G In 1 Vial, Pharmacy Bulk Package","636","RC","0143-9164-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0143-9163-01)  / 5.13 G In 1 Vial, Pharmacy Bulk Package","636","RC","0143-9163-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial In 1 Package (0143-9162-10)  / 1025 Mg In 1 Vial (0143-9162-01)","636","RC","0143-9162-10","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9162-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9162-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9161-01","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9157-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 10 Vial, Single-Dose In 1 Carton (0143-9156-10)  / 4 Ml In 1 Vial, Single-Dose (0143-9156-01)","636","RC","0143-9156-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foscarnet Sodium: 10 Carton In 1 Case (0143-9192-01)  / 1 Bottle In 1 Carton / 250 Ml In 1 Bottle","636","RC","0143-9192-01","NDC","","","facility","both","1","EA","","36.36","36.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9209-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9273-01","NDC","","","facility","both","1","EA","","55","55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 25 Vial In 1 Carton (0143-9262-25)  / 3 Ml In 1 Vial (0143-9262-01)","636","RC","0143-9262-25","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9254-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexrazoxane: 1 Vial In 1 Box (0143-9247-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9247-01","NDC","","","facility","both","1","EA","","126.85","126.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9245-01","NDC","","","facility","both","1","EA","","6.42","6.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9245-01","NDC","","","facility","both","1","EA","","6.78","6.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bleomycin: 1 Vial In 1 Box, Unit-Dose (0143-9241-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9241-01","NDC","","","facility","both","1","EA","","24.96","24.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bleomycin: 1 Vial In 1 Box, Unit-Dose (0143-9240-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9240-01","NDC","","","facility","both","1","EA","","24.72","24.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bleomycin: 1 Vial In 1 Box, Unit-Dose (0143-9240-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9240-01","NDC","","","facility","both","1","EA","","27.73","27.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Idarubicin Hydrochloride: 1 Vial, Glass In 1 Box (0143-9218-01)  / 10 Ml In 1 Vial, Glass","636","RC","0143-9218-01","NDC","","","facility","both","1","EA","","46.48","46.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Idarubicin Hydrochloride: 1 Vial, Glass In 1 Box (0143-9218-01)  / 10 Ml In 1 Vial, Glass","636","RC","0143-9218-01","NDC","","","facility","both","1","EA","","48.3","48.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Idarubicin Hydrochloride: 1 Vial, Glass In 1 Box (0143-9218-01)  / 10 Ml In 1 Vial, Glass","636","RC","0143-9218-01","NDC","","","facility","both","1","EA","","55.19","55.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Idarubicin Hydrochloride: 1 Vial, Glass In 1 Box (0143-9217-01)  / 5 Ml In 1 Vial, Glass","636","RC","0143-9217-01","NDC","","","facility","both","1","EA","","28.99","28.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Idarubicin Hydrochloride: 1 Vial, Glass In 1 Box (0143-9217-01)  / 5 Ml In 1 Vial, Glass","636","RC","0143-9217-01","NDC","","","facility","both","1","EA","","28.99","28.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chloroprocaine Hydrochloride: 10 Vial In 1 Carton (0143-9210-10)  / 20 Ml In 1 Vial (0143-9210-01)","636","RC","0143-9210-10","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9210-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chloroprocaine Hydrochloride: 10 Vial In 1 Carton (0143-9209-10)  / 20 Ml In 1 Vial (0143-9209-01)","636","RC","0143-9209-10","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9156-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 3 Ml In 1 Vial (0143-9924-90)","636","RC","0143-9924-90","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9022-01","NDC","","","facility","both","1","EA","","6.05","6.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vimpat: 10 Vial, Glass In 1 Carton (0131-1810-67)  / 20 Ml In 1 Vial, Glass","636","RC","0131-1810-67","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9022-01","NDC","","","facility","both","1","EA","","6.05","6.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulvestrant: 2 Syringe, Glass In 1 Carton (0143-9022-02)  / 5 Ml In 1 Syringe, Glass (0143-9022-01)","636","RC","0143-9022-02","NDC","","","facility","both","1","EA","","6.05","6.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulvestrant: 2 Syringe, Glass In 1 Carton (0143-9022-02)  / 5 Ml In 1 Syringe, Glass (0143-9022-01)","636","RC","0143-9022-02","NDC","","","facility","both","1","EA","","6.05","6.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9156-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9141-01","NDC","","","facility","both","1","EA","","5.69","5.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 25 Vial In 1 Carton (0143-9139-25)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","0143-9139-25","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 25 Vial In 1 Carton (0143-9139-25)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","0143-9139-25","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9139-01","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9139-01","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9139-01","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Box (0143-9135-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9135-01","NDC","","","facility","both","1","EA","","17.89","17.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Box (0143-9135-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9135-01","NDC","","","facility","both","1","EA","","35.79","35.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bortezomib: 1 Vial In 1 Carton (0143-9098-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9098-01","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bortezomib: 1 Vial In 1 Carton (0143-9098-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9098-01","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bortezomib: 1 Vial In 1 Carton (0143-9098-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0143-9098-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial In 1 Box (0143-9093-01)  / 25 Ml In 1 Vial","636","RC","0143-9093-01","NDC","","","facility","both","1","EA","","82.94","82.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial In 1 Box (0143-9093-01)  / 25 Ml In 1 Vial","636","RC","0143-9093-01","NDC","","","facility","both","1","EA","","82.94","82.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Multi-Dose In 1 Box (0143-9087-01)  / 100 Ml In 1 Vial, Multi-Dose","636","RC","0143-9087-01","NDC","","","facility","both","1","EA","","9.96","9.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulvestrant: 2 Syringe, Glass In 1 Carton (0143-9022-02)  / 5 Ml In 1 Syringe, Glass (0143-9022-01)","636","RC","0143-9022-02","NDC","","","facility","both","1","EA","","6.05","6.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulvestrant: 2 Syringe, Glass In 1 Carton (0143-9022-02)  / 5 Ml In 1 Syringe, Glass (0143-9022-01)","636","RC","0143-9022-02","NDC","","","facility","both","1","EA","","6.05","6.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9156-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 10 Vial, Pharmacy Bulk Package In 1 Carton (0143-9983-03)  / 1 Injection, Powder, For Solution In 1 Vial, Pharmacy Bulk Package (0143-9983-91)","636","RC","0143-9983-03","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Container In 1 Case (0264-7800-00)  / 1000 Ml In 1 Container","636","RC","0264-7800-00","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose In Lactated Ringers: 12 Container In 1 Case (0264-7751-00)  / 1000 Ml In 1 Container","636","RC","0264-7751-00","NDC","","","facility","both","1","EA","","5.37","5.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 24 Container In 1 Case (0264-7750-20)  / 250 Ml In 1 Container","636","RC","0264-7750-20","NDC","","","facility","both","1","EA","","3.46","3.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 24 Container In 1 Case (0264-7750-10)  / 500 Ml In 1 Container","636","RC","0264-7750-10","NDC","","","facility","both","1","EA","","4.33","4.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 12 Container In 1 Case (0264-7750-07)  / 1000 Ml In 1 Container","636","RC","0264-7750-07","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 12 Container In 1 Case (0264-7750-00)  / 1000 Ml In 1 Container","636","RC","0264-7750-00","NDC","","","facility","both","1","EA","","3.5","3.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Container In 1 Case (0264-7800-09)  / 1000 Ml In 1 Container","636","RC","0264-7800-09","NDC","","","facility","both","1","EA","","1.9","1.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose: 12 Container In 1 Case (0264-7625-00)  / 1000 Ml In 1 Container","636","RC","0264-7625-00","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7616-00)  / 1000 Ml In 1 Container","636","RC","0264-7616-00","NDC","","","facility","both","1","EA","","7.19","7.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 24 Container In 1 Case (0264-7612-10)  / 500 Ml In 1 Container","636","RC","0264-7612-10","NDC","","","facility","both","1","EA","","4.3","4.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-7800-10)  / 500 Ml In 1 Container","636","RC","0264-7800-10","NDC","","","facility","both","1","EA","","4.44","4.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium In Sodium Chloride: 24 Container In 1 Case (0264-9872-10)  / 500 Ml In 1 Container","636","RC","0264-9872-10","NDC","","","facility","both","1","EA","","6.58","6.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Dextrose: 24 Container In 1 Case (0264-9598-20)  / 250 Ml In 1 Container","636","RC","0264-9598-20","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Dextrose: 24 Container In 1 Case (0264-9598-20)  / 250 Ml In 1 Container","636","RC","0264-9598-20","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Dextrose: 24 Container In 1 Case (0264-9598-20)  / 250 Ml In 1 Container","636","RC","0264-9598-20","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium In Dextrose: 24 Container In 1 Case (0264-9587-20)  / 250 Ml In 1 Container","636","RC","0264-9587-20","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Sodium Chloride: 12 Container In 1 Case (0264-7865-00)  / 1000 Ml In 1 Container","636","RC","0264-7865-00","NDC","","","facility","both","1","EA","","3.21","3.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-7806-10)  / 500 Ml In 1 Container","636","RC","0264-7806-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-7805-10)  / 500 Ml In 1 Container","636","RC","0264-7805-10","NDC","","","facility","both","1","EA","","5.38","5.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-7802-10)  / 500 Ml In 1 Container","636","RC","0264-7802-10","NDC","","","facility","both","1","EA","","4.09","4.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Container In 1 Case (0264-7802-00)  / 1000 Ml In 1 Container","636","RC","0264-7802-00","NDC","","","facility","both","1","EA","","2.67","2.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-7800-20)  / 250 Ml In 1 Container","636","RC","0264-7800-20","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7612-00)  / 1000 Ml In 1 Container","636","RC","0264-7612-00","NDC","","","facility","both","1","EA","","5.34","5.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 4 Container In 1 Case (0264-7387-50)  / 2000 Ml In 1 Container","636","RC","0264-7387-50","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Container In 1 Case (0264-5804-00)  / 1000 Ml In 1 Container","636","RC","0264-5804-00","NDC","","","facility","both","1","EA","","2.55","2.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Container In 1 Case (0264-5802-10)  / 500 Ml In 1 Container","636","RC","0264-5802-10","NDC","","","facility","both","1","EA","","2.69","2.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Container In 1 Case (0264-5802-00)  / 1000 Ml In 1 Container","636","RC","0264-5802-00","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Dextrose: 24 Container In 1 Case (0264-4400-54)  / 100 Ml In 1 Container","636","RC","0264-4400-54","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Container In 1 Case (0264-4206-54)  / 100 Ml In 1 Container","636","RC","0264-4206-54","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Container In 1 Case (0264-4204-52)  / 50 Ml In 1 Container","636","RC","0264-4204-52","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 24 Container In 1 Case (0264-4100-90)  / 100 Ml In 1 Container","636","RC","0264-4100-90","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 24 Container In 1 Case (0264-4100-90)  / 100 Ml In 1 Container","636","RC","0264-4100-90","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"8 CONTAINER in 1 CASE (0264-2201-50)  / 2000 mL in 1 CONTAINER","636","RC","0264-2201-50","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride For Irrigation: 4 Container In 1 Case (0264-7388-50)  / 2000 Ml In 1 Container","636","RC","0264-7388-50","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 24 Container In 1 Case (0264-7610-10)  / 500 Ml In 1 Container","636","RC","0264-7610-10","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7610-00)  / 1000 Ml In 1 Container","636","RC","0264-7610-00","NDC","","","facility","both","1","EA","","2.69","2.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 12 Container In 1 Case (0264-7610-00)  / 1000 Ml In 1 Container","636","RC","0264-7610-00","NDC","","","facility","both","1","EA","","2.7","2.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mannitol: 24 Container In 1 Case (0264-7578-10)  / 500 Ml In 1 Container","636","RC","0264-7578-10","NDC","","","facility","both","1","EA","","8.16","8.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Container In 1 Case (0264-7520-20)  / 250 Ml In 1 Container","636","RC","0264-7520-20","NDC","","","facility","both","1","EA","","5.96","5.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Container In 1 Case (0264-7520-10)  / 500 Ml In 1 Container","636","RC","0264-7520-10","NDC","","","facility","both","1","EA","","3.21","3.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 Container In 1 Case (0264-7520-00)  / 1000 Ml In 1 Container","636","RC","0264-7520-00","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Container In 1 Case (0264-7510-20)  / 250 Ml In 1 Container","636","RC","0264-7510-20","NDC","","","facility","both","1","EA","","2.76","2.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 Container In 1 Case (0264-7510-10)  / 500 Ml In 1 Container","636","RC","0264-7510-10","NDC","","","facility","both","1","EA","","3.91","3.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 Container In 1 Case (0264-7510-00)  / 1000 Ml In 1 Container","636","RC","0264-7510-00","NDC","","","facility","both","1","EA","","5.42","5.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride For Irrigation: 4 Container In 1 Case (0264-7388-60)  / 3000 Ml In 1 Container","636","RC","0264-7388-60","NDC","","","facility","both","1","EA","","2.7","2.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kinevac: 10 Vial In 1 Package (0270-0556-15)  / 5 Ml In 1 Vial","636","RC","0270-0556-15","NDC","","","facility","both","1","EA","","86.64","86.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 1000 Ml In 1 Bag (0338-0023-04)","636","RC","0338-0023-04","NDC","","","facility","both","1","EA","","1.7","1.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 500 Ml In 1 Bag (0338-0023-03)","636","RC","0338-0023-03","NDC","","","facility","both","1","EA","","3.21","3.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1000 Ml In 1 Bag (0338-0043-04)","636","RC","0338-0043-04","NDC","","","facility","both","1","EA","","3.31","3.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 1 Bag In 1 Package (0338-0017-48)  / 100 Ml In 1 Bag","636","RC","0338-0017-48","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 1 Bag In 1 Package (0338-0017-41)  / 50 Ml In 1 Bag","636","RC","0338-0017-41","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 16 Bag In 1 Pouch (0338-0017-31)  / 50 Ml In 1 Bag","636","RC","0338-0017-31","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 4 Bag In 1 Pouch (0338-0017-18)  / 100 Ml In 1 Bag","636","RC","0338-0017-18","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 4 Bag In 1 Pouch (0338-0017-11)  / 50 Ml In 1 Bag","636","RC","0338-0017-11","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 250 Ml In 1 Bag (0338-0023-02)","636","RC","0338-0023-02","NDC","","","facility","both","1","EA","","3.75","3.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 6 Bag In 1 Carton (0338-0047-46)  / 2000 Ml In 1 Bag","636","RC","0338-0047-46","NDC","","","facility","both","1","EA","","8.1","8.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-10)  / 25 Ml In 1 Bag","636","RC","0338-0049-10","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1000 Ml In 1 Bag (0338-0049-04)","636","RC","0338-0049-04","NDC","","","facility","both","1","EA","","3.06","3.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1000 Ml In 1 Bag (0338-0049-04)","636","RC","0338-0049-04","NDC","","","facility","both","1","EA","","637.5","637.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 500 Ml In 1 Bag (0338-0049-03)","636","RC","0338-0049-03","NDC","","","facility","both","1","EA","","3.42","3.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 250 Ml In 1 Bag (0338-0049-02)","636","RC","0338-0049-02","NDC","","","facility","both","1","EA","","3.77","3.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 Bottle, Plastic In 1 Carton (0338-0048-04)  / 1000 Ml In 1 Bottle, Plastic","636","RC","0338-0048-04","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 18 Bottle, Plastic In 1 Carton (0338-0048-03)  / 500 Ml In 1 Bottle, Plastic","636","RC","0338-0048-03","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Carton (0338-0047-47)  / 3000 Ml In 1 Bag","636","RC","0338-0047-47","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 1000 Ml In 1 Bag (0338-0017-04)","636","RC","0338-0017-04","NDC","","","facility","both","1","EA","","7.14","7.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Saphnelo: 1 Vial, Glass In 1 Carton (0310-3040-00)  / 2 Ml In 1 Vial, Glass","636","RC","0310-3040-00","NDC","","","facility","both","1","EA","","32.27","32.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Saphnelo: 1 Vial, Glass In 1 Carton (0310-3040-00)  / 2 Ml In 1 Vial, Glass","636","RC","0310-3040-00","NDC","","","facility","both","1","EA","","32.29","32.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tagrisso: 30 Tablet, Film Coated In 1 Bottle (0310-1350-30)","636","RC","0310-1350-30","NDC","","","facility","both","1","EA","","893.14","893.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0310-3200-01","NDC","","","facility","both","1","EA","","219.28","219.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Andexxa: 5 Vial, Single-Use In 1 Carton (0310-3200-05)  / 20 Ml In 1 Vial, Single-Use (0310-3200-01)","636","RC","0310-3200-05","NDC","","","facility","both","1","EA","","218.73","218.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imfinzi: 1 Vial In 1 Carton (0310-4500-12)  / 2.4 Ml In 1 Vial","636","RC","0310-4500-12","NDC","","","facility","both","1","EA","","151.58","151.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imjudo: 1 Vial In 1 Carton (0310-4535-30)  / 15 Ml In 1 Vial","636","RC","0310-4535-30","NDC","","","facility","both","1","EA","","163.54","163.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 500 Ml In 1 Bag (0338-0017-03)","636","RC","0338-0017-03","NDC","","","facility","both","1","EA","","2.46","2.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 250 Ml In 1 Bag (0338-0017-02)","636","RC","0338-0017-02","NDC","","","facility","both","1","EA","","4.7","4.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imfinzi: 1 Vial In 1 Carton (0310-4611-50)  / 10 Ml In 1 Vial","636","RC","0310-4611-50","NDC","","","facility","both","1","EA","","132.13","132.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imfinzi: 1 Vial In 1 Carton (0310-4611-50)  / 10 Ml In 1 Vial","636","RC","0310-4611-50","NDC","","","facility","both","1","EA","","136.18","136.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imfinzi: 1 Vial In 1 Carton (0310-4611-50)  / 10 Ml In 1 Vial","636","RC","0310-4611-50","NDC","","","facility","both","1","EA","","136.4","136.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imfinzi: 1 Vial In 1 Carton (0310-4611-50)  / 10 Ml In 1 Vial","636","RC","0310-4611-50","NDC","","","facility","both","1","EA","","137.54","137.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imfinzi: 1 Vial In 1 Carton (0310-4611-50)  / 10 Ml In 1 Vial","636","RC","0310-4611-50","NDC","","","facility","both","1","EA","","138.41","138.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imjudo: 1 Vial In 1 Carton (0310-4535-30)  / 15 Ml In 1 Vial","636","RC","0310-4535-30","NDC","","","facility","both","1","EA","","159.27","159.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imjudo: 1 Vial In 1 Carton (0310-4535-30)  / 15 Ml In 1 Vial","636","RC","0310-4535-30","NDC","","","facility","both","1","EA","","159.71","159.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imjudo: 1 Vial In 1 Carton (0310-4535-30)  / 15 Ml In 1 Vial","636","RC","0310-4535-30","NDC","","","facility","both","1","EA","","163.15","163.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flolan: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0173-0519-00)","636","RC","0173-0519-00","NDC","","","facility","both","1","EA","","20.56","20.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flolan: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0173-0517-00)","636","RC","0173-0517-00","NDC","","","facility","both","1","EA","","21.03","21.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclosporine: 1 Bottle In 1 Package (0172-7313-20)  / 50 Ml In 1 Bottle","636","RC","0172-7313-20","NDC","","","facility","both","1","EA","","2.8","2.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nucala: 1 Vial In 1 Carton (0173-0881-01)  / 1 Ml In 1 Vial","636","RC","0173-0881-01","NDC","","","facility","both","1","EA","","55.73","55.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nucala: 1 Vial In 1 Carton (0173-0881-01)  / 1 Ml In 1 Vial","636","RC","0173-0881-01","NDC","","","facility","both","1","EA","","55.26","55.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Pamoate: 100 Capsule In 1 Bottle (0185-0676-01)","636","RC","0185-0676-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jemperli: 1 Vial In 1 Carton (0173-0898-03)  / 10 Ml In 1 Vial","636","RC","0173-0898-03","NDC","","","facility","both","1","EA","","347.4","347.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jemperli: 1 Vial In 1 Carton (0173-0898-03)  / 10 Ml In 1 Vial","636","RC","0173-0898-03","NDC","","","facility","both","1","EA","","366.77","366.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolin R: 1 Vial In 1 Carton (0169-1833-11)  / 10 Ml In 1 Vial","636","RC","0169-1833-11","NDC","","","facility","both","1","EA","","3.04","3.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolin R: 1 Vial In 1 Carton (0169-1833-11)  / 10 Ml In 1 Vial","636","RC","0169-1833-11","NDC","","","facility","both","1","EA","","3.06","3.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0143-9983-91","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolog: 1 Vial, Glass In 1 Carton (0169-7501-11)  / 10 Ml In 1 Vial, Glass","636","RC","0169-7501-11","NDC","","","facility","both","1","EA","","3.56","3.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0169-7215-11","NDC","","","facility","both","1","EA","","3.79","3.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0169-7211-11","NDC","","","facility","both","1","EA","","3.94","3.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novoseven Rt: 1 Kit In 1 Kit (0169-7205-01)  *  5 Ml In 1 Vial, Glass (0169-7215-11)  *  5 Ml In 1 Syringe, Glass (0169-7015-98)","636","RC","0169-7205-01","NDC","","","facility","both","1","EA","","3.75","3.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novoseven Rt: 1 Kit In 1 Kit (0169-7202-01)  *  2 Ml In 1 Vial, Glass (0169-7212-11)  *  2 Ml In 1 Syringe, Glass (0169-7012-98)","636","RC","0169-7202-01","NDC","","","facility","both","1","EA","","3.79","3.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novoseven Rt: 1 Kit In 1 Kit (0169-7202-01)  *  2 Ml In 1 Vial, Glass (0169-7212-11)  *  2 Ml In 1 Syringe, Glass (0169-7012-98)","636","RC","0169-7202-01","NDC","","","facility","both","1","EA","","3.94","3.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novoseven Rt: 1 Kit In 1 Kit (0169-7201-01)  *  1 Ml In 1 Vial, Glass (0169-7211-11)  *  1 Ml In 1 Syringe, Glass (0169-7011-98)","636","RC","0169-7201-01","NDC","","","facility","both","1","EA","","3.94","3.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novoseven Rt: 1 Kit In 1 Kit (0169-7201-01)  *  1 Ml In 1 Vial, Glass (0169-7211-11)  *  1 Ml In 1 Syringe, Glass (0169-7011-98)","636","RC","0169-7201-01","NDC","","","facility","both","1","EA","","3.94","3.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolog: 5 Syringe, Plastic In 1 Carton (0169-6339-10)  / 3 Ml In 1 Syringe, Plastic","636","RC","0169-6339-10","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolog: 5 Syringe, Plastic In 1 Carton (0169-6339-10)  / 3 Ml In 1 Syringe, Plastic","636","RC","0169-6339-10","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolog: 5 Syringe, Plastic In 1 Carton (0169-6339-10)  / 3 Ml In 1 Syringe, Plastic","636","RC","0169-6339-10","NDC","","","facility","both","1","EA","","4.53","4.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0206-8852-08","NDC","","","facility","both","1","EA","","3","3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1610-01","NDC","","","facility","both","1","EA","","9.1","9.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1610-01","NDC","","","facility","both","1","EA","","9.1","9.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1610-01","NDC","","","facility","both","1","EA","","9.12","9.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1605-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1605-01","NDC","","","facility","both","1","EA","","9.46","9.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1605-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1605-01","NDC","","","facility","both","1","EA","","9.46","9.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1605-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1605-01","NDC","","","facility","both","1","EA","","9.46","9.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1605-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1605-01","NDC","","","facility","both","1","EA","","9.5","9.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1605-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1605-01","NDC","","","facility","both","1","EA","","9.53","9.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1605-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1605-01","NDC","","","facility","both","1","EA","","9.53","9.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1605-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1605-01","NDC","","","facility","both","1","EA","","9.56","9.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1610-01","NDC","","","facility","both","1","EA","","9.09","9.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1605-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1605-01","NDC","","","facility","both","1","EA","","9.58","9.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1605-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1605-01","NDC","","","facility","both","1","EA","","9.65","9.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1605-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1605-01","NDC","","","facility","both","1","EA","","9.65","9.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1605-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1605-01","NDC","","","facility","both","1","EA","","9.65","9.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1610-01","NDC","","","facility","both","1","EA","","9.09","9.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1610-01","NDC","","","facility","both","1","EA","","9.08","9.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1610-01","NDC","","","facility","both","1","EA","","9.03","9.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 16 Container In 1 Case (0264-2201-00)  / 1000 Ml In 1 Container","636","RC","0264-2201-00","NDC","","","facility","both","1","EA","","2.04","2.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 116 Container In 1 Case (0264-1800-36)  / 25 Ml In 1 Container","636","RC","0264-1800-36","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 64 Container In 1 Case (0264-1800-32)  / 100 Ml In 1 Container","636","RC","0264-1800-32","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 84 Container In 1 Case (0264-1800-31)  / 50 Ml In 1 Container","636","RC","0264-1800-31","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 64 Container In 1 Case (0264-1510-32)  / 100 Ml In 1 Container","636","RC","0264-1510-32","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 84 Container In 1 Case (0264-1510-31)  / 50 Ml In 1 Container","636","RC","0264-1510-31","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1610-01","NDC","","","facility","both","1","EA","","9.01","9.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1610-01","NDC","","","facility","both","1","EA","","9.01","9.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1610-01","NDC","","","facility","both","1","EA","","9.01","9.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1610-01","NDC","","","facility","both","1","EA","","9.01","9.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeomin: 1 Vial, Single-Use In 1 Carton (0259-1610-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0259-1610-01","NDC","","","facility","both","1","EA","","9.01","9.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 16 Container In 1 Case (0264-2201-10)  / 500 Ml In 1 Container","636","RC","0264-2201-10","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pfizerpen: 1 Vial In 1 Carton (0049-0530-28)  / 1 Powder, For Solution In 1 Vial","636","RC","0049-0530-28","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0049-0520-84","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pfizerpen: 10 Vial In 1 Carton (0049-0520-83)  / 1 Powder, For Solution In 1 Vial (0049-0520-84)","636","RC","0049-0520-83","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Unasyn: 10 Vial In 1 Carton (0049-0013-83)  / 1 Injection, Powder, For Solution In 1 Vial (0049-0013-81)","636","RC","0049-0013-83","NDC","","","facility","both","1","EA","","12.57","12.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Premarin: 1 Vial In 1 Carton (0046-0749-05)  / 5 Ml In 1 Vial","636","RC","0046-0749-05","NDC","","","facility","both","1","EA","","610.89","610.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Premarin: 1 Vial In 1 Carton (0046-0749-05)  / 5 Ml In 1 Vial","636","RC","0046-0749-05","NDC","","","facility","both","1","EA","","625.41","625.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vfend: 1 Vial, Single-Dose In 1 Carton (0049-3190-28)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0049-3190-28","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle, Plastic (0054-0019-25)","636","RC","0054-0019-25","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 10 Blister Pack In 1 Carton (0054-0019-20)  / 10 Tablet In 1 Blister Pack","636","RC","0054-0019-20","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 10 Blister Pack In 1 Carton (0054-0018-20)  / 10 Tablet In 1 Blister Pack","636","RC","0054-0018-20","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuminar-25: 1 VIAL, GLASS in 1 CARTON (0053-7680-32)  / 50 mL in 1 VIAL, GLASS (0053-7680-91) ","636","RC","0053-7680-32","NDC","","","facility","both","1","EA","","59.76","59.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tice Bcg: 1 Vial In 1 Carton (0052-0602-02)  / 50 Ml In 1 Vial (0052-0602-01)","636","RC","0052-0602-02","NDC","","","facility","both","1","EA","","132.17","132.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tice Bcg: 1 Vial In 1 Carton (0052-0602-02)  / 50 Ml In 1 Vial (0052-0602-01)","636","RC","0052-0602-02","NDC","","","facility","both","1","EA","","137.99","137.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0024-5154-11","NDC","","","facility","both","1","EA","","651.97","651.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0024-5154-11","NDC","","","facility","both","1","EA","","652.95","652.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elitek: 3 Kit In 1 Carton (0024-5150-10)  / 1 Kit In 1 Kit *  1 Ml In 1 Vial, Single-Use (0024-5154-11)  *  1 Ml In 1 Ampule (0024-5152-11)","636","RC","0024-5150-10","NDC","","","facility","both","1","EA","","645.75","645.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elitek: 3 Kit In 1 Carton (0024-5150-10)  / 1 Kit In 1 Kit *  1 Ml In 1 Vial, Single-Use (0024-5154-11)  *  1 Ml In 1 Ampule (0024-5152-11)","636","RC","0024-5150-10","NDC","","","facility","both","1","EA","","657.84","657.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sarclisa: 1 Vial, Single-Dose In 1 Carton (0024-0656-01)  / 25 Ml In 1 Vial, Single-Dose","636","RC","0024-0656-01","NDC","","","facility","both","1","EA","","153.67","153.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0024-5823-15","NDC","","","facility","both","1","EA","","424.4","424.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sarclisa: 1 Vial, Single-Dose In 1 Carton (0024-0654-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0024-0654-01","NDC","","","facility","both","1","EA","","151.73","151.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox Cosmetic: 1 Vial, Glass In 1 Carton (0023-9232-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass","636","RC","0023-9232-01","NDC","","","facility","both","1","EA","","11.81","11.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox Cosmetic: 1 Vial, Glass In 1 Carton (0023-9232-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass","636","RC","0023-9232-01","NDC","","","facility","both","1","EA","","11.81","11.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10)  / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)","636","RC","0023-6082-10","NDC","","","facility","both","1","EA","","30.45","30.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sarclisa: 1 Vial, Single-Dose In 1 Carton (0024-0654-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0024-0654-01","NDC","","","facility","both","1","EA","","153.99","153.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0024-5823-15","NDC","","","facility","both","1","EA","","403.37","403.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jevtana: 1 Kit In 1 Carton (0024-5824-11)  *  5.7 Ml In 1 Vial, Glass (0024-5823-15)  *  5.7 Ml In 1 Vial, Glass (0024-5822-01)","636","RC","0024-5824-11","NDC","","","facility","both","1","EA","","416.83","416.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jevtana: 1 Kit In 1 Carton (0024-5824-11)  *  5.7 Ml In 1 Vial, Glass (0024-5823-15)  *  5.7 Ml In 1 Vial, Glass (0024-5822-01)","636","RC","0024-5824-11","NDC","","","facility","both","1","EA","","414","414","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jevtana: 1 Kit In 1 Carton (0024-5824-11)  *  5.7 Ml In 1 Vial, Glass (0024-5823-15)  *  5.7 Ml In 1 Vial, Glass (0024-5822-01)","636","RC","0024-5824-11","NDC","","","facility","both","1","EA","","298.57","298.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jevtana: 1 Kit In 1 Carton (0024-5824-11)  *  5.7 Ml In 1 Vial, Glass (0024-5823-15)  *  5.7 Ml In 1 Vial, Glass (0024-5822-01)","636","RC","0024-5824-11","NDC","","","facility","both","1","EA","","404.92","404.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jevtana: 1 Kit In 1 Carton (0024-5824-11)  *  5.7 Ml In 1 Vial, Glass (0024-5823-15)  *  5.7 Ml In 1 Vial, Glass (0024-5822-01)","636","RC","0024-5824-11","NDC","","","facility","both","1","EA","","413.2","413.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infed: 10 Vial, Single-Dose In 1 Carton (0023-6082-10)  / 2 Ml In 1 Vial, Single-Dose (0023-6082-01)","636","RC","0023-6082-10","NDC","","","facility","both","1","EA","","30.53","30.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine: 30 Tablet In 1 Bottle (0054-0176-13)","636","RC","0054-0176-13","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 500 Ml In 1 Bottle, Plastic (0054-3177-63)","636","RC","0054-3177-63","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 240 Ml In 1 Bottle, Plastic (0054-3177-57)","636","RC","0054-3177-57","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4181-25)","636","RC","0054-4181-25","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8183-25)  / 1 Tablet In 1 Blister Pack","636","RC","0054-8183-25","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8183-25)  / 1 Tablet In 1 Blister Pack","636","RC","0054-8183-25","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8181-25)  / 1 Tablet In 1 Blister Pack","636","RC","0054-8181-25","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8180-25)  / 1 Tablet In 1 Blister Pack","636","RC","0054-8180-25","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8179-25)  / 1 Tablet In 1 Blister Pack","636","RC","0054-8179-25","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8176-25)  / 1 Tablet In 1 Blister Pack","636","RC","0054-8176-25","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8176-25)  / 1 Tablet In 1 Blister Pack","636","RC","0054-8176-25","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8175-25)  / 1 Tablet In 1 Blister Pack","636","RC","0054-8175-25","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Blister Pack In 1 Carton (0054-8174-25)  / 1 Tablet In 1 Blister Pack","636","RC","0054-8174-25","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4186-25)","636","RC","0054-4186-25","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Tablet In 1 Bottle, Plastic (0054-4183-25)","636","RC","0054-4183-25","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Intensol: 30 Ml In 1 Bottle, Glass (0054-3176-44)","636","RC","0054-3176-44","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 100 Capsule In 1 Bottle (0054-0382-25)","636","RC","0054-0382-25","NDC","","","facility","both","1","EA","","12.43","12.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine: 30 Tablet In 1 Bottle (0054-0177-13)","636","RC","0054-0177-13","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron Hydrochloride: 1 Bottle, Glass In 1 Carton (0054-0064-47)  / 50 Ml In 1 Bottle, Glass","636","RC","0054-0064-47","NDC","","","facility","both","1","EA","","3.49","3.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0023-6082-01","NDC","","","facility","both","1","EA","","30.12","30.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mylotarg: 1 Vial, Single-Dose In 1 Carton (0008-4510-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0008-4510-01","NDC","","","facility","both","1","EA","","372.59","372.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mylotarg: 1 Vial, Single-Dose In 1 Carton (0008-4510-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0008-4510-01","NDC","","","facility","both","1","EA","","400.77","400.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rapamune: 100 Tablet, Sugar Coated In 1 Bottle (0008-1042-05)","636","RC","0008-1042-05","NDC","","","facility","both","1","EA","","57.07","57.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Protonix I.V.: 1 Vial In 1 Carton (0008-0923-51)  / 10 Ml In 1 Vial","636","RC","0008-0923-51","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Besponsa: 1 Vial, Single-Dose In 1 Carton (0008-0100-01)  / 4 Ml In 1 Vial, Single-Dose","636","RC","0008-0100-01","NDC","","","facility","both","1","EA","","3059.87","3059.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Besponsa: 1 Vial, Single-Dose In 1 Carton (0008-0100-01)  / 4 Ml In 1 Vial, Single-Dose","636","RC","0008-0100-01","NDC","","","facility","both","1","EA","","3182.64","3182.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0008-4990-19","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bridion: 10 Vial, Single-Dose In 1 Carton (0006-5423-12)  / 2 Ml In 1 Vial, Single-Dose (0006-5423-02)","636","RC","0006-5423-12","NDC","","","facility","both","1","EA","","186.79","186.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-5423-02","NDC","","","facility","both","1","EA","","248.97","248.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-5004-02","NDC","","","facility","both","1","EA","","672.39","672.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prevymis: 1 Vial, Single-Dose In 1 Carton (0006-5004-01)  / 24 Ml In 1 Vial, Single-Dose (0006-5004-02)","636","RC","0006-5004-01","NDC","","","facility","both","1","EA","","674.32","674.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0003-02)  / 4 Ml In 1 Vial","636","RC","0009-0003-02","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0039-30","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0039-30","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0039-30","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0018-20)  / 8 Ml In 1 Vial","636","RC","0009-0018-20","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0018-20)  / 8 Ml In 1 Vial","636","RC","0009-0018-20","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0018-20)  / 8 Ml In 1 Vial","636","RC","0009-0018-20","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0003-02)  / 4 Ml In 1 Vial","636","RC","0009-0003-02","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Cortef: 1 Vial, Single-Dose In 1 Carton (0009-0013-05)  / 2 Ml In 1 Vial, Single-Dose","636","RC","0009-0013-05","NDC","","","facility","both","1","EA","","24.57","24.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Cortef: 25 Vial, Single-Dose In 1 Carton (0009-0011-04)  / 2 Ml In 1 Vial, Single-Dose (0009-0011-03)","636","RC","0009-0011-04","NDC","","","facility","both","1","EA","","9.59","9.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0011-03","NDC","","","facility","both","1","EA","","11.49","11.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0011-03","NDC","","","facility","both","1","EA","","18.37","18.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Cortef: 1 Vial, Single-Dose In 1 Carton (0009-0013-05)  / 2 Ml In 1 Vial, Single-Dose","636","RC","0009-0013-05","NDC","","","facility","both","1","EA","","18.37","18.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-5003-02","NDC","","","facility","both","1","EA","","638.88","638.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prevymis: 1 Vial, Single-Dose In 1 Carton (0006-5003-01)  / 12 Ml In 1 Vial, Single-Dose (0006-5003-02)","636","RC","0006-5003-01","NDC","","","facility","both","1","EA","","206.45","206.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Keytruda: 2 Vial In 1 Carton (0006-3026-04)  / 4 Ml In 1 Vial (0006-3026-01)","636","RC","0006-3026-04","NDC","","","facility","both","1","EA","","87.81","87.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Keytruda: 2 Vial In 1 Carton (0006-3026-04)  / 4 Ml In 1 Vial (0006-3026-01)","636","RC","0006-3026-04","NDC","","","facility","both","1","EA","","88.06","88.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Keytruda: 2 Vial In 1 Carton (0006-3026-04)  / 4 Ml In 1 Vial (0006-3026-01)","636","RC","0006-3026-04","NDC","","","facility","both","1","EA","","89.54","89.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Keytruda: 2 Vial In 1 Carton (0006-3026-04)  / 4 Ml In 1 Vial (0006-3026-01)","636","RC","0006-3026-04","NDC","","","facility","both","1","EA","","98.98","98.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Keytruda: 1 Vial In 1 Carton (0006-3026-02)  / 4 Ml In 1 Vial (0006-3026-01)","636","RC","0006-3026-02","NDC","","","facility","both","1","EA","","9.72","9.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Keytruda: 1 Vial In 1 Carton (0006-3026-02)  / 4 Ml In 1 Vial (0006-3026-01)","636","RC","0006-3026-02","NDC","","","facility","both","1","EA","","12.81","12.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Keytruda: 1 Vial In 1 Carton (0006-3026-02)  / 4 Ml In 1 Vial (0006-3026-01)","636","RC","0006-3026-02","NDC","","","facility","both","1","EA","","25.35","25.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Keytruda: 1 Vial In 1 Carton (0006-3026-02)  / 4 Ml In 1 Vial (0006-3026-01)","636","RC","0006-3026-02","NDC","","","facility","both","1","EA","","35.57","35.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-3026-01","NDC","","","facility","both","1","EA","","89.85","89.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Keytruda: 2 Vial In 1 Carton (0006-3026-04)  / 4 Ml In 1 Vial (0006-3026-01)","636","RC","0006-3026-04","NDC","","","facility","both","1","EA","","85.83","85.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-3026-01","NDC","","","facility","both","1","EA","","90.09","90.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-3026-01","NDC","","","facility","both","1","EA","","91.55","91.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-3026-01","NDC","","","facility","both","1","EA","","98.98","98.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zinplava: 1 Vial, Single-Dose In 1 Carton (0006-3025-00)  / 40 Ml In 1 Vial, Single-Dose (0006-3025-01)","636","RC","0006-3025-00","NDC","","","facility","both","1","EA","","67.14","67.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zinplava: 1 Vial, Single-Dose In 1 Carton (0006-3025-00)  / 40 Ml In 1 Vial, Single-Dose (0006-3025-01)","636","RC","0006-3025-00","NDC","","","facility","both","1","EA","","67.17","67.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zinplava: 1 Vial, Single-Dose In 1 Carton (0006-3025-00)  / 40 Ml In 1 Vial, Single-Dose (0006-3025-01)","636","RC","0006-3025-00","NDC","","","facility","both","1","EA","","67.98","67.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zinplava: 1 Vial, Single-Dose In 1 Carton (0006-3025-00)  / 40 Ml In 1 Vial, Single-Dose (0006-3025-01)","636","RC","0006-3025-00","NDC","","","facility","both","1","EA","","69.61","69.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-3026-01","NDC","","","facility","both","1","EA","","91.18","91.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-3061-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-4897-01","NDC","","","facility","both","1","EA","","50.84","50.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pedvaxhib: 10 Vial, Single-Dose In 1 Carton (0006-4897-00)  / .5 Ml In 1 Vial, Single-Dose (0006-4897-01)","636","RC","0006-4897-00","NDC","","","facility","both","1","EA","","50.83","50.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-4837-01","NDC","","","facility","both","1","EA","","204.09","204.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-4827-01","NDC","","","facility","both","1","EA","","313.01","313.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Varivax: 10 Vial, Single-Dose In 1 Carton (0006-4827-00)  / .5 Ml In 1 Vial, Single-Dose (0006-4827-01)","636","RC","0006-4827-00","NDC","","","facility","both","1","EA","","313.46","313.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-4681-01","NDC","","","facility","both","1","EA","","158.32","158.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-4171-01","NDC","","","facility","both","1","EA","","466.03","466.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-4121-01","NDC","","","facility","both","1","EA","","535.84","535.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-4095-01","NDC","","","facility","both","1","EA","","50.65","50.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-3856-01","NDC","","","facility","both","1","EA","","4.07","4.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0006-3856-01","NDC","","","facility","both","1","EA","","4.2","4.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0039-33","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0039-33","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0039-33","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.67","11.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.68","11.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.68","11.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.69","11.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.72","11.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.72","11.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.72","11.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.67","11.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Idamycin Pfs: 1 Vial, Single-Dose In 1 Carton (0013-2586-91)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0013-2586-91","NDC","","","facility","both","1","EA","","82.76","82.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Idamycin Pfs: 1 Vial, Single-Dose In 1 Carton (0013-2576-91)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0013-2576-91","NDC","","","facility","both","1","EA","","70.94","70.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Idamycin Pfs: 1 Vial, Single-Dose In 1 Carton (0013-2576-05)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0013-2576-05","NDC","","","facility","both","1","EA","","80.7","80.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atgam: 5 Ampule In 1 Carton (0009-7224-02)  / 5 Ml In 1 Ampule (0009-7224-01)","636","RC","0009-7224-02","NDC","","","facility","both","1","EA","","5315.68","5315.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.67","11.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.67","11.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.67","11.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0023-6082-01","NDC","","","facility","both","1","EA","","30.17","30.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ozurdex: 1 Pouch In 1 Carton (0023-3348-07)  / 1 Implant In 1 Pouch","636","RC","0023-3348-07","NDC","","","facility","both","1","EA","","353.06","353.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ozurdex: 1 Pouch In 1 Carton (0023-3348-07)  / 1 Implant In 1 Pouch","636","RC","0023-3348-07","NDC","","","facility","both","1","EA","","353.06","353.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ozurdex: 1 Pouch In 1 Carton (0023-3348-07)  / 1 Implant In 1 Pouch","636","RC","0023-3348-07","NDC","","","facility","both","1","EA","","353.06","353.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.62","11.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.65","11.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Botox: 1 Vial In 1 Carton (0023-1145-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","0023-1145-01","NDC","","","facility","both","1","EA","","11.66","11.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atgam: 5 Ampule In 1 Carton (0009-7224-02)  / 5 Ml In 1 Ampule (0009-7224-01)","636","RC","0009-7224-02","NDC","","","facility","both","1","EA","","5378","5378","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-7224-01","NDC","","","facility","both","1","EA","","5367.88","5367.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Depo-Testosterone: 1 Vial In 1 Carton (0009-0417-01)  / 1 Ml In 1 Vial","636","RC","0009-0417-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Depo-Estradiol: 1 Vial In 1 Carton (0009-0271-01)  / 5 Ml In 1 Vial","636","RC","0009-0271-01","NDC","","","facility","both","1","EA","","72.36","72.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Depo-Estradiol: 1 Vial In 1 Carton (0009-0271-01)  / 5 Ml In 1 Vial","636","RC","0009-0271-01","NDC","","","facility","both","1","EA","","80.54","80.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0047-27","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0047-27","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0047-27","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0698-01)  / 16 Ml In 1 Vial","636","RC","0009-0698-01","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0047-25","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0047-25","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 25 Vial In 1 Carton (0009-0047-22)  / 2 Ml In 1 Vial (0009-0047-25)","636","RC","0009-0047-22","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 25 Vial In 1 Carton (0009-0047-22)  / 2 Ml In 1 Vial (0009-0047-25)","636","RC","0009-0047-22","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 25 Vial In 1 Carton (0009-0047-22)  / 2 Ml In 1 Vial (0009-0047-25)","636","RC","0009-0047-22","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0047-25","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0698-01)  / 16 Ml In 1 Vial","636","RC","0009-0698-01","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0728-05","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Corvert: 1 Vial, Single-Dose In 1 Carton (0009-3794-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0009-3794-01","NDC","","","facility","both","1","EA","","146.16","146.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Corvert: 1 Vial, Single-Dose In 1 Carton (0009-3794-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0009-3794-01","NDC","","","facility","both","1","EA","","146.16","146.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Depo-Medrol: 1 Vial, Single-Dose In 1 Package (0009-3073-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","0009-3073-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Depo-Medrol: 1 Vial, Single-Dose In 1 Package (0009-3073-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","0009-3073-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Depo-Medrol: 1 Vial, Single-Dose In 1 Package (0009-3073-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","0009-3073-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0902-11","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0870-21","NDC","","","facility","both","1","EA","","2.84","2.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Cortef: 1 Vial In 1 Carton (0009-0825-01)  / 2 Ml In 1 Vial","636","RC","0009-0825-01","NDC","","","facility","both","1","EA","","14.19","14.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-0775-20","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0758-01)  / 8 Ml In 1 Vial","636","RC","0009-0758-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Solu-Medrol: 1 Vial In 1 Carton (0009-0758-01)  / 8 Ml In 1 Vial","636","RC","0009-0758-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Depo-Provera: 1 Vial In 1 Carton (0009-0746-30)  / 1 Ml In 1 Vial","636","RC","0009-0746-30","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Depo-Provera: 1 Vial In 1 Carton (0009-0746-30)  / 1 Ml In 1 Vial","636","RC","0009-0746-30","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0009-7224-01","NDC","","","facility","both","1","EA","","5445.43","5445.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33)  / 10 Ml In 1 Vial, Glass","636","RC","0088-2220-33","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33)  / 10 Ml In 1 Vial, Glass","636","RC","0088-2220-33","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Noxafil: 1 Vial, Glass In 1 Carton (0085-4331-01)  / 16.7 Ml In 1 Vial, Glass","636","RC","0085-4331-01","NDC","","","facility","both","1","EA","","851.02","851.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cosentyx: 5 Ml In 1 Vial, Glass (0078-1168-61)","636","RC","0078-1168-61","NDC","","","facility","both","1","EA","","30.91","30.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cosentyx: 5 Ml In 1 Vial, Glass (0078-1168-61)","636","RC","0078-1168-61","NDC","","","facility","both","1","EA","","31.14","31.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Ml In 1 Bottle (0093-2026-31)","636","RC","0093-2026-31","NDC","","","facility","both","1","EA","","13.86","13.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ilaris: 1 Vial, Single-Use In 1 Carton (0078-0734-61)  / 1 Ml In 1 Vial, Single-Use","636","RC","0078-0734-61","NDC","","","facility","both","1","EA","","188.14","188.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0078-0797-61","NDC","","","facility","both","1","EA","","379.23","379.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0078-0467-61","NDC","","","facility","both","1","EA","","57.63","57.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0078-0804-61","NDC","","","facility","both","1","EA","","378.62","378.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0811-81)  *  6 Ml In 1 Vial (0078-0790-61)  *  2 Ml In 1 Syringe","636","RC","0078-0811-81","NDC","","","facility","both","1","EA","","578.97","578.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leqvio: 1 Syringe, Glass In 1 Carton (0078-1000-60)  / 1.5 Ml In 1 Syringe, Glass","636","RC","0078-1000-60","NDC","","","facility","both","1","EA","","21.43","21.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leqvio: 1 Syringe, Glass In 1 Carton (0078-1000-60)  / 1.5 Ml In 1 Syringe, Glass","636","RC","0078-1000-60","NDC","","","facility","both","1","EA","","21.62","21.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triesence: 1 Blister Pack In 1 Carton (0078-0897-78)  / 1 Vial, Glass In 1 Blister Pack / 1 Ml In 1 Vial, Glass","636","RC","0078-0897-78","NDC","","","facility","both","1","EA","","33.3","33.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triesence: 1 Blister Pack In 1 Carton (0078-0897-78)  / 1 Vial, Glass In 1 Blister Pack / 1 Ml In 1 Vial, Glass","636","RC","0078-0897-78","NDC","","","facility","both","1","EA","","33.65","33.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adakveo: 10 Ml In 1 Vial, Glass (0078-0883-61)","636","RC","0078-0883-61","NDC","","","facility","both","1","EA","","220.76","220.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adakveo: 10 Ml In 1 Vial, Glass (0078-0883-61)","636","RC","0078-0883-61","NDC","","","facility","both","1","EA","","220.76","220.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adakveo: 10 Ml In 1 Vial, Glass (0078-0883-61)","636","RC","0078-0883-61","NDC","","","facility","both","1","EA","","220.76","220.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adakveo: 10 Ml In 1 Vial, Glass (0078-0883-61)","636","RC","0078-0883-61","NDC","","","facility","both","1","EA","","220.77","220.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0825-81)  *  2 Ml In 1 Syringe *  6 Ml In 1 Vial (0078-0804-61)","636","RC","0078-0825-81","NDC","","","facility","both","1","EA","","341.65","341.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0825-81)  *  2 Ml In 1 Syringe *  6 Ml In 1 Vial (0078-0804-61)","636","RC","0078-0825-81","NDC","","","facility","both","1","EA","","358.21","358.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0825-81)  *  2 Ml In 1 Syringe *  6 Ml In 1 Vial (0078-0804-61)","636","RC","0078-0825-81","NDC","","","facility","both","1","EA","","378.59","378.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0825-81)  *  2 Ml In 1 Syringe *  6 Ml In 1 Vial (0078-0804-61)","636","RC","0078-0825-81","NDC","","","facility","both","1","EA","","378.62","378.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81)  *  6 Ml In 1 Vial (0078-0797-61)  *  2 Ml In 1 Syringe","636","RC","0078-0818-81","NDC","","","facility","both","1","EA","","309.39","309.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81)  *  6 Ml In 1 Vial (0078-0797-61)  *  2 Ml In 1 Syringe","636","RC","0078-0818-81","NDC","","","facility","both","1","EA","","310.31","310.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81)  *  6 Ml In 1 Vial (0078-0797-61)  *  2 Ml In 1 Syringe","636","RC","0078-0818-81","NDC","","","facility","both","1","EA","","352.18","352.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81)  *  6 Ml In 1 Vial (0078-0797-61)  *  2 Ml In 1 Syringe","636","RC","0078-0818-81","NDC","","","facility","both","1","EA","","379.23","379.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sandostatin Lar Depot: 1 Kit In 1 Kit (0078-0818-81)  *  6 Ml In 1 Vial (0078-0797-61)  *  2 Ml In 1 Syringe","636","RC","0078-0818-81","NDC","","","facility","both","1","EA","","379.25","379.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 1 Case In 1 Carton (0115-1694-30)  / 1 Syringe, Glass In 1 Case / .3 Ml In 1 Syringe, Glass","636","RC","0115-1694-30","NDC","","","facility","both","1","EA","","71.41","71.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclosporine Modified: 30 Blister Pack In 1 Carton (0093-9018-65)  / 1 Capsule, Liquid Filled In 1 Blister Pack (0093-9018-19)","636","RC","0093-9018-65","NDC","","","facility","both","1","EA","","1.43","1.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0121-0489-05","NDC","","","facility","both","1","EA","","10.8","10.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hydrochloride: 10 Tray In 1 Case (0121-0489-00)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-0489-05)","636","RC","0121-0489-00","NDC","","","facility","both","1","EA","","12.57","12.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0093-9018-19","NDC","","","facility","both","1","EA","","1.43","1.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 100 Capsule In 1 Bottle (0093-7334-01)","636","RC","0093-7334-01","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0093-6816-19","NDC","","","facility","both","1","EA","","9.12","9.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabergoline: 1 Bottle In 1 Carton (0093-5420-88)  / 8 Tablet In 1 Bottle","636","RC","0093-5420-88","NDC","","","facility","both","1","EA","","3.24","3.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0078-0422-61","NDC","","","facility","both","1","EA","","17.84","17.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1306-01","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1306-01","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1306-01","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1305-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1305-01)","636","RC","0069-1305-10","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1305-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1305-01)","636","RC","0069-1305-10","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1305-01","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1305-01","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1306-01","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1305-01","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Inflectra: 1 Vial, Single-Use In 1 Carton (0069-0809-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","0069-0809-01","NDC","","","facility","both","1","EA","","78.17","78.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Inflectra: 1 Vial, Single-Use In 1 Carton (0069-0809-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","0069-0809-01","NDC","","","facility","both","1","EA","","88.84","88.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abrysvo: 1 Tray In 1 Carton (0069-0344-01)  / 1 Kit In 1 Tray (0069-0344-21)  *  .5 Ml In 1 Vial, Glass (0069-0207-01)  *  .69 Ml In 1 Syringe, Glass (0069-0250-01)","636","RC","0069-0344-01","NDC","","","facility","both","1","EA","","437.14","437.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1305-01","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nyvepria: 1 Carton In 1 Carton (0069-0324-01)  / 1 Syringe In 1 Carton / .6 Ml In 1 Syringe","636","RC","0069-0324-01","NDC","","","facility","both","1","EA","","264.38","264.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1306-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1306-01)","636","RC","0069-1306-10","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1307-01","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1309-01","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1309-01","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1309-01","NDC","","","facility","both","1","EA","","4.93","4.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1309-01","NDC","","","facility","both","1","EA","","7.5","7.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1309-01","NDC","","","facility","both","1","EA","","16.32","16.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1309-01","NDC","","","facility","both","1","EA","","17.39","17.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1308-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1308-01)","636","RC","0069-1308-10","NDC","","","facility","both","1","EA","","1.2","1.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1308-01","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1308-01","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1308-01","NDC","","","facility","both","1","EA","","2.2","2.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1308-01","NDC","","","facility","both","1","EA","","4.29","4.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1307-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1307-01)","636","RC","0069-1307-10","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retacrit: 10 Vial, Single-Dose In 1 Carton (0069-1307-10)  / 1 Ml In 1 Vial, Single-Dose (0069-1307-01)","636","RC","0069-1307-10","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1307-01","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1307-01","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-1308-01","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nyvepria: 1 Carton In 1 Carton (0069-0324-01)  / 1 Syringe In 1 Carton / .6 Ml In 1 Syringe","636","RC","0069-0324-01","NDC","","","facility","both","1","EA","","291.48","291.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nyvepria: 1 Carton In 1 Carton (0069-0324-01)  / 1 Syringe In 1 Carton / .6 Ml In 1 Syringe","636","RC","0069-0324-01","NDC","","","facility","both","1","EA","","315.33","315.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triesence: 1 Blister Pack In 1 Carton (0065-0543-01)  / 1 Vial, Glass In 1 Blister Pack / 1 Ml In 1 Vial, Glass","636","RC","0065-0543-01","NDC","","","facility","both","1","EA","","6.7","6.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 10 Blister Pack In 1 Carton (0054-8740-25)  / 10 Tablet In 1 Blister Pack","636","RC","0054-8740-25","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 10 Blister Pack In 1 Carton (0054-8739-25)  / 10 Tablet In 1 Blister Pack","636","RC","0054-8739-25","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 10 Blister Pack In 1 Carton (0054-8724-25)  / 10 Tablet In 1 Blister Pack","636","RC","0054-8724-25","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triesence: 1 Blister Pack In 1 Carton (0065-0543-01)  / 1 Vial, Glass In 1 Blister Pack / 1 Ml In 1 Vial, Glass","636","RC","0065-0543-01","NDC","","","facility","both","1","EA","","6.49","6.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ruxience: 1 Vial, Single-Use In 1 Carton (0069-0249-01)  / 50 Ml In 1 Vial, Single-Use","636","RC","0069-0249-01","NDC","","","facility","both","1","EA","","98.89","98.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"1 VIAL in 1 CARTON (0069-0248-01)  / 100 mL in 1 VIAL","636","RC","0069-0248-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ruxience: 1 Vial, Single-Use In 1 Carton (0069-0238-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","0069-0238-01","NDC","","","facility","both","1","EA","","96.08","96.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"1 VIAL in 1 CARTON (0069-0234-01)  / 50 mL in 1 VIAL","636","RC","0069-0234-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-0217-01","NDC","","","facility","both","1","EA","","9.9","9.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-0207-01","NDC","","","facility","both","1","EA","","445.81","445.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-0059-04","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Container (0069-0059-03)  / 1 Ml In 1 Vial (0069-0059-04)","636","RC","0069-0059-03","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-0043-02","NDC","","","facility","both","1","EA","","3.96","3.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rifadin Iv: 1 Vial, Glass In 1 Carton (0068-0597-01)  / 10 Ml In 1 Vial, Glass","636","RC","0068-0597-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (0069-1542-20)  / 100 Ml In 1 Vial, Multi-Dose","636","RC","0069-1542-20","NDC","","","facility","both","1","EA","","4.89","4.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-2432-01","NDC","","","facility","both","1","EA","","192","192","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3663-03)  *  1.5 Ml In 1 Syringe *  1 Ml In 1 Packet","636","RC","0074-3663-03","NDC","","","facility","both","1","EA","","2847.12","2847.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3663-03)  *  1.5 Ml In 1 Syringe *  1 Ml In 1 Packet","636","RC","0074-3663-03","NDC","","","facility","both","1","EA","","2898.36","2898.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3663-03)  *  1.5 Ml In 1 Syringe *  1 Ml In 1 Packet","636","RC","0074-3663-03","NDC","","","facility","both","1","EA","","2989.23","2989.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3663-03)  *  1.5 Ml In 1 Syringe *  1 Ml In 1 Packet","636","RC","0074-3663-03","NDC","","","facility","both","1","EA","","2989.26","2989.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3663-03)  *  1.5 Ml In 1 Syringe *  1 Ml In 1 Packet","636","RC","0074-3663-03","NDC","","","facility","both","1","EA","","2989.47","2989.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3663-03)  *  1.5 Ml In 1 Syringe *  1 Ml In 1 Packet","636","RC","0074-3663-03","NDC","","","facility","both","1","EA","","2989.47","2989.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3641-03)  *  1 Ml In 1 Syringe *  1 Ml In 1 Packet","636","RC","0074-3641-03","NDC","","","facility","both","1","EA","","2885.92","2885.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3641-03)  *  1 Ml In 1 Syringe *  1 Ml In 1 Packet","636","RC","0074-3641-03","NDC","","","facility","both","1","EA","","2951.4","2951.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3641-03)  *  1 Ml In 1 Syringe *  1 Ml In 1 Packet","636","RC","0074-3641-03","NDC","","","facility","both","1","EA","","2989.3","2989.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3473-03)  *  1 Swab In 1 Packet *  1.5 Ml In 1 Syringe","636","RC","0074-3473-03","NDC","","","facility","both","1","EA","","3218.22","3218.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3473-03)  *  1 Swab In 1 Packet *  1.5 Ml In 1 Syringe","636","RC","0074-3473-03","NDC","","","facility","both","1","EA","","3218.22","3218.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3473-03)  *  1 Swab In 1 Packet *  1.5 Ml In 1 Syringe","636","RC","0074-3473-03","NDC","","","facility","both","1","EA","","3312.29","3312.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3346-03)  *  1.5 Ml In 1 Syringe *  1 Swab In 1 Packet","636","RC","0074-3346-03","NDC","","","facility","both","1","EA","","3392.74","3392.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3346-03)  *  1.5 Ml In 1 Syringe *  1 Swab In 1 Packet","636","RC","0074-3346-03","NDC","","","facility","both","1","EA","","3416.98","3416.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3346-03)  *  1.5 Ml In 1 Syringe *  1 Swab In 1 Packet","636","RC","0074-3346-03","NDC","","","facility","both","1","EA","","3562.2","3562.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3346-03)  *  1.5 Ml In 1 Syringe *  1 Swab In 1 Packet","636","RC","0074-3346-03","NDC","","","facility","both","1","EA","","3562.22","3562.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lupron Depot: 1 Kit In 1 Carton (0074-3641-03)  *  1 Ml In 1 Syringe *  1 Ml In 1 Packet","636","RC","0074-3641-03","NDC","","","facility","both","1","EA","","2894.55","2894.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zortress: 60 Blister Pack In 1 Box (0078-0422-20)  / 1 Tablet In 1 Blister Pack (0078-0422-61)","636","RC","0078-0422-20","NDC","","","facility","both","1","EA","","17.77","17.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0078-0414-61","NDC","","","facility","both","1","EA","","17.85","17.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simulect: 1 Vial, Single-Use In 1 Carton (0078-0331-84)  / 5 Ml In 1 Vial, Single-Use","636","RC","0078-0331-84","NDC","","","facility","both","1","EA","","7978.98","7978.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simulect: 1 Vial, Single-Use In 1 Carton (0078-0331-84)  / 5 Ml In 1 Vial, Single-Use","636","RC","0078-0331-84","NDC","","","facility","both","1","EA","","8024.85","8024.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neoral: 1 Bottle In 1 Carton (0078-0274-22)  / 50 Ml In 1 Bottle","636","RC","0078-0274-22","NDC","","","facility","both","1","EA","","17.2","17.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0078-0248-61","NDC","","","facility","both","1","EA","","18.5","18.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0078-0109-61","NDC","","","facility","both","1","EA","","28.44","28.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Skyrizi: 1 Vial, Single-Dose In 1 Carton (0074-5015-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0074-5015-01","NDC","","","facility","both","1","EA","","29.45","29.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Skyrizi: 1 Vial, Single-Dose In 1 Carton (0074-5015-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0074-5015-01","NDC","","","facility","both","1","EA","","29.67","29.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Skyrizi: 1 Vial, Single-Dose In 1 Carton (0074-5015-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0074-5015-01","NDC","","","facility","both","1","EA","","30.23","30.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Skyrizi: 1 Vial, Single-Dose In 1 Carton (0074-5015-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0074-5015-01","NDC","","","facility","both","1","EA","","30.52","30.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zemplar: 25 Vial, Single-Dose In 1 Tray (0074-4637-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","0074-4637-01","NDC","","","facility","both","1","EA","","4.1","4.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gengraf: 5 Blister Pack In 1 Carton (0074-3109-32)  / 6 Capsule In 1 Blister Pack","636","RC","0074-3109-32","NDC","","","facility","both","1","EA","","6.12","6.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duopa: 7 Cartridge In 1 Carton (0074-3012-07)  / 100 Ml In 1 Cartridge","636","RC","0074-3012-07","NDC","","","facility","both","1","EA","","405.54","405.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zithromax: 1 Bottle In 1 Carton (0069-3120-19)  / 15 Ml In 1 Bottle","636","RC","0069-3120-19","NDC","","","facility","both","1","EA","","42.11","42.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (0069-3030-20)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0069-3030-20","NDC","","","facility","both","1","EA","","12.4","12.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (0069-3030-20)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0069-3030-20","NDC","","","facility","both","1","EA","","13.9","13.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Comirnaty: 10 Syringe, Glass In 1 Carton (0069-2528-10)  / .418 Ml In 1 Syringe, Glass (0069-2528-01)","636","RC","0069-2528-10","NDC","","","facility","both","1","EA","","163.4","163.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-2528-01","NDC","","","facility","both","1","EA","","165.25","165.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-2432-01","NDC","","","facility","both","1","EA","","192","192","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0069-6001-10","NDC","","","facility","both","1","EA","","20.88","20.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xalkori: 60 Capsule In 1 Bottle (0069-8140-20)","636","RC","0069-8140-20","NDC","","","facility","both","1","EA","","713.2","713.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duopa: 7 Cartridge In 1 Carton (0074-3012-07)  / 100 Ml In 1 Cartridge","636","RC","0074-3012-07","NDC","","","facility","both","1","EA","","405.54","405.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zemplar: 25 Vial, Single-Dose In 1 Tray (0074-1658-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","0074-1658-01","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gengraf: 3 Blister Pack In 1 Carton (0074-3108-32)  / 10 Capsule In 1 Blister Pack","636","RC","0074-3108-32","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-11)  / 50 Ml In 1 Bag","636","RC","0338-0049-11","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 100 Tablet, Coated In 1 Bottle (0527-2963-37)","636","RC","0527-2963-37","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 100 Tablet, Coated In 1 Bottle (0527-2961-37)","636","RC","0527-2961-37","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hcl: 100 Tablet, Film Coated In 1 Bottle, Plastic (0536-1214-29)","636","RC","0536-1214-29","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-6710-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0517-5602-25)  / 2 Ml In 1 Vial, Single-Dose (0517-5602-01)","636","RC","0517-5602-25","NDC","","","facility","both","1","EA","","9.32","9.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-5602-01","NDC","","","facility","both","1","EA","","9.99","9.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0517-5601-25)  / 1 Ml In 1 Vial, Single-Dose (0517-5601-01)","636","RC","0517-5601-25","NDC","","","facility","both","1","EA","","17.26","17.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitroglycerin: 25 Vial, Single-Dose In 1 Tray (0517-4810-25)  / 10 Ml In 1 Vial, Single-Dose (0517-4810-01)","636","RC","0517-4810-25","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-4810-01","NDC","","","facility","both","1","EA","","2.2","2.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Chloride: 10 Vial, Glass In 1 Box (0517-6710-10)  / 10 Ml In 1 Vial, Glass","636","RC","0517-6710-10","NDC","","","facility","both","1","EA","","19.15","19.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Multi-Dose In 1 Tray (0517-4620-25)  / 20 Ml In 1 Vial, Multi-Dose","636","RC","0517-4620-25","NDC","","","facility","both","1","EA","","3.88","3.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Multi-Dose In 1 Tray (0517-4620-25)  / 20 Ml In 1 Vial, Multi-Dose","636","RC","0517-4620-25","NDC","","","facility","both","1","EA","","5.2","5.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Multi-Dose In 1 Tray (0517-4620-25)  / 20 Ml In 1 Vial, Multi-Dose","636","RC","0517-4620-25","NDC","","","facility","both","1","EA","","5.23","5.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Multi-Dose In 1 Tray (0517-4605-25)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","0517-4605-25","NDC","","","facility","both","1","EA","","7.21","7.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Multi-Dose In 1 Tray (0517-4605-25)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","0517-4605-25","NDC","","","facility","both","1","EA","","7.23","7.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Multi-Dose In 1 Tray (0517-4605-25)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","0517-4605-25","NDC","","","facility","both","1","EA","","7.27","7.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4602-25)  / 2 Ml In 1 Vial, Single-Dose","636","RC","0517-4602-25","NDC","","","facility","both","1","EA","","7.18","7.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-7504-01","NDC","","","facility","both","1","EA","","12.24","12.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Droperidol: 25 Vial, Single-Dose In 1 Tray (0517-9702-25)  / 2 Ml In 1 Vial, Single-Dose","636","RC","0517-9702-25","NDC","","","facility","both","1","EA","","8.77","8.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-9702-01","NDC","","","facility","both","1","EA","","4.82","4.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-9120-01","NDC","","","facility","both","1","EA","","3.4","3.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 25 Vial, Glass In 1 Tray (0517-7604-25)  / 4 Ml In 1 Vial, Glass","636","RC","0517-7604-25","NDC","","","facility","both","1","EA","","7.01","7.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-7604-01","NDC","","","facility","both","1","EA","","6.94","6.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 25 Vial, Glass In 1 Tray (0517-7504-25)  / 4 Ml In 1 Vial, Glass","636","RC","0517-7504-25","NDC","","","facility","both","1","EA","","12.99","12.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 1 Vial, Single-Dose In 1 Carton (0548-5400-00)  / 1 Ml In 1 Vial, Single-Dose","636","RC","0548-5400-00","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (0548-5602-00)  / .4 Ml In 1 Syringe","636","RC","0548-5602-00","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rhogam Ultra-Filtered Plus: 1 Pouch In 1 Carton (0562-7805-01)  / 1 Injection, Solution In 1 Pouch (0562-7805-00)","636","RC","0562-7805-01","NDC","","","facility","both","1","EA","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0562-7805-00","NDC","","","facility","both","1","EA","","148.66","148.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neostigmine Methylsulfate: 10 Carton In 1 Package (0548-9602-00)  / 1 Vial, Multi-Dose In 1 Carton / 10 Ml In 1 Vial, Multi-Dose","636","RC","0548-9602-00","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cortrosyn: 10 Vial In 1 Carton (0548-5900-00)  / 1 Ml In 1 Vial","636","RC","0548-5900-00","NDC","","","facility","both","1","EA","","28.86","28.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cortrosyn: 10 Vial In 1 Carton (0548-5900-00)  / 1 Ml In 1 Vial","636","RC","0548-5900-00","NDC","","","facility","both","1","EA","","33.2","33.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 1 Vial In 1 Carton (0548-5608-00)  / 3 Ml In 1 Vial","636","RC","0548-5608-00","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4602-25)  / 2 Ml In 1 Vial, Single-Dose","636","RC","0517-4602-25","NDC","","","facility","both","1","EA","","7.39","7.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4602-25)  / 2 Ml In 1 Vial, Single-Dose","636","RC","0517-4602-25","NDC","","","facility","both","1","EA","","7.46","7.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4601-25)  / 1 Ml In 1 Vial, Single-Dose","636","RC","0517-4601-25","NDC","","","facility","both","1","EA","","8","8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cresemba: 10 Carton In 1 Carton (0469-0420-99)  / 1 Vial, Single-Dose In 1 Carton (0469-0420-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0469-0420-99","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cresemba: 1 Vial, Single-Dose In 1 Carton (0469-0420-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0469-0420-01","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cresemba: 1 Vial, Single-Dose In 1 Carton (0469-0420-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0469-0420-01","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avycaz: 10 Vial, Single-Dose In 1 Carton (0456-2700-10)  / 1 Powder, For Solution In 1 Vial, Single-Dose (0456-2700-01)","636","RC","0456-2700-10","NDC","","","facility","both","1","EA","","148.73","148.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0456-2700-01","NDC","","","facility","both","1","EA","","161.29","161.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0456-2700-01","NDC","","","facility","both","1","EA","","163.48","163.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyloy: 1 Vial In 1 Box (0469-3425-10)  / 5 Ml In 1 Vial","636","RC","0469-3425-10","NDC","","","facility","both","1","EA","","44.8","44.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prograf: 1 Bottle In 1 Carton (0469-0657-73)  / 100 Capsule, Gelatin Coated In 1 Bottle","636","RC","0469-0657-73","NDC","","","facility","both","1","EA","","11.52","11.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ambisome: 12.5 Ml In 1 Vial, Single-Dose (0469-3051-30)","636","RC","0469-3051-30","NDC","","","facility","both","1","EA","","32.22","32.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prograf: 10 Ampule In 1 Box (0469-3016-01)  / 1 Ml In 1 Ampule","636","RC","0469-3016-01","NDC","","","facility","both","1","EA","","68.7","68.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prograf: 10 Ampule In 1 Box (0469-3016-01)  / 1 Ml In 1 Ampule","636","RC","0469-3016-01","NDC","","","facility","both","1","EA","","73.18","73.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ambisome: 12.5 Ml In 1 Vial, Single-Dose (0469-3051-30)","636","RC","0469-3051-30","NDC","","","facility","both","1","EA","","32.42","32.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-22)  / 2 Ml In 1 Vial, Single-Dose (0409-9094-12)","636","RC","0409-9094-22","NDC","","","facility","both","1","EA","","3.82","3.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-9094-18","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-9094-16","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-9094-12","NDC","","","facility","both","1","EA","","2.02","2.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-25)  / 5 Ml In 1 Vial, Single-Dose (0409-9094-18)","636","RC","0409-9094-25","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride And Epinephrine: 25 Vial, Single-Dose In 1 Tray (0409-9045-17)  / 30 Ml In 1 Vial, Single-Dose (0409-9045-16)","636","RC","0409-9045-17","NDC","","","facility","both","1","EA","","2.79","2.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 POUCH in 1 CASE (0409-7985-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","636","RC","0409-7985-09","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 10 Ampule In 1 Cello Pack (0409-9093-32)  / 2 Ml In 1 Ampule (0409-9093-37)","636","RC","0409-9093-32","NDC","","","facility","both","1","EA","","2.33","2.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 25 Vial, Single-Dose In 1 Tray (0409-9094-31)  / 20 Ml In 1 Vial, Single-Dose (0409-9094-16)","636","RC","0409-9094-31","NDC","","","facility","both","1","EA","","1.6","1.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-9094-41","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0456-0600-01","NDC","","","facility","both","1","EA","","5.59","5.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0456-0600-01","NDC","","","facility","both","1","EA","","5.63","5.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-9566-01","NDC","","","facility","both","1","EA","","2.84","2.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Box (0409-9558-05)  / 5 Ml In 1 Vial, Multi-Dose (0409-9558-11)","636","RC","0409-9558-05","NDC","","","facility","both","1","EA","","2.29","2.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-9158-50","NDC","","","facility","both","1","EA","","4.25","4.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-9158-31","NDC","","","facility","both","1","EA","","4.27","4.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-9104-21","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 25 Carton In 1 Tray (0409-9094-61)  / 1 Vial, Single-Dose In 1 Carton / 50 Ml In 1 Vial, Single-Dose (0409-9094-41)","636","RC","0409-9094-61","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 25 Vial, Glass In 1 Tray (0517-1001-25)  / 1 Ml In 1 Vial, Glass (0517-1001-01)","636","RC","0517-1001-25","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-1001-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-0901-01","NDC","","","facility","both","1","EA","","10.57","10.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylergonovine Maleate: 20 Vial, Single-Dose In 1 Carton (0517-0740-20)  / 1 Ml In 1 Vial, Single-Dose (0517-0740-01)","636","RC","0517-0740-20","NDC","","","facility","both","1","EA","","34.06","34.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-0740-01","NDC","","","facility","both","1","EA","","36.55","36.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-1004-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Betamethasone Sodium Phosphate And Betamethasone Acetate: 1 Vial, Multi-Dose In 1 Carton (0517-0720-01)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","0517-0720-01","NDC","","","facility","both","1","EA","","8.32","8.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Estradiol Valerate: 1 Vial, Multi-Dose In 1 Carton (0517-0440-01)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","0517-0440-01","NDC","","","facility","both","1","EA","","9.62","9.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 25 VIAL, SINGLE-DOSE in 1 TRAY (0517-0401-25)  / 1 mL in 1 VIAL, SINGLE-DOSE","636","RC","0517-0401-25","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-0381-01","NDC","","","facility","both","1","EA","","4.03","4.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-0381-01","NDC","","","facility","both","1","EA","","4.05","4.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-0381-01","NDC","","","facility","both","1","EA","","4.06","4.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-0374-01","NDC","","","facility","both","1","EA","","2.85","2.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-0374-01","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-0374-01","NDC","","","facility","both","1","EA","","3.33","3.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fomepizole: 1 Vial In 1 Carton (0517-0710-01)  / 1.5 Ml In 1 Vial","636","RC","0517-0710-01","NDC","","","facility","both","1","EA","","9.25","9.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 25 VIAL, SINGLE-DOSE in 1 TRAY (0517-1010-25)  / 1 mL in 1 VIAL, SINGLE-DOSE","636","RC","0517-1010-25","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-1020-01","NDC","","","facility","both","1","EA","","2.18","2.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4601-25)  / 1 Ml In 1 Vial, Single-Dose","636","RC","0517-4601-25","NDC","","","facility","both","1","EA","","8.53","8.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 25 Vial, Single-Dose In 1 Tray (0517-4601-25)  / 1 Ml In 1 Vial, Single-Dose","636","RC","0517-4601-25","NDC","","","facility","both","1","EA","","8.58","8.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01)  / 20 Ml In 1 Vial","636","RC","0517-4300-01","NDC","","","facility","both","1","EA","","18.2","18.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01)  / 20 Ml In 1 Vial","636","RC","0517-4300-01","NDC","","","facility","both","1","EA","","18.24","18.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01)  / 20 Ml In 1 Vial","636","RC","0517-4300-01","NDC","","","facility","both","1","EA","","21.26","21.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel Protein Bound Particles Albumin Bound: 1 Vial In 1 Carton (0517-4300-01)  / 20 Ml In 1 Vial","636","RC","0517-4300-01","NDC","","","facility","both","1","EA","","21.51","21.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0517-4002-01","NDC","","","facility","both","1","EA","","29.07","29.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venofer: 10 Vial, Single-Dose In 1 Box (0517-2340-10)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0517-2340-10","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venofer: 10 Vial, Single-Dose In 1 Box (0517-2340-10)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0517-2340-10","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venofer: 10 Vial, Single-Dose In 1 Box (0517-2340-10)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0517-2340-10","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venofer: 1 Vial, Single-Dose In 1 Box (0517-2340-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0517-2340-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venofer: 1 Vial, Single-Dose In 1 Box (0517-2340-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0517-2340-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide Sodium: 1 Vial In 1 Carton (0517-1820-01)  / 18 Ml In 1 Vial","636","RC","0517-1820-01","NDC","","","facility","both","1","EA","","46.81","46.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide Sodium: 1 Vial In 1 Carton (0517-1820-01)  / 18 Ml In 1 Vial","636","RC","0517-1820-01","NDC","","","facility","both","1","EA","","141.49","141.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin: 25 Vial, Single-Dose In 1 Carton (0517-1020-25)  / 1 Ml In 1 Vial, Single-Dose (0517-1020-01)","636","RC","0517-1020-25","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0480-3290-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0480-3290-01","NDC","","","facility","both","1","EA","","14.07","14.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0480-3290-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0480-3290-01","NDC","","","facility","both","1","EA","","14.09","14.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 1 Kit In 1 Carton (0480-1554-08)  *  2 Ml In 1 Vial (0480-9732-01)  *  2 Ml In 1 Syringe (0480-1200-21)","636","RC","0480-1554-08","NDC","","","facility","both","1","EA","","15.11","15.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 1 Kit In 1 Carton (0480-1453-08)  *  2 Ml In 1 Vial (0480-9735-01)  *  2 Ml In 1 Syringe (0480-1200-21)","636","RC","0480-1453-08","NDC","","","facility","both","1","EA","","15.11","15.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 1 Kit In 1 Carton (0480-1453-08)  *  2 Ml In 1 Vial (0480-9735-01)  *  2 Ml In 1 Syringe (0480-1200-21)","636","RC","0480-1453-08","NDC","","","facility","both","1","EA","","15.11","15.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 1 Kit In 1 Carton (0480-1342-08)  *  2 Ml In 1 Vial (0480-9734-01)  *  2 Ml In 1 Syringe (0480-1200-21)","636","RC","0480-1342-08","NDC","","","facility","both","1","EA","","15.11","15.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 1 Kit In 1 Carton (0480-1342-08)  *  2 Ml In 1 Vial (0480-9734-01)  *  2 Ml In 1 Syringe (0480-1200-21)","636","RC","0480-1342-08","NDC","","","facility","both","1","EA","","15.11","15.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 1 Kit In 1 Carton (0480-1232-08)  *  2 Ml In 1 Vial (0480-9733-01)  *  2 Ml In 1 Syringe (0480-1200-21)","636","RC","0480-1232-08","NDC","","","facility","both","1","EA","","15.11","15.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 1 Kit In 1 Carton (0480-1232-08)  *  2 Ml In 1 Vial (0480-9733-01)  *  2 Ml In 1 Syringe (0480-1200-21)","636","RC","0480-1232-08","NDC","","","facility","both","1","EA","","15.11","15.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 1 Kit In 1 Carton (0480-1554-08)  *  2 Ml In 1 Vial (0480-9732-01)  *  2 Ml In 1 Syringe (0480-1200-21)","636","RC","0480-1554-08","NDC","","","facility","both","1","EA","","15.11","15.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0480-9732-01","NDC","","","facility","both","1","EA","","15.11","15.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0480-9734-01","NDC","","","facility","both","1","EA","","15.11","15.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0480-9735-01","NDC","","","facility","both","1","EA","","15.11","15.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuterol Sulfate: 25 Pouch In 1 Carton (0487-9904-25)  / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose","636","RC","0487-9904-25","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuterol Sulfate: 30 Pouch In 1 Carton (0487-9904-01)  / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose","636","RC","0487-9904-01","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuterol Sulfate: 30 Pouch In 1 Carton (0487-9901-30)  / 1 Vial, Single-Dose In 1 Pouch / .5 Ml In 1 Vial, Single-Dose","636","RC","0487-9901-30","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide: 30 Pouch In 1 Carton (0487-9801-01)  / 1 Vial, Single-Dose In 1 Pouch / 2.5 Ml In 1 Vial, Single-Dose","636","RC","0487-9801-01","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide: 6 Pouch In 1 Carton (0487-9701-01)  / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule","636","RC","0487-9701-01","NDC","","","facility","both","1","EA","","16.48","16.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide: 30 Pouch In 1 Carton (0487-9601-30)  / 1 Ampule In 1 Pouch / 2 Ml In 1 Ampule","636","RC","0487-9601-30","NDC","","","facility","both","1","EA","","4.99","4.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide: 6 Pouch In 1 Carton (0487-9601-01)  / 5 Ampule In 1 Pouch / 2 Ml In 1 Ampule","636","RC","0487-9601-01","NDC","","","facility","both","1","EA","","7.34","7.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0487-9501-02","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuterol Sulfate: 30 Pouch In 1 Carton (0487-9501-01)  / 1 Vial, Single-Dose In 1 Pouch / 3 Ml In 1 Vial, Single-Dose","636","RC","0487-9501-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (0487-0201-01)  / 1 Vial, Single-Use In 1 Pouch / 3 Ml In 1 Vial, Single-Use","636","RC","0487-0201-01","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Edisylate: 25 Vial In 1 Package (0713-0351-25)  / 2 Ml In 1 Vial (0713-0351-02)","636","RC","0713-0351-25","NDC","","","facility","both","1","EA","","4.71","4.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0713-0351-02","NDC","","","facility","both","1","EA","","3.97","3.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 1 Vial, Multi-Dose In 1 Carton (0703-9526-01)  / 30 Ml In 1 Vial, Multi-Dose","636","RC","0703-9526-01","NDC","","","facility","both","1","EA","","11.96","11.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3059-72","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-2322-06","NDC","","","facility","both","1","EA","","14.27","14.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aprepitant: 1 Blister Pack In 1 Carton (0781-2321-06)  / 1 Capsule In 1 Blister Pack","636","RC","0781-2321-06","NDC","","","facility","both","1","EA","","15.4","15.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Bottle (0781-2104-01)","636","RC","0781-2104-01","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Bottle (0781-2102-01)","636","RC","0781-2102-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 100 Capsule In 1 Bottle (0781-2067-01)","636","RC","0781-2067-01","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Bottle (0781-2103-01)","636","RC","0781-2103-01","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0703-9514-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0703-9032-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0703-0110-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 1 Vial In 1 Carton (0703-0018-01)  / 50 Ml In 1 Vial","636","RC","0703-0018-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 1 Vial In 1 Carton (0703-0018-01)  / 50 Ml In 1 Vial","636","RC","0703-0018-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 1 Vial In 1 Carton (0703-0018-01)  / 50 Ml In 1 Vial","636","RC","0703-0018-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Caffeine Citrate: 10 Vial In 1 Box (0641-6267-10)  / 3 Ml In 1 Vial (0641-6267-01)","636","RC","0641-6267-10","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0110-03)  / 1 Ml In 1 Vial (0703-0110-01)","636","RC","0703-0110-03","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6267-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Acetate: 1 Vial In 1 Carton (0641-6262-01)  / 50 Ml In 1 Vial","636","RC","0641-6262-01","NDC","","","facility","both","1","EA","","9.99","9.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Acetate: 1 Vial In 1 Carton (0641-6261-01)  / 20 Ml In 1 Vial","636","RC","0641-6261-01","NDC","","","facility","both","1","EA","","5.3","5.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6244-01","NDC","","","facility","both","1","EA","","6.44","6.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (0641-6231-25)  / 20 Ml In 1 Vial, Single-Dose (0641-6231-01)","636","RC","0641-6231-25","NDC","","","facility","both","1","EA","","2.39","2.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6231-01","NDC","","","facility","both","1","EA","","2.19","2.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0703-0113-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0703-0113-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0703-8540-21","NDC","","","facility","both","1","EA","","2.95","2.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludarabine Phosphate: 1 VIAL, SINGLE-DOSE in 1 CARTON (0703-5854-01)  / 2 mL in 1 VIAL, SINGLE-DOSE","636","RC","0703-5854-01","NDC","","","facility","both","1","EA","","93.5","93.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 VIAL, SINGLE-USE in 1 CARTON (0703-5140-01)  / 10 mL in 1 VIAL, SINGLE-USE","636","RC","0703-5140-01","NDC","","","facility","both","1","EA","","5.76","5.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0703-4502-01","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carboplatin: 1 Vial, Multi-Dose In 1 Carton (0703-4239-01)  / 60 Ml In 1 Vial, Multi-Dose","636","RC","0703-4239-01","NDC","","","facility","both","1","EA","","8.36","8.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Palonosetron Hydrochloride: 1 Vial, Single-Use In 1 Carton (0703-4094-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","0703-4094-01","NDC","","","facility","both","1","EA","","12.33","12.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial, Single-Dose In 1 Carton (0703-3678-01)  / 40 Ml In 1 Vial, Single-Dose","636","RC","0703-3678-01","NDC","","","facility","both","1","EA","","2.02","2.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial, Single-Dose In 1 Carton (0703-3675-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0703-3675-01","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial, Single-Dose In 1 Carton (0703-3675-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0703-3675-01","NDC","","","facility","both","1","EA","","1.49","1.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial, Single-Dose In 1 Carton (0703-3671-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","0703-3671-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial, Single-Dose In 1 Carton (0703-3671-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","0703-3671-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Treprostinil: 1 Vial, Multi-Dose In 1 Carton (0703-0696-01)  / 20 Ml In 1 Vial, Multi-Dose","636","RC","0703-0696-01","NDC","","","facility","both","1","EA","","35.76","35.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Treprostinil: 1 Vial, Multi-Dose In 1 Carton (0703-0686-01)  / 20 Ml In 1 Vial, Multi-Dose","636","RC","0703-0686-01","NDC","","","facility","both","1","EA","","35.76","35.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Treprostinil: 1 Vial, Multi-Dose In 1 Carton (0703-0676-01)  / 20 Ml In 1 Vial, Multi-Dose","636","RC","0703-0676-01","NDC","","","facility","both","1","EA","","17.45","17.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Vial, Multi-Dose In 1 Carton (0703-0243-01)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","0703-0243-01","NDC","","","facility","both","1","EA","","2.42","2.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Vial, Single-Dose In 1 Carton (0703-0241-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","0703-0241-01","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0113-03)  / 5 Ml In 1 Vial (0703-0113-01)","636","RC","0703-0113-03","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial In 1 Carton (0703-0113-03)  / 5 Ml In 1 Vial (0703-0113-01)","636","RC","0703-0113-03","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3059-72","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3110-90","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3113-90","NDC","","","facility","both","1","EA","","1.6","1.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3481-70","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3481-70","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3476-94","NDC","","","facility","both","1","EA","","1.73","1.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3465-94","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3454-94","NDC","","","facility","both","1","EA","","2.29","2.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cosyntropin: 10 Vial In 1 Carton (0781-3440-95)  / 1 Ml In 1 Vial (0781-3440-71)","636","RC","0781-3440-95","NDC","","","facility","both","1","EA","","52.86","52.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3486-75","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3440-71","NDC","","","facility","both","1","EA","","52.87","52.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Vial, Single-Use In 1 Carton (0781-3416-94)  / 20 Ml In 1 Vial, Single-Use","636","RC","0781-3416-94","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Vial, Single-Use In 1 Carton (0781-3416-94)  / 20 Ml In 1 Vial, Single-Use","636","RC","0781-3416-94","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3411-70","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial, Glass In 1 Package (0781-3408-95)  / 1 Injection, Powder, For Solution In 1 Vial, Glass (0781-3408-80)","636","RC","0781-3408-95","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3408-80","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3440-71","NDC","","","facility","both","1","EA","","50.1","50.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0781-3491-94)","636","RC","0781-3491-94","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone: 100 TABLET in 1 BOTTLE (0781-5022-01) ","636","RC","0781-5022-01","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3555-10","NDC","","","facility","both","1","EA","","2.06","2.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (0781-3545-25)  / 1 Ml In 1 Vial, Multi-Dose (0781-3545-10)","636","RC","0781-3545-25","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3545-10","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (0781-3540-25)  / 10 Ml In 1 Vial, Multi-Dose (0781-3540-10)","636","RC","0781-3540-25","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3540-10","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0781-3531-91","NDC","","","facility","both","1","EA","","13.26","13.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0781-3531-91","NDC","","","facility","both","1","EA","","13.28","13.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0781-3531-91","NDC","","","facility","both","1","EA","","13.28","13.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0781-3531-91","NDC","","","facility","both","1","EA","","13.28","13.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0781-3531-91","NDC","","","facility","both","1","EA","","13.3","13.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial, Single-Dose In 1 Carton (0781-3531-91)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0781-3531-91","NDC","","","facility","both","1","EA","","16.6","16.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0781-3491-94)","636","RC","0781-3491-94","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0781-3491-94)","636","RC","0781-3491-94","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial, Glass In 1 Package (0781-3407-95)  / 1 Injection, Powder, For Solution In 1 Vial, Glass (0781-3407-78)","636","RC","0781-3407-95","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone Sodium: 1 Vial, Single-Use In 1 Carton (0781-3208-85)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Use","636","RC","0781-3208-85","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 1 Vial, Pharmacy Bulk Package In 1 Carton (0781-3180-94)  / 250 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","0781-3180-94","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 1 Vial In 1 Carton (0781-3159-72)  / 2 Ml In 1 Vial","636","RC","0781-3159-72","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 1 Vial In 1 Carton (0781-3159-72)  / 2 Ml In 1 Vial","636","RC","0781-3159-72","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 10 Vial, Glass In 1 Carton (0781-3156-95)  / 100 Ml In 1 Vial, Glass (0781-3156-06)","636","RC","0781-3156-95","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3209-90","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ferumoxytol: 1 Vial, Single-Dose In 1 Carton (0781-3154-01)  / 17 Ml In 1 Vial, Single-Dose","636","RC","0781-3154-01","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3114-91","NDC","","","facility","both","1","EA","","1.76","1.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial, Single-Use In 1 Carton (0781-3113-95)  / 15 Ml In 1 Vial, Single-Use (0781-3113-90)","636","RC","0781-3113-95","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3156-06","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3232-94","NDC","","","facility","both","1","EA","","2.76","2.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial, Glass In 1 Package (0781-3404-95)  / 1 Injection, Powder, For Solution In 1 Vial, Glass (0781-3404-85)","636","RC","0781-3404-95","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3404-85","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Palonosetron Hydrochloride: 1 Vial, Single-Dose In 1 Carton (0781-3312-75)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0781-3312-75","NDC","","","facility","both","1","EA","","5.81","5.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3290-91","NDC","","","facility","both","1","EA","","4.38","4.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3290-91","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3289-91","NDC","","","facility","both","1","EA","","6.1","6.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin In 5 Percent Dextrose: 24 Bag In 1 Carton (0781-3289-09)  / 50 Ml In 1 Bag (0781-3289-91)","636","RC","0781-3289-09","NDC","","","facility","both","1","EA","","6.07","6.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin In 5 Percent Dextrose: 24 Bag In 1 Carton (0781-3289-09)  / 50 Ml In 1 Bag (0781-3289-91)","636","RC","0781-3289-09","NDC","","","facility","both","1","EA","","6.44","6.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3256-03","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (0781-3253-94)","636","RC","0781-3253-94","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3244-94)  / 50 Ml In 1 Vial, Single-Dose","636","RC","0781-3244-94","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (0781-3244-94)  / 50 Ml In 1 Vial, Single-Dose","636","RC","0781-3244-94","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 10 Vial In 1 Carton (0781-3232-95)  / 10 Ml In 1 Vial (0781-3232-94)","636","RC","0781-3232-95","NDC","","","facility","both","1","EA","","4.98","4.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0781-3407-78","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 POUCH in 1 CASE (0409-7985-02)  / 1 BAG in 1 POUCH / 250 mL in 1 BAG","636","RC","0409-7985-02","NDC","","","facility","both","1","EA","","12.37","12.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiamine Hydrochloride: 25 Vial In 1 Carton (0641-6228-25)  / 2 Ml In 1 Vial (0641-6228-01)","636","RC","0641-6228-25","NDC","","","facility","both","1","EA","","3.16","3.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-1398-31","NDC","","","facility","both","1","EA","","23.13","23.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-1398-31","NDC","","","facility","both","1","EA","","28.29","28.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-1397-31","NDC","","","facility","both","1","EA","","45.56","45.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-0948-31","NDC","","","facility","both","1","EA","","1.2","1.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 25 Vial, Single-Dose In 1 Package (0641-0928-25)  / 1 Ml In 1 Vial, Single-Dose (0641-0928-21)","636","RC","0641-0928-25","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-0928-21","NDC","","","facility","both","1","EA","","1.29","1.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital Sodium: 25 Vial In 1 Carton (0641-0477-25)  / 1 Ml In 1 Vial (0641-0477-21)","636","RC","0641-0477-25","NDC","","","facility","both","1","EA","","46","46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-0477-21","NDC","","","facility","both","1","EA","","95.41","95.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-0476-21","NDC","","","facility","both","1","EA","","15.94","15.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-0400-37","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hydrochloride: 25 Vial In 1 Package (0641-0376-25)  / 1 Ml In 1 Vial (0641-0376-21)","636","RC","0641-0376-25","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hydrochloride: 25 Vial In 1 Package (0641-0376-25)  / 1 Ml In 1 Vial (0641-0376-21)","636","RC","0641-0376-25","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hydrochloride: 25 Vial In 1 Package (0641-0376-25)  / 1 Ml In 1 Vial (0641-0376-21)","636","RC","0641-0376-25","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 25 Ampule In 1 Carton (0641-1398-35)  / 2 Ml In 1 Ampule (0641-1398-31)","636","RC","0641-1398-35","NDC","","","facility","both","1","EA","","20.37","20.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6008-01","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6008-01","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6008-01","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial In 1 Carton (0641-6007-10)  / 10 Ml In 1 Vial (0641-6007-01)","636","RC","0641-6007-10","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial In 1 Carton (0641-6007-10)  / 10 Ml In 1 Vial (0641-6007-01)","636","RC","0641-6007-10","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6007-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 25 Ampule In 1 Carton (0641-1398-35)  / 2 Ml In 1 Ampule (0641-1398-31)","636","RC","0641-1398-35","NDC","","","facility","both","1","EA","","18.86","18.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6007-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6001-01","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 25 Ampule In 1 Carton (0641-1495-35)  / 1 Ml In 1 Ampule (0641-1495-31)","636","RC","0641-1495-35","NDC","","","facility","both","1","EA","","1.54","1.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-1495-31","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-1410-31","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-1410-31","NDC","","","facility","both","1","EA","","2.44","2.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6007-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-0376-21","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-0376-21","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (0641-0367-25)  / 1 Ml In 1 Vial (0641-0367-21)","636","RC","0641-0367-25","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0597-0053-01","NDC","","","facility","both","1","EA","","224.39","224.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spevigo: 2 Vial, Glass In 1 Carton (0597-0035-10)  / 7.5 Ml In 1 Vial, Glass","636","RC","0597-0035-10","NDC","","","facility","both","1","EA","","70.9","70.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0597-0053-01","NDC","","","facility","both","1","EA","","197.65","197.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Praxbind: 2 Vial, Single-Dose In 1 Carton (0597-0197-05)  / 50 Ml In 1 Vial, Single-Dose","636","RC","0597-0197-05","NDC","","","facility","both","1","EA","","90.56","90.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-0367-21","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle, Plastic (0603-5336-21)","636","RC","0603-5336-21","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial In 1 Carton (0641-6008-10)  / 4 Ml In 1 Vial (0641-6008-01)","636","RC","0641-6008-10","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neostigmine Methylsulfate: 10 Vial, Multi-Dose In 1 Carton (0641-6149-10)  / 10 Ml In 1 Vial, Multi-Dose (0641-6149-01)","636","RC","0641-6149-10","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6149-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6145-01","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6137-01","NDC","","","facility","both","1","EA","","2.04","2.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6136-01","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6151-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6132-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6127-01","NDC","","","facility","both","1","EA","","1.88","1.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 25 Vial, Single-Dose In 1 Package (0641-6125-25)  / 1 Ml In 1 Vial, Single-Dose (0641-6125-01)","636","RC","0641-6125-25","NDC","","","facility","both","1","EA","","4.13","4.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6125-01","NDC","","","facility","both","1","EA","","8.71","8.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6117-01","NDC","","","facility","both","1","EA","","2.19","2.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6116-01","NDC","","","facility","both","1","EA","","3.28","3.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 25 Vial, Single-Dose In 1 Package (0641-6127-25)  / 1 Ml In 1 Vial, Single-Dose (0641-6127-01)","636","RC","0641-6127-25","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6151-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6151-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6228-01","NDC","","","facility","both","1","EA","","3.11","3.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6205-01","NDC","","","facility","both","1","EA","","9.26","9.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenylephrine Hydrochloride: 10 Vial, Pharmacy Bulk Package In 1 Carton (0641-6188-10)  / 5 Ml In 1 Vial, Pharmacy Bulk Package (0641-6188-01)","636","RC","0641-6188-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6176-01","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6176-01","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6176-01","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Octreotide Acetate: 10 Vial, Single-Dose In 1 Carton (0641-6175-10)  / 1 Ml In 1 Vial, Single-Dose (0641-6175-01)","636","RC","0641-6175-10","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6175-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6175-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6174-01","NDC","","","facility","both","1","EA","","1.89","1.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6174-01","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6174-01","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6174-01","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6166-01","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6151-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6103-01","NDC","","","facility","both","1","EA","","9.3","9.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6084-01","NDC","","","facility","both","1","EA","","2.44","2.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6044-01","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infumorph 500: 20 Ml In 1 Ampule (0641-6040-01)","636","RC","0641-6040-01","NDC","","","facility","both","1","EA","","11.62","11.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infumorph 200: 20 Ml In 1 Ampule (0641-6039-01)","636","RC","0641-6039-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl Citrate: 20 Ml In 1 Vial (0641-6029-01)","636","RC","0641-6029-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6028-01","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6028-01","NDC","","","facility","both","1","EA","","1.88","1.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6027-01","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6027-01","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6022-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6022-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6021-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6019-01","NDC","","","facility","both","1","EA","","7.21","7.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6046-01","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6048-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenergan: 25 Ampule In 1 Carton (0641-6082-25)  / 1 Ml In 1 Ampule (0641-6082-01)","636","RC","0641-6082-25","NDC","","","facility","both","1","EA","","2.14","2.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6082-01","NDC","","","facility","both","1","EA","","2.46","2.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 20 Ml In 1 Carton (0641-6079-01)","636","RC","0641-6079-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 20 Ml In 1 Carton (0641-6079-01)","636","RC","0641-6079-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6078-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6078-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6061-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam: 10 Vial In 1 Carton (0641-6060-10)  / 10 Ml In 1 Vial (0641-6060-01)","636","RC","0641-6060-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6060-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6059-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6057-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6053-01","NDC","","","facility","both","1","EA","","2.7","2.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0641-6103-01","NDC","","","facility","both","1","EA","","18.16","18.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 20 POUCH in 1 CASE (0409-7984-37)  / 4 BAG in 1 POUCH / 100 mL in 1 BAG","636","RC","0409-7984-37","NDC","","","facility","both","1","EA","","2.14","2.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 20 POUCH in 1 CASE (0409-7984-36)  / 4 BAG in 1 POUCH / 50 mL in 1 BAG","636","RC","0409-7984-36","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0182-01)  / 52.6 Ml In 1 Vial, Single-Dose","636","RC","0409-0182-01","NDC","","","facility","both","1","EA","","9.74","9.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0181-25)  / 26.3 Ml In 1 Vial, Single-Dose","636","RC","0409-0181-25","NDC","","","facility","both","1","EA","","4.68","4.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0181-25)  / 26.3 Ml In 1 Vial, Single-Dose","636","RC","0409-0181-25","NDC","","","facility","both","1","EA","","9.21","9.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0181-01)  / 26.3 Ml In 1 Vial, Single-Dose","636","RC","0409-0181-01","NDC","","","facility","both","1","EA","","9.64","9.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0181-01)  / 26.3 Ml In 1 Vial, Single-Dose","636","RC","0409-0181-01","NDC","","","facility","both","1","EA","","9.65","9.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 24 Pouch In 1 Carton (0409-0152-24)  / 1 Bag In 1 Pouch (0409-0152-01)  / 100 Ml In 1 Bag","636","RC","0409-0152-24","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-0152-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-0152-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-0152-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-0125-25)  / 20 Ml In 1 Vial, Multi-Dose (0409-0125-01)","636","RC","0409-0125-25","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-0125-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam: 25 Vial, Single-Dose In 1 Carton (0409-0001-25)  / 2 Ml In 1 Vial, Single-Dose (0409-0001-01)","636","RC","0409-0001-25","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-0001-01","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0378-9671-31","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0182-01)  / 52.6 Ml In 1 Vial, Single-Dose","636","RC","0409-0182-01","NDC","","","facility","both","1","EA","","8.26","8.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0182-01)  / 52.6 Ml In 1 Vial, Single-Dose","636","RC","0409-0182-01","NDC","","","facility","both","1","EA","","8.25","8.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0183-01)  / 5.26 Ml In 1 Vial, Single-Dose","636","RC","0409-0183-01","NDC","","","facility","both","1","EA","","7.58","7.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0186-01)  / 25 Ml In 1 Vial, Single-Dose","636","RC","0409-0186-01","NDC","","","facility","both","1","EA","","16.27","16.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0409-1319-01)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","0409-1319-01","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30)  / 1 Ml In 1 Cartridge (0409-1312-03)","636","RC","0409-1312-30","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30)  / 1 Ml In 1 Cartridge (0409-1312-03)","636","RC","0409-1312-30","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1312-30)  / 1 Ml In 1 Cartridge (0409-1312-03)","636","RC","0409-1312-30","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Cartridge In 1 Carton (0409-1304-31)  / 1 Ml In 1 Cartridge (0409-1304-03)","636","RC","0409-1304-31","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1304-03","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1304-03","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1304-03","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1273-03","NDC","","","facility","both","1","EA","","12.4","12.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1219-41","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 25 Carton In 1 Case (0409-1219-01)  / 1 Vial, Multi-Dose In 1 Carton / 10 Ml In 1 Vial, Multi-Dose (0409-1219-41)","636","RC","0409-1219-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1215-21","NDC","","","facility","both","1","EA","","45.89","45.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Carton In 1 Container (0409-1323-05)  / 1 Syringe, Plastic In 1 Carton / 5 Ml In 1 Syringe, Plastic (0409-1323-15)","636","RC","0409-1323-05","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 10 Carton In 1 Package (0409-1630-10)  / 1 Syringe, Plastic In 1 Carton / 10 Ml In 1 Syringe, Plastic (0409-1630-15)","636","RC","0409-1630-10","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 10 Carton In 1 Package (0409-1630-10)  / 1 Syringe, Plastic In 1 Carton / 10 Ml In 1 Syringe, Plastic (0409-1630-15)","636","RC","0409-1630-10","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 10 Carton In 1 Package (0409-1630-10)  / 1 Syringe, Plastic In 1 Carton / 10 Ml In 1 Syringe, Plastic (0409-1630-15)","636","RC","0409-1630-10","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1626-21","NDC","","","facility","both","1","EA","","8.15","8.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1623-21","NDC","","","facility","both","1","EA","","7.32","7.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Butorphanol Tartrate: 10 Vial, Single-Dose In 1 Carton (0409-1623-01)  / 1 Ml In 1 Vial, Single-Dose (0409-1623-21)","636","RC","0409-1623-01","NDC","","","facility","both","1","EA","","5.68","5.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Marcaine: 1 Vial, Multi-Dose In 1 Carton (0409-1610-50)  / 50 Ml In 1 Vial, Multi-Dose","636","RC","0409-1610-50","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1464-61","NDC","","","facility","both","1","EA","","3.5","3.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1463-71","NDC","","","facility","both","1","EA","","5.26","5.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1463-69","NDC","","","facility","both","1","EA","","5.35","5.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nalbuphine Hydrochloride: 10 Ampule In 1 Tray (0409-1463-01)  / 1 Ml In 1 Ampule (0409-1463-71)","636","RC","0409-1463-01","NDC","","","facility","both","1","EA","","4.83","4.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 VIAL, MULTI-DOSE in 1 BOX (0409-1412-10)  / 10 mL in 1 VIAL, MULTI-DOSE (0409-1412-40) ","636","RC","0409-1412-10","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 VIAL in 1 BOX (0409-1412-04)  / 4 mL in 1 VIAL (0409-1412-34) ","636","RC","0409-1412-04","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 VIAL in 1 BOX (0409-1412-04)  / 4 mL in 1 VIAL (0409-1412-34) ","636","RC","0409-1412-04","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1391-21","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1323-15","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1207-13","NDC","","","facility","both","1","EA","","4.63","4.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)","636","RC","0409-1159-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)","636","RC","0409-1159-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Vial, Single-Dose In 1 Carton (0409-1134-03)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0409-1134-03","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)","636","RC","0409-1159-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1005-01","NDC","","","facility","both","1","EA","","9.9","9.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-0830-11","NDC","","","facility","both","1","EA","","4.16","4.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-0829-11","NDC","","","facility","both","1","EA","","4.1","4.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Topotecan: 1 Vial, Single-Dose In 1 Carton (0409-0302-01)  / 4 Ml In 1 Vial, Single-Dose","636","RC","0409-0302-01","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Topotecan: 1 Vial, Single-Dose In 1 Carton (0409-0302-01)  / 4 Ml In 1 Vial, Single-Dose","636","RC","0409-0302-01","NDC","","","facility","both","1","EA","","2.64","2.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-0212-11","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docetaxel: 1 Vial, Multi-Dose In 1 Carton (0409-0201-10)  / 8 Ml In 1 Vial, Multi-Dose","636","RC","0409-0201-10","NDC","","","facility","both","1","EA","","2.46","2.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (0409-0186-01)  / 25 Ml In 1 Vial, Single-Dose","636","RC","0409-0186-01","NDC","","","facility","both","1","EA","","15.78","15.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbocaine: 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-1041-30)  / 30 mL in 1 VIAL, SINGLE-DOSE","636","RC","0409-1041-30","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1159-18)","636","RC","0409-1159-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1159-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1159-19)","636","RC","0409-1159-02","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1159-18","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1165-19","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1165-19","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1165-18","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1165-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1165-19)","636","RC","0409-1165-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1165-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1165-19)","636","RC","0409-1165-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1165-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1165-18)","636","RC","0409-1165-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1162-19","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1162-18","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1162-18","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1162-18","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1162-19)","636","RC","0409-1162-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1162-19)","636","RC","0409-1162-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-02)  / 30 Ml In 1 Vial, Single-Dose (0409-1162-19)","636","RC","0409-1162-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-1162-01)  / 10 Ml In 1 Vial, Single-Dose (0409-1162-18)","636","RC","0409-1162-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1159-19","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1159-18","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 100 Ml In 1 Bag (0338-0553-18)","636","RC","0338-0553-18","NDC","","","facility","both","1","EA","","5.77","5.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 100 Ml In 1 Bag (0338-0551-18)","636","RC","0338-0551-18","NDC","","","facility","both","1","EA","","8.64","8.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Dextrose: 24 Bag In 1 Carton (0338-0411-02)  / 250 Ml In 1 Bag","636","RC","0338-0411-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Dextrose: 24 Bag In 1 Carton (0338-0411-02)  / 250 Ml In 1 Bag","636","RC","0338-0411-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride And Dextrose: 24 Bag In 1 Carton (0338-0411-02)  / 250 Ml In 1 Bag","636","RC","0338-0411-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Osmitrol: 500 Ml In 1 Bag (0338-0357-03)","636","RC","0338-0357-03","NDC","","","facility","both","1","EA","","5.3","5.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Osmitrol: 250 Ml In 1 Bag (0338-0357-02)","636","RC","0338-0357-02","NDC","","","facility","both","1","EA","","15.2","15.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myxredlin: 12 Container In 1 Carton (0338-0126-12)  / 100 Ml In 1 Container","636","RC","0338-0126-12","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myxredlin: 12 Container In 1 Carton (0338-0126-12)  / 100 Ml In 1 Container","636","RC","0338-0126-12","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose And Sodium Chloride: 1000 Ml In 1 Bag (0338-0671-04)","636","RC","0338-0671-04","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Dextrose: 1000 Ml In 1 Bag (0338-0683-04)","636","RC","0338-0683-04","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 24 Bag In 1 Carton (0338-1055-48)  / 100 Ml In 1 Bag","636","RC","0338-1055-48","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitroglycerin In Dextrose: 12 Bottle, Glass In 1 Box (0338-1051-02)  / 250 Ml In 1 Bottle, Glass","636","RC","0338-1051-02","NDC","","","facility","both","1","EA","","1.82","1.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dopamine Hydrochloride And Dextrose: 18 Bag In 1 Carton (0338-1009-02)  / 250 Ml In 1 Bag","636","RC","0338-1009-02","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dopamine Hydrochloride And Dextrose: 18 Bag In 1 Carton (0338-1007-02)  / 250 Ml In 1 Bag","636","RC","0338-1007-02","NDC","","","facility","both","1","EA","","2.3","2.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dopamine Hydrochloride And Dextrose: 18 Bag In 1 Carton (0338-1005-02)  / 250 Ml In 1 Bag","636","RC","0338-1005-02","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 24 Bag In 1 Carton (0338-0709-48)  / 100 Ml In 1 Bag","636","RC","0338-0709-48","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 24 Bag In 1 Carton (0338-0705-48)  / 100 Ml In 1 Bag","636","RC","0338-0705-48","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Sodium Chloride: 14 Bag In 1 Carton (0338-0704-34)  / 1000 Ml In 1 Bag","636","RC","0338-0704-34","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 24 Bag In 1 Carton (0338-0703-48)  / 100 Ml In 1 Bag","636","RC","0338-0703-48","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride In Sodium Chloride: 14 Bag In 1 Carton (0338-0691-04)  / 1000 Ml In 1 Bag","636","RC","0338-0691-04","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers And Dextrose: 1000 Ml In 1 Bag (0338-0125-04)","636","RC","0338-0125-04","NDC","","","facility","both","1","EA","","7.2","7.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 1000 Ml In 1 Bag (0338-0117-04)","636","RC","0338-0117-04","NDC","","","facility","both","1","EA","","5.73","5.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxil: 1 Vial, Single-Use In 1 Carton (0338-0063-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","0338-0063-01","NDC","","","facility","both","1","EA","","94.52","94.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 Bag In 1 Carton (0338-0054-03)  / 500 Ml In 1 Bag","636","RC","0338-0054-03","NDC","","","facility","both","1","EA","","6.78","6.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1 Bag In 1 Package (0338-0049-48)  / 100 Ml In 1 Bag","636","RC","0338-0049-48","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1 Bag In 1 Package (0338-0049-41)  / 50 Ml In 1 Bag","636","RC","0338-0049-41","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxil: 1 Vial, Single-Use In 1 Carton (0338-0063-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","0338-0063-01","NDC","","","facility","both","1","EA","","93.86","93.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 16 Bag In 1 Package (0338-0049-38)  / 100 Ml In 1 Bag","636","RC","0338-0049-38","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 16 Bag In 1 Package (0338-0049-31)  / 50 Ml In 1 Bag","636","RC","0338-0049-31","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-18)  / 100 Ml In 1 Bag","636","RC","0338-0049-18","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-18)  / 100 Ml In 1 Bag","636","RC","0338-0049-18","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 4 Bag In 1 Package (0338-0049-18)  / 100 Ml In 1 Bag","636","RC","0338-0049-18","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 20 Bag In 1 Carton (0338-0066-20)  / 500 Ml In 1 Bag","636","RC","0338-0066-20","NDC","","","facility","both","1","EA","","8.51","8.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxil: 1 Vial, Single-Use In 1 Carton (0338-0067-01)  / 25 Ml In 1 Vial, Single-Use","636","RC","0338-0067-01","NDC","","","facility","both","1","EA","","104.94","104.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxil: 1 Vial, Single-Use In 1 Carton (0338-0067-01)  / 25 Ml In 1 Vial, Single-Use","636","RC","0338-0067-01","NDC","","","facility","both","1","EA","","103.35","103.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 500 Ml In 1 Bag (0338-0117-03)","636","RC","0338-0117-03","NDC","","","facility","both","1","EA","","5.39","5.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 250 Ml In 1 Bag (0338-0117-02)","636","RC","0338-0117-02","NDC","","","facility","both","1","EA","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0089-04)  / 1000 Ml In 1 Bag","636","RC","0338-0089-04","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 24 Bag In 1 Carton (0338-0089-03)  / 500 Ml In 1 Bag","636","RC","0338-0089-03","NDC","","","facility","both","1","EA","","6.3","6.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0085-04)  / 1000 Ml In 1 Bag","636","RC","0338-0085-04","NDC","","","facility","both","1","EA","","7.18","7.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 24 Bag In 1 Carton (0338-0085-03)  / 500 Ml In 1 Bag","636","RC","0338-0085-03","NDC","","","facility","both","1","EA","","6.47","6.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose And Sodium Chloride: 14 Bag In 1 Carton (0338-0077-04)  / 1000 Ml In 1 Bag","636","RC","0338-0077-04","NDC","","","facility","both","1","EA","","9","9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (0338-0072-25)  / 1 Ml In 1 Vial","636","RC","0338-0072-25","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (0338-0072-25)  / 1 Ml In 1 Vial","636","RC","0338-0072-25","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (0338-0072-25)  / 1 Ml In 1 Vial","636","RC","0338-0072-25","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 10 Bag In 1 Carton (0338-0070-10)  / 1000 Ml In 1 Bag","636","RC","0338-0070-10","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 10 Vial In 1 Carton (0338-0069-10)  / 1 Ml In 1 Vial","636","RC","0338-0069-10","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 10 Vial In 1 Carton (0338-0069-10)  / 1 Ml In 1 Vial","636","RC","0338-0069-10","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 24 Bag In 1 Carton (0338-1055-48)  / 100 Ml In 1 Bag","636","RC","0338-1055-48","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 24 Bag In 1 Carton (0338-1055-48)  / 100 Ml In 1 Bag","636","RC","0338-1055-48","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 20 Capsule In 1 Carton (0378-3266-94)","636","RC","0378-3266-94","NDC","","","facility","both","1","EA","","143.63","143.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0378-3266-32","NDC","","","facility","both","1","EA","","143.63","143.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0378-8270-31","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0378-7970-64","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide: 30 Pouch In 1 Carton (0378-7970-55)  / 1 Ampule In 1 Pouch (0378-7970-31)  / 2.5 Ml In 1 Ampule","636","RC","0378-7970-55","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0378-7970-31","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0378-8765-16","NDC","","","facility","both","1","EA","","2.96","2.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0338-3814-50","NDC","","","facility","both","1","EA","","3.42","3.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin Phosphate: 24 Bag In 1 Carton (0338-3814-24)  / 50 Ml In 1 Bag (0338-3814-50)","636","RC","0338-3814-24","NDC","","","facility","both","1","EA","","3.66","3.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0338-3612-50","NDC","","","facility","both","1","EA","","4.41","4.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0338-3612-50","NDC","","","facility","both","1","EA","","4.42","4.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 24 Bag In 1 Carton (0338-3503-41)  / 50 Ml In 1 Bag","636","RC","0338-3503-41","NDC","","","facility","both","1","EA","","2.81","2.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 40 Bag In 1 Carton (0338-1715-40)  / 100 Ml In 1 Bag","636","RC","0338-1715-40","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ifex: 1 Vial, Single-Dose In 1 Carton (0338-3993-01)  / 60 Ml In 1 Vial, Single-Dose","636","RC","0338-3993-01","NDC","","","facility","both","1","EA","","48.88","48.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Dextrose: 40 Bag In 1 Case (0338-1709-40)  / 100 Ml In 1 Bag","636","RC","0338-1709-40","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesnex: 1 Vial, Multi-Dose In 1 Box (0338-1305-01)  / 10 Ml In 1 Vial, Multi-Dose","636","RC","0338-1305-01","NDC","","","facility","both","1","EA","","2.56","2.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1077-02)  / 250 Ml In 1 Bag","636","RC","0338-1077-02","NDC","","","facility","both","1","EA","","10.59","10.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1075-02)  / 250 Ml In 1 Bag","636","RC","0338-1075-02","NDC","","","facility","both","1","EA","","32.04","32.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1075-02)  / 250 Ml In 1 Bag","636","RC","0338-1075-02","NDC","","","facility","both","1","EA","","32.19","32.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine Hydrochloride In Dextrose: 18 Bag In 1 Carton (0338-1075-02)  / 250 Ml In 1 Bag","636","RC","0338-1075-02","NDC","","","facility","both","1","EA","","47.45","47.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 500 mL in 1 BAG (0338-6304-03) ","636","RC","0338-6304-03","NDC","","","facility","both","1","EA","","5.25","5.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin In 0.9% Sodium Chloride: 12 Bag In 1 Carton (0338-9640-12)  / 100 Ml In 1 Bag","636","RC","0338-9640-12","NDC","","","facility","both","1","EA","","76.14","76.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 1000 Ml In 1 Bag (0338-9543-06)","636","RC","0338-9543-06","NDC","","","facility","both","1","EA","","3.22","3.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 500 Ml In 1 Bag (0338-9543-04)","636","RC","0338-9543-04","NDC","","","facility","both","1","EA","","9.77","9.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 250 Ml In 1 Bag (0338-9543-02)","636","RC","0338-9543-02","NDC","","","facility","both","1","EA","","8.69","8.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 100 Ml In 1 Bag (0338-9159-30)","636","RC","0338-9159-30","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1630-15","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6102-19","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6102-18","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6102-18","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6102-18","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-10)  / 10 Ml In 1 Vial, Single-Dose (0409-6102-20)","636","RC","0409-6102-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6102-19","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-10)  / 10 Ml In 1 Vial, Single-Dose (0409-6102-20)","636","RC","0409-6102-10","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-04)  / 4 Ml In 1 Vial, Single-Dose (0409-6102-18)","636","RC","0409-6102-04","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-04)  / 4 Ml In 1 Vial, Single-Dose (0409-6102-18)","636","RC","0409-6102-04","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial, Single-Dose In 1 Tray (0409-6102-02)  / 2 Ml In 1 Vial, Single-Dose (0409-6102-19)","636","RC","0409-6102-02","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6010-02","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-5922-16","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aminophylline: 25 Vial, Single-Dose In 1 Tray (0409-5922-01)  / 20 Ml In 1 Vial, Single-Dose (0409-5922-16)","636","RC","0409-5922-01","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-5921-16","NDC","","","facility","both","1","EA","","19.53","19.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aminophylline: 25 Vial, Single-Dose In 1 Tray (0409-5921-01)  / 10 Ml In 1 Vial, Single-Dose (0409-5921-16)","636","RC","0409-5921-01","NDC","","","facility","both","1","EA","","3.39","3.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6102-19","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6102-20","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Testosterone Cypionate: 1 Vial In 1 Carton (0409-6562-01)  / 1 Ml In 1 Vial","636","RC","0409-6562-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial, Single-Dose In 1 Tray (0409-6534-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose (0409-6534-11)","636","RC","0409-6534-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial, Single-Dose In 1 Tray (0409-6534-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose (0409-6534-11)","636","RC","0409-6534-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6533-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Vial, Pharmacy Bulk Package In 1 Carton (0409-6509-01)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","0409-6509-01","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6102-20","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6482-11","NDC","","","facility","both","1","EA","","47.64","47.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6482-11","NDC","","","facility","both","1","EA","","50.87","50.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythrocin Lactobionate: 10 Vial In 1 Tray (0409-6482-01)  / 10 Ml In 1 Vial (0409-6482-11)","636","RC","0409-6482-01","NDC","","","facility","both","1","EA","","47.64","47.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6476-54","NDC","","","facility","both","1","EA","","18.44","18.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 BOTTLE, PLASTIC in 1 CASE (0409-6138-03)  / 500 mL in 1 BOTTLE, PLASTIC","636","RC","0409-6138-03","NDC","","","facility","both","1","EA","","5.06","5.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6102-20","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aminophylline: 25 Vial, Single-Dose In 1 Tray (0409-5921-01)  / 10 Ml In 1 Vial, Single-Dose (0409-5921-16)","636","RC","0409-5921-01","NDC","","","facility","both","1","EA","","3.66","3.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dopamine Hydrochloride: 25 Vial, Single-Dose In 1 Tray (0409-5820-01)  / 5 Ml In 1 Vial, Single-Dose (0409-5820-11)","636","RC","0409-5820-01","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"CIPROFLOXACIN: 24 POUCH in 1 CASE (0409-4777-02)  / 1 BAG in 1 POUCH / 200 mL in 1 BAG (0409-4777-21) ","636","RC","0409-4777-02","NDC","","","facility","both","1","EA","","2.88","2.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4755-18","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4713-75","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 800 Ampule In 1 Case (0409-4713-65)  / 5 Ml In 1 Ampule (0409-4713-75)","636","RC","0409-4713-65","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4713-12","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4699-54","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium And Dextrose: 30 Pouch In 1 Case (0409-4520-30)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag (0409-4520-02)","636","RC","0409-4520-30","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4520-02","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4444-01","NDC","","","facility","both","1","EA","","3.8","3.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4346-16","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4332-11","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4688-22","NDC","","","facility","both","1","EA","","6.17","6.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-5084-13","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-5082-11","NDC","","","facility","both","1","EA","","2.42","2.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 10 Carton In 1 Package (0409-4933-01)  / 1 Syringe, Glass In 1 Carton / 10 Ml In 1 Syringe, Glass (0409-4933-11)","636","RC","0409-4933-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 10 Carton In 1 Package (0409-4933-01)  / 1 Syringe, Glass In 1 Carton / 10 Ml In 1 Syringe, Glass (0409-4933-11)","636","RC","0409-4933-01","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 10 Carton In 1 Container (0409-4902-34)  / 1 Syringe In 1 Carton / 50 Ml In 1 Syringe (0409-4902-64)","636","RC","0409-4902-34","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4888-06","NDC","","","facility","both","1","EA","","3.67","3.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4888-03","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4888-02","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4888-01","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6635-18","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 20 POUCH in 1 CASE (0409-7923-37)  / 4 BAG in 1 POUCH / 100 mL in 1 BAG","636","RC","0409-7923-37","NDC","","","facility","both","1","EA","","4.22","4.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 20 POUCH in 1 CASE (0409-7923-36)  / 4 BAG in 1 POUCH / 50 mL in 1 BAG","636","RC","0409-7923-36","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 12 POUCH in 1 CASE (0409-7922-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","636","RC","0409-7922-09","NDC","","","facility","both","1","EA","","9","9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 POUCH in 1 CASE (0409-7922-02)  / 1 BAG in 1 POUCH / 250 mL in 1 BAG","636","RC","0409-7922-02","NDC","","","facility","both","1","EA","","9","9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-7810-11","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dopamine Hydrochloride In Dextrose: 12 Bag In 1 Carton (0409-7809-22)  / 250 Ml In 1 Bag (0409-7809-11)","636","RC","0409-7809-22","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-7809-11","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-7650-52","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-7620-13","NDC","","","facility","both","1","EA","","4.6","4.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dopamine Hydrochloride In Dextrose: 12 Bag In 1 Carton (0409-7810-22)  / 250 Ml In 1 Bag (0409-7810-11)","636","RC","0409-7810-22","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose and Sodium Chloride: 12 POUCH in 1 CASE (0409-7924-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","636","RC","0409-7924-09","NDC","","","facility","both","1","EA","","9","9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose and Sodium Chloride: 24 POUCH in 1 CASE (0409-7926-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG","636","RC","0409-7926-03","NDC","","","facility","both","1","EA","","9.44","9.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 BAG in 1 CASE (0409-7983-25)  / 250 mL in 1 BAG","636","RC","0409-7983-25","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 POUCH in 1 CASE (0409-7983-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","636","RC","0409-7983-09","NDC","","","facility","both","1","EA","","4.83","4.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 24 POUCH in 1 CASE (0409-7983-02)  / 1 BAG in 1 POUCH / 250 mL in 1 BAG","636","RC","0409-7983-02","NDC","","","facility","both","1","EA","","9","9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 12 BAG in 1 CASE (0409-7953-48)  / 1000 mL in 1 BAG","636","RC","0409-7953-48","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 24 BAG in 1 CASE (0409-7953-30)  / 500 mL in 1 BAG","636","RC","0409-7953-30","NDC","","","facility","both","1","EA","","1.7","1.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 12 POUCH in 1 CASE (0409-7953-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","636","RC","0409-7953-09","NDC","","","facility","both","1","EA","","9.8","9.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers: 24 POUCH in 1 CASE (0409-7953-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG","636","RC","0409-7953-03","NDC","","","facility","both","1","EA","","9.9","9.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose and Sodium Chloride: 12 POUCH in 1 CASE (0409-7941-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","636","RC","0409-7941-09","NDC","","","facility","both","1","EA","","4.36","4.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 POUCH in 1 CASE (0409-7930-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG","636","RC","0409-7930-03","NDC","","","facility","both","1","EA","","9.86","9.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 24 POUCH in 1 CASE (0409-7930-02)  / 1 BAG in 1 POUCH / 250 mL in 1 BAG","636","RC","0409-7930-02","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactated Ringers and Dextrose: 12 POUCH in 1 CASE (0409-7929-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","636","RC","0409-7929-09","NDC","","","facility","both","1","EA","","7.27","7.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 18 Pouch In 1 Case (0409-7620-03)  / 1 Bag In 1 Pouch / 500 Ml In 1 Bag (0409-7620-13)","636","RC","0409-7620-03","NDC","","","facility","both","1","EA","","6.3","6.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 10 Carton In 1 Container (0409-7517-16)  / 1 Syringe, Plastic In 1 Carton / 50 Ml In 1 Syringe, Plastic (0409-7517-66)","636","RC","0409-7517-16","NDC","","","facility","both","1","EA","","15.35","15.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6729-41","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Pouch In 1 Case (0409-6729-24)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag (0409-6729-11)","636","RC","0409-6729-24","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Pouch In 1 Case (0409-6729-23)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag (0409-6729-41)","636","RC","0409-6729-23","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6729-11","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"24 POUCH in 1 CASE (0409-6729-03)  / 1 BAG in 1 POUCH / 500 mL in 1 BAG (0409-6729-21) ","636","RC","0409-6729-03","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6778-11","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amidate: 10 Vial, Single-Dose In 1 Tray (0409-6695-02)  / 20 Ml In 1 Vial, Single-Dose (0409-6695-12)","636","RC","0409-6695-02","NDC","","","facility","both","1","EA","","50.87","50.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6653-18","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 25 Vial, Single-Dose In 1 Tray (0409-6653-05)  / 20 Ml In 1 Vial, Single-Dose (0409-6653-18)","636","RC","0409-6653-05","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6648-16","NDC","","","facility","both","1","EA","","4.99","4.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 25 Vial, Single-Dose In 1 Tray (0409-6648-02)  / 50 Ml In 1 Vial, Single-Dose (0409-6648-16)","636","RC","0409-6648-02","NDC","","","facility","both","1","EA","","5.65","5.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-6727-11","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride in Sodium Chloride: 12 POUCH in 1 CASE (0409-7115-09)  / 1 BAG in 1 POUCH / 1000 mL in 1 BAG","636","RC","0409-7115-09","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-7419-14","NDC","","","facility","both","1","EA","","58.5","58.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-7418-13","NDC","","","facility","both","1","EA","","49.5","49.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-7338-11","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-7338-11","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone Sodium: 10 Vial, Single-Use In 1 Carton (0409-7338-01)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Use (0409-7338-11)","636","RC","0409-7338-01","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-7335-13","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-7332-11","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone Sodium: 10 Vial, Single-Use In 1 Carton (0409-7332-01)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Use (0409-7332-11)","636","RC","0409-7332-01","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-7299-83","NDC","","","facility","both","1","EA","","6.56","6.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Acetate: 25 Vial, Single-Dose In 1 Tray (0409-7299-73)  / 20 Ml In 1 Vial, Single-Dose (0409-7299-83)","636","RC","0409-7299-73","NDC","","","facility","both","1","EA","","5.89","5.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 12 BOTTLE, PLASTIC in 1 CASE (0409-7138-09)  / 1000 mL in 1 BOTTLE, PLASTIC","636","RC","0409-7138-09","NDC","","","facility","both","1","EA","","4.47","4.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-7517-66","NDC","","","facility","both","1","EA","","21.4","21.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1630-15","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial In 1 Tray (0409-4332-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (0409-4332-11)","636","RC","0409-4332-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2344-62","NDC","","","facility","both","1","EA","","10.02","10.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferoxamine Mesylate: 4 Vial, Single-Use In 1 Carton (0409-2337-25)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use (0409-2337-15)","636","RC","0409-2337-25","NDC","","","facility","both","1","EA","","16.85","16.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2337-15","NDC","","","facility","both","1","EA","","16.49","16.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2308-69","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2308-21","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam: 10 Vial, Single-Dose In 1 Carton (0409-2308-02)  / 2 Ml In 1 Vial, Single-Dose (0409-2308-22)","636","RC","0409-2308-02","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam: 10 Vial, Single-Dose In 1 Carton (0409-2308-01)  / 1 Ml In 1 Vial, Single-Dose (0409-2308-21)","636","RC","0409-2308-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam: 25 Vial, Single-Dose In 1 Tray (0409-2305-17)  / 2 Ml In 1 Vial, Single-Dose (0409-2305-16)","636","RC","0409-2305-17","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2305-16","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam: 10 Vial, Single-Dose In 1 Carton (0409-2305-05)  / 5 Ml In 1 Vial, Single-Dose (0409-2305-04)","636","RC","0409-2305-05","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2305-04","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (0409-2267-54)  / 40 Ml In 1 Vial, Multi-Dose","636","RC","0409-2267-54","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (0409-2267-20)  / 20 Ml In 1 Vial, Multi-Dose","636","RC","0409-2267-20","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2347-31","NDC","","","facility","both","1","EA","","9.53","9.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 1 Vial, Single-Dose In 1 Box (0409-2634-50)  / 50 Ml In 1 Vial, Single-Dose","636","RC","0409-2634-50","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 1 Vial, Single-Dose In 1 Box (0409-2634-50)  / 50 Ml In 1 Vial, Single-Dose","636","RC","0409-2634-50","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2634-25","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2634-25","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2634-10","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2634-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Box (0409-2634-05)  / 5 Ml In 1 Vial, Single-Dose (0409-2634-25)","636","RC","0409-2634-05","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2347-31","NDC","","","facility","both","1","EA","","9.48","9.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Box (0409-2634-05)  / 5 Ml In 1 Vial, Single-Dose (0409-2634-25)","636","RC","0409-2634-05","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Box (0409-2634-01)  / 1 Ml In 1 Vial, Single-Dose (0409-2634-10)","636","RC","0409-2634-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam: 10 Vial, Multi-Dose In 1 Carton (0409-2596-05)  / 10 Ml In 1 Vial, Multi-Dose (0409-2596-15)","636","RC","0409-2596-05","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine In Dextrose: 12 Pouch In 1 Case (0409-2347-32)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag (0409-2347-31)","636","RC","0409-2347-32","NDC","","","facility","both","1","EA","","4.96","4.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine In Dextrose: 12 Pouch In 1 Case (0409-2347-32)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag (0409-2347-31)","636","RC","0409-2347-32","NDC","","","facility","both","1","EA","","12.87","12.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine In Dextrose: 12 Pouch In 1 Case (0409-2347-32)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag (0409-2347-31)","636","RC","0409-2347-32","NDC","","","facility","both","1","EA","","23.89","23.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Box (0409-2634-01)  / 1 Ml In 1 Vial, Single-Dose (0409-2634-10)","636","RC","0409-2634-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2220-01","NDC","","","facility","both","1","EA","","3","3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1775-40","NDC","","","facility","both","1","EA","","68.8","68.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 10 Carton In 1 Package (0409-1775-10)  / 1 Syringe, Plastic In 1 Carton / 10 Ml In 1 Syringe, Plastic (0409-1775-40)","636","RC","0409-1775-10","NDC","","","facility","both","1","EA","","73.69","73.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1746-71","NDC","","","facility","both","1","EA","","3.3","3.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1746-71","NDC","","","facility","both","1","EA","","5.59","5.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Tartrate: 10 Vial, Single-Dose In 1 Carton (0409-1778-05)  / 5 Ml In 1 Vial, Single-Dose (0409-1778-15)","636","RC","0409-1778-05","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1632-21","NDC","","","facility","both","1","EA","","31.13","31.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vecuronium Bromide: 10 Vial In 1 Carton (0409-1632-01)  / 10 Ml In 1 Vial (0409-1632-21)","636","RC","0409-1632-01","NDC","","","facility","both","1","EA","","12.57","12.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1631-40","NDC","","","facility","both","1","EA","","20.03","20.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Chloride: 10 Carton In 1 Container (0409-1631-10)  / 1 Syringe, Plastic In 1 Carton (0409-1631-40)  / 10 Ml In 1 Syringe, Plastic","636","RC","0409-1631-10","NDC","","","facility","both","1","EA","","31.37","31.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Marcaine With Epinephrine: 10 Vial, Single-Dose In 1 Carton (0409-1746-10)  / 10 Ml In 1 Vial, Single-Dose (0409-1746-70)","636","RC","0409-1746-10","NDC","","","facility","both","1","EA","","6.92","6.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Tartrate: 10 Vial, Single-Dose In 1 Carton (0409-1778-05)  / 5 Ml In 1 Vial, Single-Dose (0409-1778-15)","636","RC","0409-1778-05","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2050-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2045-01","NDC","","","facility","both","1","EA","","6.53","6.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Vial, Single-Dose In 1 Carton (0409-2022-01)  / 50 Ml In 1 Vial, Single-Dose","636","RC","0409-2022-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1902-11","NDC","","","facility","both","1","EA","","178.82","178.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procainamide Hydrochloride: 25 Carton In 1 Case (0409-1902-01)  / 1 Vial, Multi-Dose In 1 Carton (0409-1902-11)  / 10 Ml In 1 Vial, Multi-Dose","636","RC","0409-1902-01","NDC","","","facility","both","1","EA","","101.53","101.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Vial, Single-Dose In 1 Carton (0409-1896-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0409-1896-20","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1891-03","NDC","","","facility","both","1","EA","","5.53","5.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 10 Cartridge In 1 Carton (0409-1891-01)  / 1 Ml In 1 Cartridge (0409-1891-03)","636","RC","0409-1891-01","NDC","","","facility","both","1","EA","","6.46","6.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1886-22","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 25 Vial, Single-Dose In 1 Carton (0409-1886-02)  / 5 Ml In 1 Vial, Single-Dose (0409-1886-22)","636","RC","0409-1886-02","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1778-15","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-1778-15","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 1 Vial, Single-Dose In 1 Box (0409-2634-50)  / 50 Ml In 1 Vial, Single-Dose","636","RC","0409-2634-50","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Single-Dose In 1 Tray (0409-2720-01)  / 1 Ml In 1 Vial, Single-Dose (0409-2720-30)","636","RC","0409-2720-01","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4031-16","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 5 Vial, Glass In 1 Carton (0409-3815-12)  / 10 Ml In 1 Vial, Glass (0409-3815-11)","636","RC","0409-3815-12","NDC","","","facility","both","1","EA","","2.28","2.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3815-11","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 5 Vial, Glass In 1 Carton (0409-3814-12)  / 10 Ml In 1 Vial, Glass (0409-3814-11)","636","RC","0409-3814-12","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3795-19","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3793-19","NDC","","","facility","both","1","EA","","4.73","4.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine In Dextrose: 12 Pouch In 1 Case (0409-3724-32)  / 1 Bag In 1 Pouch / 250 Ml In 1 Bag (0409-3724-11)","636","RC","0409-3724-32","NDC","","","facility","both","1","EA","","5.96","5.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3613-11","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Spinal: 10 Ampule In 1 Carton (0409-3613-01)  / 2 Ml In 1 Ampule (0409-3613-11)","636","RC","0409-3613-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Spinal: 10 Ampule In 1 Carton (0409-3613-01)  / 2 Ml In 1 Ampule (0409-3613-11)","636","RC","0409-3613-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 25 Vial, Multi-Dose In 1 Tray (0409-3578-01)  / 2 Ml In 1 Vial, Multi-Dose (0409-3578-11)","636","RC","0409-3578-01","NDC","","","facility","both","1","EA","","3.38","3.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3435-01","NDC","","","facility","both","1","EA","","5.9","5.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3414-21","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3793-19","NDC","","","facility","both","1","EA","","5","5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4275-01)  / 50 Ml In 1 Vial, Multi-Dose (0409-4275-16)","636","RC","0409-4275-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4276-01)  / 20 Ml In 1 Vial, Multi-Dose (0409-4276-16)","636","RC","0409-4276-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4283-11","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 5 Cello Pack In 1 Package (0409-4283-01)  / 5 Ampule In 1 Cello Pack (0409-4283-25)  / 5 Ml In 1 Ampule (0409-4283-11)","636","RC","0409-4283-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4282-12","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Ampule In 1 Carton (0409-4282-02)  / 10 Ml In 1 Ampule (0409-4282-12)","636","RC","0409-4282-02","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4279-16","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4277-17","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4277-02)  / 50 Ml In 1 Vial, Multi-Dose (0409-4277-17)","636","RC","0409-4277-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-4276-17","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Tray (0409-4276-02)  / 50 Ml In 1 Vial, Multi-Dose (0409-4276-17)","636","RC","0409-4276-02","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3299-16","NDC","","","facility","both","1","EA","","4.82","4.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3299-15","NDC","","","facility","both","1","EA","","8.22","8.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3213-11","NDC","","","facility","both","1","EA","","5.31","5.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2723-30","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2723-30","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Single-Dose In 1 Tray (0409-2723-01)  / 1 Ml In 1 Vial, Single-Dose (0409-2723-30)","636","RC","0409-2723-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2720-31","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-2720-30","NDC","","","facility","both","1","EA","","2.44","2.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Tray (0409-2720-02)  / 10 Ml In 1 Vial, Multi-Dose (0409-2720-31)","636","RC","0409-2720-02","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milrinone Lactate: 10 BAG in 1 CASE (0409-2776-23)  / 100 mL in 1 BAG (0409-2776-43) ","636","RC","0409-2776-23","NDC","","","facility","both","1","EA","","6.24","6.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3300-01","NDC","","","facility","both","1","EA","","4.84","4.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (0409-3307-03)  / 30 Ml In 1 Vial (0409-3307-11)","636","RC","0409-3307-03","NDC","","","facility","both","1","EA","","3.49","3.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3365-11","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3365-11","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3365-11","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0409-3365-10)  / 1 Ml In 1 Vial, Single-Dose (0409-3365-11)","636","RC","0409-3365-10","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0409-3365-10)  / 1 Ml In 1 Vial, Single-Dose (0409-3365-11)","636","RC","0409-3365-10","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Carton (0409-3365-10)  / 1 Ml In 1 Vial, Single-Dose (0409-3365-11)","636","RC","0409-3365-10","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3330-01","NDC","","","facility","both","1","EA","","4.86","4.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3308-11","NDC","","","facility","both","1","EA","","3.72","3.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (0409-3308-03)  / 30 Ml In 1 Vial (0409-3308-11)","636","RC","0409-3308-03","NDC","","","facility","both","1","EA","","2.06","2.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0409-3414-18","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68382-860-02","NDC","","","facility","both","1","EA","","19.01","19.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vimizim: 1 Vial In 1 Carton (68135-100-01)  / 5 Ml In 1 Vial","636","RC","68135-100-01","NDC","","","facility","both","1","EA","","434.12","434.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naglazyme: 1 Vial In 1 Carton (68135-020-01)  / 5 Ml In 1 Vial","636","RC","68135-020-01","NDC","","","facility","both","1","EA","","583.49","583.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naglazyme: 1 Vial In 1 Carton (68135-020-01)  / 5 Ml In 1 Vial","636","RC","68135-020-01","NDC","","","facility","both","1","EA","","593.99","593.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naglazyme: 1 Vial In 1 Carton (68135-020-01)  / 5 Ml In 1 Vial","636","RC","68135-020-01","NDC","","","facility","both","1","EA","","608.38","608.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68094-763-59","NDC","","","facility","both","1","EA","","5.26","5.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vimizim: 1 Vial In 1 Carton (68135-100-01)  / 5 Ml In 1 Vial","636","RC","68135-100-01","NDC","","","facility","both","1","EA","","460.12","460.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68382-910-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone: 25 Tablet In 1 Bottle (68382-919-11)","636","RC","68382-919-11","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aprepitant: 1 Blister Pack In 1 Carton (68462-585-76)  / 6 Capsule In 1 Blister Pack (68462-585-40)","636","RC","68462-585-76","NDC","","","facility","both","1","EA","","16.46","16.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-585-40","NDC","","","facility","both","1","EA","","10.6","10.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-584-40","NDC","","","facility","both","1","EA","","10.03","10.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aprepitant: 1 Blister Pack In 1 Carton (68462-583-40)  / 1 Capsule In 1 Blister Pack","636","RC","68462-583-40","NDC","","","facility","both","1","EA","","13.1","13.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-470-40","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-470-40","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial, Single-Dose In 1 Carton (68462-469-54)  / 4 Ml In 1 Vial, Single-Dose (68462-469-40)","636","RC","68462-469-54","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-469-40","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-469-40","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-469-40","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial, Multi-Dose In 1 Carton (68462-470-54)  / 10 Ml In 1 Vial, Multi-Dose (68462-470-40)","636","RC","68462-470-54","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 25 Vial, Single-Dose In 1 Carton (68462-621-02)  / 2 Ml In 1 Vial, Single-Dose (68462-621-54)","636","RC","68462-621-02","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 25 Vial, Single-Dose In 1 Carton (68462-621-54)  / 2 Ml In 1 Vial, Single-Dose (68462-621-02)","636","RC","68462-621-54","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sirolimus: 100 Tablet, Film Coated In 1 Bottle (68462-682-01)","636","RC","68462-682-01","NDC","","","facility","both","1","EA","","5.31","5.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 25 Vial, Single-Dose In 1 Carton (68462-621-02)  / 2 Ml In 1 Vial, Single-Dose (68462-621-54)","636","RC","68462-621-02","NDC","","","facility","both","1","EA","","1.54","1.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 10 Vial, Single-Dose In 1 Carton (68462-622-64)  / 10 Ml In 1 Vial, Single-Dose (68462-622-10)","636","RC","68462-622-64","NDC","","","facility","both","1","EA","","2.12","2.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 10 Vial, Single-Dose In 1 Carton (68462-622-10)  / 10 Ml In 1 Vial, Single-Dose (68462-622-64)","636","RC","68462-622-10","NDC","","","facility","both","1","EA","","2.07","2.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 10 Vial, Single-Dose In 1 Carton (68462-622-10)  / 10 Ml In 1 Vial, Single-Dose (68462-622-64)","636","RC","68462-622-10","NDC","","","facility","both","1","EA","","2.1","2.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 10 Vial, Single-Dose In 1 Carton (68462-622-10)  / 10 Ml In 1 Vial, Single-Dose (68462-622-64)","636","RC","68462-622-10","NDC","","","facility","both","1","EA","","2.3","2.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosphenytoin Sodium: 25 Vial, Single-Dose In 1 Carton (68462-621-54)  / 2 Ml In 1 Vial, Single-Dose (68462-621-02)","636","RC","68462-621-54","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-158-40","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-157-40","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68403-1100-6","NDC","","","facility","both","1","EA","","65278.13","65278.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone: 50 Tablet In 1 Bottle (68382-918-18)","636","RC","68382-918-18","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68084-607-11","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68084-451-11","NDC","","","facility","both","1","EA","","2.73","2.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68084-450-11","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68084-449-11","NDC","","","facility","both","1","EA","","2.21","2.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hydrochloride: 10 Blister Pack In 1 Carton (68094-018-61)  / 10 Tablet In 1 Blister Pack (68094-018-59)","636","RC","68094-018-61","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68094-018-59","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68084-918-95","NDC","","","facility","both","1","EA","","4.91","4.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolic Acid: 30 Blister Pack In 1 Box, Unit-Dose (68084-918-25)  / 1 Tablet, Delayed Release In 1 Blister Pack (68084-918-95)","636","RC","68084-918-25","NDC","","","facility","both","1","EA","","4.91","4.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolic Acid: 30 Blister Pack In 1 Box, Unit-Dose (68084-907-21)  / 1 Tablet, Delayed Release In 1 Blister Pack (68084-907-11)","636","RC","68084-907-21","NDC","","","facility","both","1","EA","","4.92","4.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68084-907-11","NDC","","","facility","both","1","EA","","4.92","4.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phentolamine Mesylate: 1 Vial In 1 Carton (68094-101-20)  / 1 Injection In 1 Vial","636","RC","68094-101-20","NDC","","","facility","both","1","EA","","417.83","417.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phentolamine Mesylate: 1 Vial In 1 Carton (68094-101-20)  / 1 Injection In 1 Vial","636","RC","68094-101-20","NDC","","","facility","both","1","EA","","529.44","529.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68084-847-11","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Pamoate: 100 Blister Pack In 1 Box, Unit-Dose (68084-847-01)  / 1 Capsule In 1 Blister Pack (68084-847-11)","636","RC","68084-847-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-755-01","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-755-01","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-756-01","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 1 Ml In 1 Ampule (69918-899-01)","636","RC","69918-899-01","NDC","","","facility","both","1","EA","","8.92","8.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Acetate: 100 Ml In 1 Vial, Pharmacy Bulk Package (69784-231-10)","636","RC","69784-231-10","NDC","","","facility","both","1","EA","","11.73","11.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Acetate: 50 Ml In 1 Vial, Pharmacy Bulk Package (69784-230-20)","636","RC","69784-230-20","NDC","","","facility","both","1","EA","","36.01","36.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Acetate: 50 Ml In 1 Vial, Pharmacy Bulk Package (69784-230-10)","636","RC","69784-230-10","NDC","","","facility","both","1","EA","","49.36","49.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","69374-946-04","NDC","","","facility","both","1","EA","","2.93","2.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","69374-523-25","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","69374-314-10","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Granisetron Hydrochloride: 2 Blister Pack In 1 Carton (69452-350-92)  / 10 Tablet, Film Coated In 1 Blister Pack","636","RC","69452-350-92","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","69452-350-60","NDC","","","facility","both","1","EA","","3.39","3.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Maleate: 100 Tablet, Film Coated In 1 Bottle (69452-310-20)","636","RC","69452-310-20","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Tablet, Film Coated In 1 Bottle (69452-173-13)","636","RC","69452-173-13","NDC","","","facility","both","1","EA","","2.14","2.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 10 Ampule In 1 Carton (69918-899-10)  / 1 Ml In 1 Ampule","636","RC","69918-899-10","NDC","","","facility","both","1","EA","","7.43","7.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-301-01","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 10 Vial In 1 Carton (70069-362-10)  / 10 Ml In 1 Vial (70069-362-01)","636","RC","70069-362-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-101-01","NDC","","","facility","both","1","EA","","6.31","6.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-101-01","NDC","","","facility","both","1","EA","","6.65","6.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-072-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-071-01","NDC","","","facility","both","1","EA","","4.8","4.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropivacaine Hydrochloride: 25 Vial In 1 Carton (70069-067-25)  / 20 Ml In 1 Vial (70069-067-01)","636","RC","70069-067-25","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropivacaine Hydrochloride: 10 Vial In 1 Carton (70069-067-10)  / 20 Ml In 1 Vial (70069-067-01)","636","RC","70069-067-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-067-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 1 Vial In 1 Carton (70069-363-01)  / 30 Ml In 1 Vial","636","RC","70069-363-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-788-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-773-01","NDC","","","facility","both","1","EA","","8.45","8.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-671-01","NDC","","","facility","both","1","EA","","7.71","7.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-661-01","NDC","","","facility","both","1","EA","","4.45","4.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-641-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-618-01","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-618-01","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-617-01","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-617-01","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-617-01","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol Decanoate: 5 Vial, Single-Dose In 1 Carton (70069-383-05)  / 1 Ml In 1 Vial, Single-Dose","636","RC","70069-383-05","NDC","","","facility","both","1","EA","","3.98","3.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol Decanoate: 1 Vial, Single-Dose In 1 Carton (70069-383-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","70069-383-01","NDC","","","facility","both","1","EA","","5.74","5.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-371-01","NDC","","","facility","both","1","EA","","2.61","2.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropivacaine Hydrochloride: 1 Vial In 1 Carton (70069-064-01)  / 30 Ml In 1 Vial","636","RC","70069-064-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine Hydrochloride: 5 Vial In 1 Carton (70069-027-05)  / 1 Ml In 1 Vial","636","RC","70069-027-05","NDC","","","facility","both","1","EA","","5.74","5.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-027-01","NDC","","","facility","both","1","EA","","6.49","6.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-021-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-020-01","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-019-01","NDC","","","facility","both","1","EA","","6.5","6.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-018-01","NDC","","","facility","both","1","EA","","12.52","12.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-012-01","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-005-01","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-063-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyxeos: 20 Ml In 1 Vial (68727-745-01)","636","RC","68727-745-01","NDC","","","facility","both","1","EA","","445.42","445.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zepzelca: 8 Ml In 1 Vial, Single-Dose (68727-712-01)","636","RC","68727-712-01","NDC","","","facility","both","1","EA","","336.08","336.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zepzelca: 8 Ml In 1 Vial, Single-Dose (68727-712-01)","636","RC","68727-712-01","NDC","","","facility","both","1","EA","","343.19","343.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zepzelca: 8 Ml In 1 Vial, Single-Dose (68727-712-01)","636","RC","68727-712-01","NDC","","","facility","both","1","EA","","364.95","364.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Giapreza: 1 Vial, Single-Dose In 1 Carton (68547-501-02)  / 1 Ml In 1 Vial, Single-Dose","636","RC","68547-501-02","NDC","","","facility","both","1","EA","","3176.91","3176.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyxeos: 20 Ml In 1 Vial (68727-745-01)","636","RC","68727-745-01","NDC","","","facility","both","1","EA","","353.88","353.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-5218-0","NDC","","","facility","both","1","EA","","15.38","15.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-5218-0","NDC","","","facility","both","1","EA","","15.54","15.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-5218-0","NDC","","","facility","both","1","EA","","16.71","16.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-5216-6","NDC","","","facility","both","1","EA","","7.86","7.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albutein: 1 Vial In 1 Carton (68516-5216-5)  / 20 Ml In 1 Vial (68516-5216-6)","636","RC","68516-5216-5","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albutein: 1 Vial In 1 Carton (68516-5216-2)  / 100 Ml In 1 Vial (68516-5216-4)","636","RC","68516-5216-2","NDC","","","facility","both","1","EA","","72.09","72.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-5214-4","NDC","","","facility","both","1","EA","","14.27","14.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-5214-4","NDC","","","facility","both","1","EA","","14.28","14.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyxeos: 20 Ml In 1 Vial (68727-745-01)","636","RC","68727-745-01","NDC","","","facility","both","1","EA","","346.54","346.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyxeos: 40 Ml In 1 Carton (68727-745-02)","636","RC","68727-745-02","NDC","","","facility","both","1","EA","","340.45","340.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fibryga: 1 Bottle, Glass In 1 Carton (68982-349-01)  / 50 Ml In 1 Bottle, Glass (68982-349-81)","636","RC","68982-349-01","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fibryga: 1 Kit In 1 Carton (68982-347-01)  *  50 Ml In 1 Bottle, Glass (68982-348-01)","636","RC","68982-347-01","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Wilate - Von Willebrand Factor/Coagulation Factor Viii Complex (Human): 10 Ml In 1 Vial (68982-182-02)","636","RC","68982-182-02","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Wilate - Von Willebrand Factor/Coagulation Factor Viii Complex (Human): 5 Ml In 1 Vial (68982-182-01)","636","RC","68982-182-01","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziihera: 2 Vial, Single-Dose In 1 Carton (68727-950-02)  / 6 Ml In 1 Vial, Single-Dose (68727-950-01)","636","RC","68727-950-02","NDC","","","facility","both","1","EA","","35.55","35.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziihera: 2 Vial, Single-Dose In 1 Carton (68727-950-02)  / 6 Ml In 1 Vial, Single-Dose (68727-950-01)","636","RC","68727-950-02","NDC","","","facility","both","1","EA","","37.03","37.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyxeos: 40 Ml In 1 Carton (68727-745-02)","636","RC","68727-745-02","NDC","","","facility","both","1","EA","","351.2","351.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziihera: 2 Vial, Single-Dose In 1 Carton (68727-950-02)  / 6 Ml In 1 Vial, Single-Dose (68727-950-01)","636","RC","68727-950-02","NDC","","","facility","both","1","EA","","42.66","42.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68727-950-01","NDC","","","facility","both","1","EA","","37.45","37.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68727-950-01","NDC","","","facility","both","1","EA","","42.66","42.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rylaze: 3 Vial, Single-Dose In 1 Carton (68727-900-03)  / .5 Ml In 1 Vial, Single-Dose (68727-900-01)","636","RC","68727-900-03","NDC","","","facility","both","1","EA","","65.67","65.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rylaze: 3 Vial, Single-Dose In 1 Carton (68727-900-03)  / .5 Ml In 1 Vial, Single-Dose (68727-900-01)","636","RC","68727-900-03","NDC","","","facility","both","1","EA","","65.83","65.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68727-900-01","NDC","","","facility","both","1","EA","","69.32","69.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68727-900-01","NDC","","","facility","both","1","EA","","72.65","72.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68727-950-01","NDC","","","facility","both","1","EA","","35.55","35.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-5214-4","NDC","","","facility","both","1","EA","","15.59","15.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albutein: 1 Vial In 1 Carton (68516-5214-2)  / 500 Ml In 1 Vial (68516-5214-4)","636","RC","68516-5214-2","NDC","","","facility","both","1","EA","","14.14","14.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Octreotide Acetate: 10 Vial In 1 Carton (68462-897-10)  / 1 Ml In 1 Vial (68462-897-01)","636","RC","68462-897-10","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-897-01","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-897-01","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-897-01","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-896-01","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Octreotide Acetate: 10 Vial In 1 Carton (68462-897-10)  / 1 Ml In 1 Vial (68462-897-01)","636","RC","68462-897-10","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-896-01","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 1 Vial, Multi-Dose In 1 Carton (68462-760-10)  / 10 Ml In 1 Vial, Multi-Dose","636","RC","68462-760-10","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-756-01","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-756-01","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 1 Vial In 1 Carton (68462-904-01)  / 16.7 Ml In 1 Vial","636","RC","68462-904-01","NDC","","","facility","both","1","EA","","128.6","128.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albutein: 1 Vial In 1 Carton (68516-5214-2)  / 500 Ml In 1 Vial (68516-5214-4)","636","RC","68516-5214-2","NDC","","","facility","both","1","EA","","14.21","14.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albutein: 1 Vial In 1 Carton (68516-5214-2)  / 500 Ml In 1 Vial (68516-5214-4)","636","RC","68516-5214-2","NDC","","","facility","both","1","EA","","16.17","16.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alphanate: 1 Kit In 1 Carton (68516-4620-2)  *  10 Ml In 1 Vial (68516-4610-2)  *  10 Ml In 1 Vial, Glass (76297-002-12)","636","RC","68516-4620-2","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alphanate: 1 Kit In 1 Carton (68516-4620-2)  *  10 Ml In 1 Vial (68516-4610-2)  *  10 Ml In 1 Vial, Glass (76297-002-12)","636","RC","68516-4620-2","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alphanate: 1 Kit In 1 Carton (68516-4619-2)  *  10 Ml In 1 Vial (68516-4608-2)  *  10 Ml In 1 Vial, Glass (76297-002-12)","636","RC","68516-4619-2","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alphanate: 1 Kit In 1 Carton (68516-4619-2)  *  10 Ml In 1 Vial (68516-4608-2)  *  10 Ml In 1 Vial, Glass (76297-002-12)","636","RC","68516-4619-2","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alphanate: 1 Kit In 1 Carton (68516-4618-2)  *  10 Ml In 1 Vial (68516-4607-2)  *  10 Ml In 1 Vial, Glass (76297-002-12)","636","RC","68516-4618-2","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alphanate: 1 Kit In 1 Carton (68516-4618-2)  *  10 Ml In 1 Vial (68516-4607-2)  *  10 Ml In 1 Vial, Glass (76297-002-12)","636","RC","68516-4618-2","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alphanate: 1 Kit In 1 Carton (68516-4617-1)  *  5 Ml In 1 Vial (68516-4606-1)  *  5 Ml In 1 Vial, Glass (76297-002-02)","636","RC","68516-4617-1","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alphanate: 1 Kit In 1 Carton (68516-4617-1)  *  5 Ml In 1 Vial (68516-4606-1)  *  5 Ml In 1 Vial, Glass (76297-002-02)","636","RC","68516-4617-1","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-4610-2","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-4610-2","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-4608-2","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-4607-2","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-4606-1","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-4606-1","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68516-4605-1","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Profilnine: 1 Kit In 1 Carton (68516-3210-1)  *  5 Ml In 1 Vial (68516-3204-1)  *  5 Ml In 1 Vial, Glass (76297-002-02)","636","RC","68516-3210-1","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-946-30","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68462-946-30","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3010-1)  / 1 Bottle In 1 Pouch / 100 Tablet, Extended Release In 1 Bottle","636","RC","68992-3010-1","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3010-3)  / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic","636","RC","68992-3010-3","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3040-1)  / 1 Bottle In 1 Pouch / 100 Tablet, Extended Release In 1 Bottle","636","RC","68992-3040-1","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 1 Bottle, Plastic In 1 Carton (69238-1595-2)  / 225 Ml In 1 Bottle, Plastic","636","RC","69238-1595-2","NDC","","","facility","both","1","EA","","4.44","4.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","69238-1594-6","NDC","","","facility","both","1","EA","","14.68","14.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sirolimus: 1 Carton In 1 Kit (69238-1594-3)  / 1 Bottle, Glass In 1 Carton (69238-1594-6)  / 60 Ml In 1 Bottle, Glass","636","RC","69238-1594-3","NDC","","","facility","both","1","EA","","15.02","15.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","69339-137-01","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","69339-136-03","NDC","","","facility","both","1","EA","","7.63","7.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (69238-1058-1)","636","RC","69238-1058-1","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide Inhalation Suspension: 30 Pouch In 1 Carton (69097-319-53)  / 1 Ampule In 1 Pouch (69097-319-32)  / 2 Ml In 1 Ampule","636","RC","69097-319-53","NDC","","","facility","both","1","EA","","5.62","5.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","69097-319-32","NDC","","","facility","both","1","EA","","5.64","5.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Arformoterol Tartrate: 6 Pouch In 1 Carton (69097-168-87)  / 5 Vial, Single-Dose In 1 Pouch (69097-168-48)  / 2 Ml In 1 Vial, Single-Dose","636","RC","69097-168-87","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","69097-168-48","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone Sodium Succinate: 1 Vial In 1 Carton (69097-004-67)  / 2 Ml In 1 Vial","636","RC","69097-004-67","NDC","","","facility","both","1","EA","","12.2","12.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3075-3)  / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic","636","RC","68992-3075-3","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3075-1)  / 1 Bottle In 1 Pouch / 100 Tablet, Extended Release In 1 Bottle","636","RC","68992-3075-1","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Envarsus Xr: 1 Pouch In 1 Carton (68992-3040-3)  / 1 Bottle, Plastic In 1 Pouch / 30 Tablet, Extended Release In 1 Bottle, Plastic","636","RC","68992-3040-3","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel Protein-Bound Particles: 1 Vial, Single-Dose In 1 Carton (69097-398-78)  / 20 Ml In 1 Vial, Single-Dose","636","RC","69097-398-78","NDC","","","facility","both","1","EA","","21.09","21.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","69194-976-01","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","69194-0348-1","NDC","","","facility","both","1","EA","","6.81","6.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lanreotide Acetate: 1 Syringe In 1 Carton (69097-870-67)  / .5 Ml In 1 Syringe","636","RC","69097-870-67","NDC","","","facility","both","1","EA","","40.92","40.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lanreotide Acetate: 1 Syringe In 1 Carton (69097-870-67)  / .5 Ml In 1 Syringe","636","RC","69097-870-67","NDC","","","facility","both","1","EA","","81.84","81.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lanreotide Acetate: 1 Syringe In 1 Carton (69097-870-67)  / .5 Ml In 1 Syringe","636","RC","69097-870-67","NDC","","","facility","both","1","EA","","81.84","81.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (69097-770-32)  / 2 Ml In 1 Vial, Multi-Dose","636","RC","69097-770-32","NDC","","","facility","both","1","EA","","1338.09","1338.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phytonadione: 10 Vial In 1 Carton (69097-708-96)  / 1 Ml In 1 Vial","636","RC","69097-708-96","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","69097-708-31","NDC","","","facility","both","1","EA","","2.48","2.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel Protein-Bound Particles: 1 Vial, Single-Dose In 1 Carton (69097-398-78)  / 20 Ml In 1 Vial, Single-Dose","636","RC","69097-398-78","NDC","","","facility","both","1","EA","","20.88","20.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-788-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 10 Vial, Multi-Dose In 1 Carton (65219-572-10)  / 10 Ml In 1 Vial, Multi-Dose (65219-572-01)","636","RC","65219-572-10","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-572-01","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-572-01","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-572-01","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-570-01","NDC","","","facility","both","1","EA","","2.86","2.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-570-01","NDC","","","facility","both","1","EA","","2.86","2.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Carton (65219-566-20)  / 40 Ml In 1 Vial","636","RC","65219-566-20","NDC","","","facility","both","1","EA","","22.41","22.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-635-00","NDC","","","facility","both","1","EA","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Carton (65219-564-20)  / 10 Ml In 1 Vial","636","RC","65219-564-20","NDC","","","facility","both","1","EA","","79.91","79.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Carton (65219-564-20)  / 10 Ml In 1 Vial","636","RC","65219-564-20","NDC","","","facility","both","1","EA","","81.83","81.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-470-05","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Carton (65219-564-20)  / 10 Ml In 1 Vial","636","RC","65219-564-20","NDC","","","facility","both","1","EA","","81.42","81.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam In Sodium Chloride: 10 Pouch In 1 Carton (65219-650-10)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","65219-650-10","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azasan: 100 Tablet In 1 Bottle (65649-231-41)","636","RC","65649-231-41","NDC","","","facility","both","1","EA","","22.36","22.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","65597-406-01","NDC","","","facility","both","1","EA","","46.14","46.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-650-02","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","65597-406-01","NDC","","","facility","both","1","EA","","49.79","49.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","65597-406-01","NDC","","","facility","both","1","EA","","51.06","51.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","65597-406-01","NDC","","","facility","both","1","EA","","51.91","51.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","65597-406-01","NDC","","","facility","both","1","EA","","52.37","52.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","65597-406-01","NDC","","","facility","both","1","EA","","52.83","52.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","65597-406-01","NDC","","","facility","both","1","EA","","54.31","54.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Ampule In 1 Carton (65282-1605-1)  / 5 Ml In 1 Ampule","636","RC","65282-1605-1","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enhertu: 1 Vial, Single-Dose In 1 Carton (65597-406-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","65597-406-01","NDC","","","facility","both","1","EA","","50.37","50.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 1 Vial, Multi-Dose In 1 Carton (65219-295-10)  / 10 Ml In 1 Vial, Multi-Dose","636","RC","65219-295-10","NDC","","","facility","both","1","EA","","5.99","5.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-293-00","NDC","","","facility","both","1","EA","","6","6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 56 Ampule In 1 Carton (65162-914-46)  / 5 Ml In 1 Ampule","636","RC","65162-914-46","NDC","","","facility","both","1","EA","","23.78","23.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial In 1 Carton (65219-029-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","65219-029-20","NDC","","","facility","both","1","EA","","74.33","74.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 1 Vial, Pharmacy Bulk Package In 1 Carton (65219-256-24)  / 180 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","65219-256-24","NDC","","","facility","both","1","EA","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 1 Vial, Pharmacy Bulk Package In 1 Carton (65219-256-00)  / 180 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","65219-256-00","NDC","","","facility","both","1","EA","","1.86","1.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-238-01","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-205-05","NDC","","","facility","both","1","EA","","49.93","49.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Temsirolimus: 1 Kit In 1 Kit (65219-200-05)  *  1 Ml In 1 Vial, Single-Dose (65219-205-05)  *  1.8 Ml In 1 Vial, Single-Dose (65219-202-05)","636","RC","65219-200-05","NDC","","","facility","both","1","EA","","49.93","49.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Vial, Single-Dose In 1 Carton (65219-190-30)  / 20 Ml In 1 Vial, Single-Dose","636","RC","65219-190-30","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-164-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65219-162-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial In 1 Carton (65219-029-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","65219-029-20","NDC","","","facility","both","1","EA","","31.54","31.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 3 Blister Pack In 1 Carton (65862-391-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","636","RC","65862-391-10","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 3 Blister Pack In 1 Carton (65862-390-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","636","RC","65862-390-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65757-302-02","NDC","","","facility","both","1","EA","","7.33","7.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65757-302-02","NDC","","","facility","both","1","EA","","7.35","7.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vivitrol: 1 Kit In 1 Carton (65757-300-01)  *  4 Ml In 1 Vial, Glass (65757-302-02)  *  4 Ml In 1 Vial, Glass (65757-304-03)","636","RC","65757-300-01","NDC","","","facility","both","1","EA","","7.35","7.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vivitrol: 1 Kit In 1 Carton (65757-300-01)  *  4 Ml In 1 Vial, Glass (65757-302-02)  *  4 Ml In 1 Vial, Glass (65757-304-03)","636","RC","65757-300-01","NDC","","","facility","both","1","EA","","7.38","7.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle, Plastic (64380-783-06)","636","RC","64380-783-06","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 100 Capsule In 1 Bottle, Plastic (64380-726-06)","636","RC","64380-726-06","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 500 Tablet, Film Coated In 1 Bottle, Plastic (64380-725-07)","636","RC","64380-725-07","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose","636","RC","64764-300-20","NDC","","","facility","both","1","EA","","56.16","56.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose","636","RC","64764-300-20","NDC","","","facility","both","1","EA","","56.16","56.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose","636","RC","64764-300-20","NDC","","","facility","both","1","EA","","56.16","56.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 1 Vial, Pharmacy Bulk Package In 1 Carton (64679-679-01)  / 180 Ml In 1 Vial, Pharmacy Bulk Package (64679-679-02)","636","RC","64679-679-01","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","64679-056-02","NDC","","","facility","both","1","EA","","2.71","2.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","64679-012-02","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Qalsody: 1 Vial, Single-Use In 1 Carton (64406-109-01)  / 15 Ml In 1 Vial, Single-Use","636","RC","64406-109-01","NDC","","","facility","both","1","EA","","219.06","219.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spinraza: 1 Vial, Single-Use In 1 Box (64406-058-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","64406-058-01","NDC","","","facility","both","1","EA","","1201.86","1201.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spinraza: 1 Vial, Single-Use In 1 Box (64406-058-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","64406-058-01","NDC","","","facility","both","1","EA","","1302.01","1302.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spinraza: 1 Vial, Single-Use In 1 Box (64406-058-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","64406-058-01","NDC","","","facility","both","1","EA","","1302.01","1302.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spinraza: 1 Vial, Single-Use In 1 Box (64406-058-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","64406-058-01","NDC","","","facility","both","1","EA","","1302.01","1302.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tysabri: 1 Vial, Single-Use In 1 Carton (64406-008-01)  / 15 Ml In 1 Vial, Single-Use","636","RC","64406-008-01","NDC","","","facility","both","1","EA","","51.23","51.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tysabri: 1 Vial, Single-Use In 1 Carton (64406-008-01)  / 15 Ml In 1 Vial, Single-Use","636","RC","64406-008-01","NDC","","","facility","both","1","EA","","51.23","51.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tysabri: 1 Vial, Single-Use In 1 Carton (64406-008-01)  / 15 Ml In 1 Vial, Single-Use","636","RC","64406-008-01","NDC","","","facility","both","1","EA","","51.38","51.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tysabri: 1 Vial, Single-Use In 1 Carton (64406-008-01)  / 15 Ml In 1 Vial, Single-Use","636","RC","64406-008-01","NDC","","","facility","both","1","EA","","52.21","52.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tysabri: 1 Vial, Single-Use In 1 Carton (64406-008-01)  / 15 Ml In 1 Vial, Single-Use","636","RC","64406-008-01","NDC","","","facility","both","1","EA","","53.28","53.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Qalsody: 1 Vial, Single-Use In 1 Carton (64406-109-01)  / 15 Ml In 1 Vial, Single-Use","636","RC","64406-109-01","NDC","","","facility","both","1","EA","","223.2","223.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Container (64380-722-06)","636","RC","64380-722-06","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63833-835-01","NDC","","","facility","both","1","EA","","110.88","110.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Berinert: 1 Kit In 1 Carton (63833-825-02)  *  10 Ml In 1 Vial (63833-835-01)  *  10 Ml In 1 Vial (63833-765-15)","636","RC","63833-825-02","NDC","","","facility","both","1","EA","","111.6","111.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Berinert: 1 Kit In 1 Carton (63833-825-02)  *  10 Ml In 1 Vial (63833-835-01)  *  10 Ml In 1 Vial (63833-765-15)","636","RC","63833-825-02","NDC","","","facility","both","1","EA","","124.59","124.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63833-627-01","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63833-627-01","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63833-626-01","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63833-626-01","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63833-625-01","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humate-P: 1 Kit In 1 Carton (63833-617-02)  *  15 Ml In 1 Vial (63833-627-01)  *  15 Ml In 1 Vial, Single-Dose (63833-765-55)","636","RC","63833-617-02","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humate-P: 1 Kit In 1 Carton (63833-617-02)  *  15 Ml In 1 Vial (63833-627-01)  *  15 Ml In 1 Vial, Single-Dose (63833-765-55)","636","RC","63833-617-02","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63833-835-01","NDC","","","facility","both","1","EA","","104.71","104.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humate-P: 1 Kit In 1 Carton (63833-616-02)  *  10 Ml In 1 Vial (63833-626-01)  *  10 Ml In 1 Vial, Single-Dose (63833-765-54)","636","RC","63833-616-02","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humate-P: 1 Kit In 1 Carton (63833-615-02)  *  5 Ml In 1 Vial (63833-625-01)  *  5 Ml In 1 Vial, Single-Dose (63833-765-53)","636","RC","63833-615-02","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humate-P: 1 Kit In 1 Carton (63833-615-02)  *  5 Ml In 1 Vial (63833-625-01)  *  5 Ml In 1 Vial, Single-Dose (63833-765-53)","636","RC","63833-615-02","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63833-397-01","NDC","","","facility","both","1","EA","","3.92","3.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63833-397-01","NDC","","","facility","both","1","EA","","3.92","3.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63833-396-01","NDC","","","facility","both","1","EA","","3.92","3.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63833-396-01","NDC","","","facility","both","1","EA","","3.92","3.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kcentra: 1 Kit In 1 Carton (63833-387-02)  *  40 Ml In 1 Vial, Single-Use (63833-397-01)  *  40 Ml In 1 Vial, Single-Use (63833-761-40)","636","RC","63833-387-02","NDC","","","facility","both","1","EA","","3.92","3.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kcentra: 1 Kit In 1 Carton (63833-387-02)  *  40 Ml In 1 Vial, Single-Use (63833-397-01)  *  40 Ml In 1 Vial, Single-Use (63833-761-40)","636","RC","63833-387-02","NDC","","","facility","both","1","EA","","3.92","3.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kcentra: 1 Kit In 1 Carton (63833-386-02)  *  20 Ml In 1 Vial, Single-Use (63833-396-01)  *  20 Ml In 1 Vial, Single-Use (63833-761-20)","636","RC","63833-386-02","NDC","","","facility","both","1","EA","","3.92","3.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kcentra: 1 Kit In 1 Carton (63833-386-02)  *  20 Ml In 1 Vial, Single-Use (63833-396-01)  *  20 Ml In 1 Vial, Single-Use (63833-761-20)","636","RC","63833-386-02","NDC","","","facility","both","1","EA","","3.92","3.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humate-P: 1 Kit In 1 Carton (63833-616-02)  *  10 Ml In 1 Vial (63833-626-01)  *  10 Ml In 1 Vial, Single-Dose (63833-765-54)","636","RC","63833-616-02","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","64193-325-01","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","64193-325-01","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Container (64380-721-06)","636","RC","64380-721-06","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 100 Capsule In 1 Container (64380-720-06)","636","RC","64380-720-06","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Chloride: 10 Syringe, Plastic In 1 Box (64253-900-91)  / 10 Ml In 1 Syringe, Plastic","636","RC","64253-900-91","NDC","","","facility","both","1","EA","","53.46","53.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","64253-900-30","NDC","","","facility","both","1","EA","","22.07","22.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Coagadex: 1 Kit In 1 Carton (64208-7753-1)  *  10 Ml In 1 Vial, Glass (64208-7756-1)  *  5 Ml In 1 Vial, Glass (64208-7755-2)","636","RC","64208-7753-1","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Coagadex: 1 Kit In 1 Carton (64208-7753-1)  *  10 Ml In 1 Vial, Glass (64208-7756-1)  *  5 Ml In 1 Vial, Glass (64208-7755-2)","636","RC","64208-7753-1","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Feiba: 1 Kit In 1 Carton (64193-426-02)  *  10 Ml In 1 Vial, Glass (64193-326-01)  *  10 Ml In 1 Vial, Glass (64764-516-10)","636","RC","64193-426-02","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Feiba: 1 Kit In 1 Carton (64193-426-02)  *  10 Ml In 1 Vial, Glass (64193-326-01)  *  10 Ml In 1 Vial, Glass (64764-516-10)","636","RC","64193-426-02","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Feiba: 1 Kit In 1 Carton (64193-425-02)  *  50 Ml In 1 Vial, Glass (64193-325-01)  *  50 Ml In 1 Vial, Glass (64764-519-50)","636","RC","64193-425-02","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Feiba: 1 Kit In 1 Carton (64193-425-02)  *  50 Ml In 1 Vial, Glass (64193-325-01)  *  50 Ml In 1 Vial, Glass (64764-519-50)","636","RC","64193-425-02","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Feiba: 1 Kit In 1 Carton (64193-424-02)  *  20 Ml In 1 Vial, Glass (64193-324-01)  *  20 Ml In 1 Vial, Glass (64764-517-20)","636","RC","64193-424-02","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","64193-326-01","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","64193-326-01","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose","636","RC","64764-300-20","NDC","","","facility","both","1","EA","","52.59","52.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose","636","RC","64764-300-20","NDC","","","facility","both","1","EA","","52","52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose","636","RC","64764-300-20","NDC","","","facility","both","1","EA","","42.43","42.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose","636","RC","64764-300-20","NDC","","","facility","both","1","EA","","41.38","41.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phytonadione: 2 Tray In 1 Carton (65145-151-10)  / 5 Vial, Single-Dose In 1 Tray (65145-151-05)  / 1 Ml In 1 Vial, Single-Dose (65145-151-01)","636","RC","65145-151-10","NDC","","","facility","both","1","EA","","2.88","2.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65145-129-01","NDC","","","facility","both","1","EA","","4.89","4.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","65145-151-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 50 Ml In 1 Bottle (65162-691-79)","636","RC","65162-691-79","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","64875-001-01","NDC","","","facility","both","1","EA","","77.4","77.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entyvio: 1 Vial, Single-Dose In 1 Carton (64764-300-20)  / 5 Ml In 1 Vial, Single-Dose","636","RC","64764-300-20","NDC","","","facility","both","1","EA","","30.31","30.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 237 Ml In 1 Bottle, Plastic (64980-509-24)","636","RC","64980-509-24","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 1 Bottle, Plastic In 1 Carton (67877-230-22)  / 225 Ml In 1 Bottle, Plastic","636","RC","67877-230-22","NDC","","","facility","both","1","EA","","8.87","8.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67877-721-33","NDC","","","facility","both","1","EA","","8.48","8.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67877-719-33","NDC","","","facility","both","1","EA","","5.43","5.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esmolol Hydrochloride In Sodium Chloride: 1 Bag In 1 Pouch (67457-658-10)  / 100 Ml In 1 Bag","636","RC","67457-658-10","NDC","","","facility","both","1","EA","","2.43","2.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esmolol Hydrochloride In Sodium Chloride: 1 Bag In 1 Pouch (67457-657-25)  / 250 Ml In 1 Bag","636","RC","67457-657-25","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-640-00","NDC","","","facility","both","1","EA","","15.36","15.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Iron Sucrose: 10 Vial, Single-Dose In 1 Carton (67457-638-10)  / 5 Ml In 1 Vial, Single-Dose","636","RC","67457-638-10","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-638-00","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eptifibatide: 1 Vial In 1 Carton (67457-631-10)  / 100 Ml In 1 Vial","636","RC","67457-631-10","NDC","","","facility","both","1","EA","","6.96","6.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 1 Vial, Multi-Dose In 1 Carton (67457-779-30)  / 30 Ml In 1 Vial, Multi-Dose","636","RC","67457-779-30","NDC","","","facility","both","1","EA","","16.41","16.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Vial, Multi-Dose In 1 Carton (67457-622-05)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","67457-622-05","NDC","","","facility","both","1","EA","","3.75","3.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (67457-618-10)  / 52.6 Ml In 1 Vial, Single-Dose","636","RC","67457-618-10","NDC","","","facility","both","1","EA","","12.33","12.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemcitabine: 1 Vial, Single-Dose In 1 Carton (67457-618-10)  / 52.6 Ml In 1 Vial, Single-Dose","636","RC","67457-618-10","NDC","","","facility","both","1","EA","","12.39","12.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 1 Bag In 1 Pouch (67457-554-00)  / 100 Ml In 1 Bag","636","RC","67457-554-00","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial, Single-Dose In 1 Carton (67457-530-35)  / 17.5 Ml In 1 Vial, Single-Dose","636","RC","67457-530-35","NDC","","","facility","both","1","EA","","4.36","4.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial, Single-Dose In 1 Carton (67457-530-35)  / 17.5 Ml In 1 Vial, Single-Dose","636","RC","67457-530-35","NDC","","","facility","both","1","EA","","4.49","4.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-475-00","NDC","","","facility","both","1","EA","","45.92","45.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eptifibatide: 1 Vial In 1 Carton (67457-629-10)  / 10 Ml In 1 Vial","636","RC","67457-629-10","NDC","","","facility","both","1","EA","","7.67","7.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docetaxel: 1 Vial, Multi-Dose In 1 Carton (67457-781-08)  / 8 Ml In 1 Vial, Multi-Dose","636","RC","67457-781-08","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 24 Bag In 1 Carton (67457-940-10)  / 100 Ml In 1 Bag","636","RC","67457-940-10","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 1 Vial In 1 Carton (67457-887-99)  / 1 Ml In 1 Vial (67457-887-00)","636","RC","67457-887-99","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-887-00","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Granisetron Hydrochloride: 1 Vial In 1 Carton (67457-864-04)  / 1 Ml In 1 Vial","636","RC","67457-864-04","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Granisetron Hydrochloride: 1 Vial In 1 Carton (67457-863-01)  / 1 Ml In 1 Vial","636","RC","67457-863-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adenosine: 1 Vial In 1 Carton (67457-857-30)  / 30 Ml In 1 Vial","636","RC","67457-857-30","NDC","","","facility","both","1","EA","","2.67","2.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adenosine: 1 Vial In 1 Carton (67457-857-30)  / 30 Ml In 1 Vial","636","RC","67457-857-30","NDC","","","facility","both","1","EA","","2.82","2.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adenosine: 10 Vial, Single-Dose In 1 Carton (67457-855-02)  / 2 Ml In 1 Vial, Single-Dose (67457-855-00)","636","RC","67457-855-02","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-855-00","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 1 Vial In 1 Carton (67457-853-50)  / 5 Ml In 1 Vial","636","RC","67457-853-50","NDC","","","facility","both","1","EA","","59.87","59.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-814-00","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-814-00","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sirolimus: 100 Tablet, Film Coated In 1 Bottle (67877-747-01)","636","RC","67877-747-01","NDC","","","facility","both","1","EA","","7.63","7.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68084-229-11","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68084-221-11","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (68084-220-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-220-11)","636","RC","68084-220-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68084-220-11","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Supprelin La: 1 Vial, Glass In 1 Carton (67979-002-01)  / 1 Implant In 1 Vial, Glass","636","RC","67979-002-01","NDC","","","facility","both","1","EA","","57731.63","57731.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zerbaxa: 10 Vial, Single-Dose In 1 Carton (67919-030-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","67919-030-01","NDC","","","facility","both","1","EA","","13.8","13.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zerbaxa: 10 Vial, Single-Dose In 1 Carton (67919-030-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","67919-030-01","NDC","","","facility","both","1","EA","","14.46","14.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dronabinol: 60 Capsule In 1 Bottle (67877-754-60)","636","RC","67877-754-60","NDC","","","facility","both","1","EA","","2.85","2.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dronabinol: 60 Capsule In 1 Bottle (67877-753-60)","636","RC","67877-753-60","NDC","","","facility","both","1","EA","","3.1","3.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sirolimus: 100 Tablet, Film Coated In 1 Bottle (67877-748-01)","636","RC","67877-748-01","NDC","","","facility","both","1","EA","","6.61","6.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68084-155-11","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","68084-149-11","NDC","","","facility","both","1","EA","","2.17","2.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-473-00","NDC","","","facility","both","1","EA","","2.88","2.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 1 Bottle, Plastic In 1 Carton (66689-307-08)  / 250 Ml In 1 Bottle, Plastic","636","RC","66689-307-08","NDC","","","facility","both","1","EA","","5.3","5.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamifant: 1 Vial, Single-Use In 1 Carton (66658-510-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","66658-510-01","NDC","","","facility","both","1","EA","","411.16","411.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-948-23)  / 50 Ml In 1 Vial, Single-Dose","636","RC","66733-948-23","NDC","","","facility","both","1","EA","","143.48","143.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","66794-219-63","NDC","","","facility","both","1","EA","","4.46","4.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 10 Bag In 1 Carton (66794-219-43)  / 300 Ml In 1 Bag (66794-219-63)","636","RC","66794-219-43","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","66794-203-02","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","66794-203-02","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","66794-203-02","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitigo: 1 Ml In 1 Vial, Single-Use (66794-162-02)","636","RC","66794-162-02","NDC","","","facility","both","1","EA","","10.63","10.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitigo: 1 Ml In 1 Vial, Single-Use (66794-162-02)","636","RC","66794-162-02","NDC","","","facility","both","1","EA","","10.63","10.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-958-23)  / 100 Ml In 1 Vial, Single-Dose","636","RC","66733-958-23","NDC","","","facility","both","1","EA","","140.39","140.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-958-23)  / 100 Ml In 1 Vial, Single-Dose","636","RC","66733-958-23","NDC","","","facility","both","1","EA","","140.39","140.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-958-23)  / 100 Ml In 1 Vial, Single-Dose","636","RC","66733-958-23","NDC","","","facility","both","1","EA","","143.8","143.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-958-23)  / 100 Ml In 1 Vial, Single-Dose","636","RC","66733-958-23","NDC","","","facility","both","1","EA","","143.87","143.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-948-23)  / 50 Ml In 1 Vial, Single-Dose","636","RC","66733-948-23","NDC","","","facility","both","1","EA","","140.76","140.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-948-23)  / 50 Ml In 1 Vial, Single-Dose","636","RC","66733-948-23","NDC","","","facility","both","1","EA","","140.95","140.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erbitux: 1 Vial, Single-Dose In 1 Carton (66733-948-23)  / 50 Ml In 1 Vial, Single-Dose","636","RC","66733-948-23","NDC","","","facility","both","1","EA","","143.3","143.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gamifant: 1 Vial, Single-Use In 1 Carton (66658-501-01)  / 2 Ml In 1 Vial, Single-Use","636","RC","66658-501-01","NDC","","","facility","both","1","EA","","461.81","461.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetadote: 4 Vial In 1 Carton (66220-207-30)  / 30 Ml In 1 Vial","636","RC","66220-207-30","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetadote: 4 Vial In 1 Carton (66220-207-30)  / 30 Ml In 1 Vial","636","RC","66220-207-30","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tyvaso: 4 Ampule In 1 Box (66302-206-03)  / 2.9 Ml In 1 Ampule","636","RC","66302-206-03","NDC","","","facility","both","1","EA","","1537.43","1537.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 1 Injection, Powder, Lyophilized, For Solution In 1 Bag (66288-1300-1)","636","RC","66288-1300-1","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefazolin: 1 Injection, Powder, Lyophilized, For Solution In 1 Bag (66288-1100-1)","636","RC","66288-1100-1","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","66794-228-02","NDC","","","facility","both","1","EA","","2.3","2.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-423-00","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-423-00","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (67457-422-54)  / 5 Ml In 1 Vial (67457-422-00)","636","RC","67457-422-54","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-422-00","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 10 Vial In 1 Carton (67457-420-10)  / 10 Ml In 1 Vial (67457-420-00)","636","RC","67457-420-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-420-00","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-423-00","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol Decanoate: 5 Vial In 1 Carton (67457-409-13)  / 1 Ml In 1 Vial (67457-409-00)","636","RC","67457-409-13","NDC","","","facility","both","1","EA","","36.52","36.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Vial In 1 Carton (67457-341-05)  / 100 Ml In 1 Vial","636","RC","67457-341-05","NDC","","","facility","both","1","EA","","9.77","9.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-340-00","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Moxifloxacin Hydrochloride: 1 Bag In 1 Carton (67457-323-25)  / 250 Ml In 1 Bag","636","RC","67457-323-25","NDC","","","facility","both","1","EA","","18.29","18.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-299-00","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-292-00","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-409-00","NDC","","","facility","both","1","EA","","36.52","36.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 25 Vial In 1 Carton (67457-423-12)  / 1 Ml In 1 Vial (67457-423-00)","636","RC","67457-423-12","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-426-00","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 10 Vial In 1 Carton (67457-457-20)  / 20 Ml In 1 Vial (67457-457-00)","636","RC","67457-457-20","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-457-00","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rifampin: 1 Vial In 1 Carton (67457-445-60)  / 10 Ml In 1 Vial","636","RC","67457-445-60","NDC","","","facility","both","1","EA","","127.52","127.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron Hydrochloride: 1 VIAL, MULTI-DOSE in 1 CARTON (67457-441-20)  / 20 mL in 1 VIAL, MULTI-DOSE","636","RC","67457-441-20","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vecuronium Bromide: 10 Vial In 1 Carton (67457-438-10)  / 10 Ml In 1 Vial (67457-438-00)","636","RC","67457-438-10","NDC","","","facility","both","1","EA","","30.27","30.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-438-00","NDC","","","facility","both","1","EA","","27.31","27.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial In 1 Carton (67457-436-50)  / 25 Ml In 1 Vial","636","RC","67457-436-50","NDC","","","facility","both","1","EA","","57.58","57.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial In 1 Carton (67457-436-50)  / 25 Ml In 1 Vial","636","RC","67457-436-50","NDC","","","facility","both","1","EA","","58.06","58.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 25 Vial In 1 Carton (67457-433-22)  / 2 Ml In 1 Vial (67457-433-00)","636","RC","67457-433-22","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-433-00","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pamidronate Disodium: 1 Vial In 1 Carton (67457-430-10)  / 10 Ml In 1 Vial","636","RC","67457-430-10","NDC","","","facility","both","1","EA","","12.12","12.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-428-00","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 10 Bag In 1 Carton (67457-266-10)  / 100 Ml In 1 Bag (67457-266-00)","636","RC","67457-266-10","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chirhostim: 8 Ml In 1 Vial, Single-Use (67066-005-01)","636","RC","67066-005-01","NDC","","","facility","both","1","EA","","71.12","71.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chirhostim: 8 Ml In 1 Vial, Single-Use (67066-005-01)","636","RC","67066-005-01","NDC","","","facility","both","1","EA","","75.81","75.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","66993-730-51","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Teriparatide: 1 Syringe In 1 Carton (66993-495-28)  / 2.24 Ml In 1 Syringe","636","RC","66993-495-28","NDC","","","facility","both","1","EA","","80.24","80.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 1 Vial In 1 Carton (66993-370-83)  / 1 Ml In 1 Vial","636","RC","66993-370-83","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chirhostim: 8 Ml In 1 Vial, Single-Use (67066-005-01)","636","RC","67066-005-01","NDC","","","facility","both","1","EA","","60.89","60.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xiaflex: 1 Kit In 1 Carton (66887-003-01)  *  1 Injection, Powder, Lyophilized, For Solution In 1 Vial *  3 Ml In 1 Vial","636","RC","66887-003-01","NDC","","","facility","both","1","EA","","136.82","136.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 25 Vial In 1 Carton (66993-370-25)  / 1 Ml In 1 Vial","636","RC","66993-370-25","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyepti: 1 Vial, Single-Dose In 1 Carton (67386-130-51)  / 1 Ml In 1 Vial, Single-Dose","636","RC","67386-130-51","NDC","","","facility","both","1","EA","","34.53","34.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cosyntropin: 10 VIAL in 1 CARTON (67457-227-02)  / 1 mL in 1 VIAL (67457-227-00) ","636","RC","67457-227-02","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-220-00","NDC","","","facility","both","1","EA","","764.21","764.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-220-00","NDC","","","facility","both","1","EA","","1056.35","1056.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duraclon: 1 Vial In 1 Carton (67457-218-10)  / 10 Ml In 1 Vial","636","RC","67457-218-10","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (67457-217-20)  / 20 Ml In 1 Vial, Multi-Dose","636","RC","67457-217-20","NDC","","","facility","both","1","EA","","29.1","29.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cidofovir: 1 Vial, Glass In 1 Carton (67457-210-05)  / 5 Ml In 1 Vial, Glass","636","RC","67457-210-05","NDC","","","facility","both","1","EA","","175.29","175.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cidofovir: 1 Vial, Glass In 1 Carton (67457-210-05)  / 5 Ml In 1 Vial, Glass","636","RC","67457-210-05","NDC","","","facility","both","1","EA","","335.04","335.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-196-00","NDC","","","facility","both","1","EA","","2.73","2.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-182-00","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rimso-50: 1 Vial, Glass In 1 Carton (67457-177-50)  / 50 Ml In 1 Vial, Glass","636","RC","67457-177-50","NDC","","","facility","both","1","EA","","36.34","36.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amiodarone Hydrochloride: 1 Vial, Glass In 1 Carton (67457-153-18)  / 18 Ml In 1 Vial, Glass","636","RC","67457-153-18","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-153-00","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyepti: 1 Vial, Single-Dose In 1 Carton (67386-130-51)  / 1 Ml In 1 Vial, Single-Dose","636","RC","67386-130-51","NDC","","","facility","both","1","EA","","33.99","33.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","67457-256-00","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-788-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 4 Vial In 1 Carton (70069-788-04)  / 30 Ml In 1 Vial","636","RC","70069-788-04","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73070-103-10","NDC","","","facility","both","1","EA","","4.35","4.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73070-103-10","NDC","","","facility","both","1","EA","","4.38","4.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Insulin Aspart: 5 Syringe, Plastic In 1 Carton (73070-103-15)  / 3 Ml In 1 Syringe, Plastic (73070-103-10)","636","RC","73070-103-15","NDC","","","facility","both","1","EA","","4.41","4.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73043-023-91","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73043-023-91","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73043-023-91","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Insulin Aspart: 1 Vial, Glass In 1 Carton (73070-100-11)  / 10 Ml In 1 Vial, Glass","636","RC","73070-100-11","NDC","","","facility","both","1","EA","","4.25","4.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daxxify: 1 Vial, Single-Use In 1 Carton (72960-112-01)  / 1.2 Ml In 1 Vial, Single-Use","636","RC","72960-112-01","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Insulin Aspart: 5 Syringe, Plastic In 1 Carton (73070-103-15)  / 3 Ml In 1 Syringe, Plastic (73070-103-10)","636","RC","73070-103-15","NDC","","","facility","both","1","EA","","4.41","4.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sylvant: 1 Vial, Single-Dose In 1 Box (73090-420-01)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","73090-420-01","NDC","","","facility","both","1","EA","","271.87","271.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-112-03","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-112-03","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-108-03","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-108-03","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-108-03","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sylvant: 1 Vial, Single-Dose In 1 Box (73090-420-01)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","73090-420-01","NDC","","","facility","both","1","EA","","282.52","282.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-105-01","NDC","","","facility","both","1","EA","","5.96","5.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Briumvi: 1 Vial, Single-Dose In 1 Carton (73150-150-06)  / 6 Ml In 1 Vial, Single-Dose","636","RC","73150-150-06","NDC","","","facility","both","1","EA","","90.43","90.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sylvant: 1 Vial, Single-Dose In 1 Box (73090-421-01)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","73090-421-01","NDC","","","facility","both","1","EA","","264.22","264.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sylvant: 1 Vial, Single-Dose In 1 Box (73090-421-01)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","73090-421-01","NDC","","","facility","both","1","EA","","277.38","277.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-102-25","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daxxify: 1 Vial, Single-Use In 1 Carton (72960-112-01)  / 1.2 Ml In 1 Vial, Single-Use","636","RC","72960-112-01","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daxxify: 1 Vial, Single-Use In 1 Carton (72960-112-01)  / 1.2 Ml In 1 Vial, Single-Use","636","RC","72960-112-01","NDC","","","facility","both","1","EA","","5.28","5.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daxxify: 1 Vial, Single-Use In 1 Carton (72960-112-01)  / 1.2 Ml In 1 Vial, Single-Use","636","RC","72960-112-01","NDC","","","facility","both","1","EA","","5.28","5.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial In 1 Carton (72819-153-02)  / 40 Ml In 1 Vial","636","RC","72819-153-02","NDC","","","facility","both","1","EA","","51.29","51.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elahere: 1 Vial, Single-Use In 1 Carton (72903-853-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","72903-853-01","NDC","","","facility","both","1","EA","","86.64","86.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elahere: 1 Vial, Single-Use In 1 Carton (72903-853-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","72903-853-01","NDC","","","facility","both","1","EA","","91.28","91.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elahere: 1 Vial, Single-Use In 1 Carton (72903-853-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","72903-853-01","NDC","","","facility","both","1","EA","","91.36","91.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elahere: 1 Vial, Single-Use In 1 Carton (72903-853-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","72903-853-01","NDC","","","facility","both","1","EA","","92.03","92.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elahere: 1 Vial, Single-Use In 1 Carton (72903-853-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","72903-853-01","NDC","","","facility","both","1","EA","","120.38","120.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folotyn: 1 Vial In 1 Carton (72893-005-01)  / 2 Ml In 1 Vial","636","RC","72893-005-01","NDC","","","facility","both","1","EA","","611.02","611.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folotyn: 1 Vial In 1 Carton (72893-005-01)  / 2 Ml In 1 Vial","636","RC","72893-005-01","NDC","","","facility","both","1","EA","","641.05","641.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folotyn: 1 Vial In 1 Carton (72893-003-01)  / 1 Ml In 1 Vial","636","RC","72893-003-01","NDC","","","facility","both","1","EA","","615.7","615.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Beleodaq: 1 Vial In 1 Carton (72893-002-01)  / 10 Ml In 1 Vial","636","RC","72893-002-01","NDC","","","facility","both","1","EA","","86.97","86.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Evomela: 1 Vial In 1 Carton (72893-001-01)  / 20 Ml In 1 Vial","636","RC","72893-001-01","NDC","","","facility","both","1","EA","","38.16","38.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Evomela: 1 Vial In 1 Carton (72893-001-01)  / 20 Ml In 1 Vial","636","RC","72893-001-01","NDC","","","facility","both","1","EA","","38.17","38.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Evomela: 1 Vial In 1 Carton (72893-001-01)  / 20 Ml In 1 Vial","636","RC","72893-001-01","NDC","","","facility","both","1","EA","","38.18","38.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-116-02","NDC","","","facility","both","1","EA","","4.66","4.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trelstar: 1 Kit In 1 Carton (74676-5906-1)  *  2 Ml In 1 Vial, Single-Dose (74676-5906-0)  *  2 Ml In 1 Syringe","636","RC","74676-5906-1","NDC","","","facility","both","1","EA","","1278.03","1278.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trelstar: 1 Kit In 1 Carton (74676-5904-1)  *  2 Ml In 1 Vial, Single-Dose (74676-5904-0)  *  2 Ml In 1 Syringe","636","RC","74676-5904-1","NDC","","","facility","both","1","EA","","1307.01","1307.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trelstar: 1 Kit In 1 Carton (74676-5904-1)  *  2 Ml In 1 Vial, Single-Dose (74676-5904-0)  *  2 Ml In 1 Syringe","636","RC","74676-5904-1","NDC","","","facility","both","1","EA","","1321.84","1321.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","76045-204-00","NDC","","","facility","both","1","EA","","9.55","9.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","76045-010-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","76045-010-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Uplizna: 3 Vial, Single-Dose In 1 Carton (75987-150-03)  / 10 Ml In 1 Vial, Single-Dose (75987-150-01)","636","RC","75987-150-03","NDC","","","facility","both","1","EA","","514.24","514.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Uplizna: 3 Vial, Single-Dose In 1 Carton (75987-150-03)  / 10 Ml In 1 Vial, Single-Dose (75987-150-01)","636","RC","75987-150-03","NDC","","","facility","both","1","EA","","514.24","514.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","75987-150-01","NDC","","","facility","both","1","EA","","509.62","509.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","75987-150-01","NDC","","","facility","both","1","EA","","514.24","514.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Proleukin: 1 Vial, Single-Dose In 1 Carton (73776-022-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","73776-022-01","NDC","","","facility","both","1","EA","","8526.08","8526.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73293-0001-1","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-163-33","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-161-43","NDC","","","facility","both","1","EA","","69.72","69.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyvgart: 1 Vial, Single-Dose In 1 Carton (73475-3041-5)  / 20 Ml In 1 Vial, Single-Dose","636","RC","73475-3041-5","NDC","","","facility","both","1","EA","","56.19","56.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-149-02","NDC","","","facility","both","1","EA","","38.47","38.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-146-33","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","73177-116-03","NDC","","","facility","both","1","EA","","2.79","2.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyvgart: 1 Vial, Single-Dose In 1 Carton (73475-3041-5)  / 20 Ml In 1 Vial, Single-Dose","636","RC","73475-3041-5","NDC","","","facility","both","1","EA","","54","54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyvgart: 1 Vial, Single-Dose In 1 Carton (73475-3041-5)  / 20 Ml In 1 Vial, Single-Dose","636","RC","73475-3041-5","NDC","","","facility","both","1","EA","","53.67","53.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyvgart: 1 Vial, Single-Dose In 1 Carton (73475-3041-5)  / 20 Ml In 1 Vial, Single-Dose","636","RC","73475-3041-5","NDC","","","facility","both","1","EA","","49.24","49.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Proleukin: 1 Vial, Single-Dose In 1 Carton (73776-022-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","73776-022-01","NDC","","","facility","both","1","EA","","8544.33","8544.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tzield: 1 Vial, Single-Dose In 1 Carton (73650-316-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","73650-316-01","NDC","","","facility","both","1","EA","","53.58","53.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Monjuvi: 1 Vial In 1 Carton (73535-208-01)  / 5 Ml In 1 Vial","636","RC","73535-208-01","NDC","","","facility","both","1","EA","","24.34","24.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Monjuvi: 1 Vial In 1 Carton (73535-208-01)  / 5 Ml In 1 Vial","636","RC","73535-208-01","NDC","","","facility","both","1","EA","","24.38","24.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Monjuvi: 1 Vial In 1 Carton (73535-208-01)  / 5 Ml In 1 Vial","636","RC","73535-208-01","NDC","","","facility","both","1","EA","","25.01","25.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyvgart: 1 Vial, Single-Dose In 1 Carton (73475-3041-5)  / 20 Ml In 1 Vial, Single-Dose","636","RC","73475-3041-5","NDC","","","facility","both","1","EA","","45.55","45.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Qutenza: 1 Kit In 1 Carton (72512-928-01)  *  1 Pouch In 1 Carton (72512-920-00)  / 1 Patch In 1 Pouch / 179 Mg In 1 Patch *  50 G In 1 Tube","636","RC","72512-928-01","NDC","","","facility","both","1","EA","","1592.52","1592.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiamine: 25 Vial, Multi-Dose In 1 Carton (72485-507-25)  / 2 Ml In 1 Vial, Multi-Dose (72485-507-01)","636","RC","72485-507-25","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72485-507-01","NDC","","","facility","both","1","EA","","2.25","2.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milrinone Lactate: 10 Vial In 1 Carton (72485-502-10)  / 20 Ml In 1 Vial (72485-502-01)","636","RC","72485-502-10","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72485-502-01","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 1 Injection, Powder, For Solution In 1 Carton (72485-423-10)","636","RC","72485-423-10","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72485-508-01","NDC","","","facility","both","1","EA","","2.99","2.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Tablet In 1 Bottle (72578-166-01)","636","RC","72578-166-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Tablet In 1 Bottle (72578-170-01)","636","RC","72578-170-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (72603-152-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","72603-152-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (72603-152-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","72603-152-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-139-01","NDC","","","facility","both","1","EA","","2.62","2.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-133-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-133-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-133-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-128-01","NDC","","","facility","both","1","EA","","3.19","3.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (72603-107-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","72603-107-01","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (72603-107-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","72603-107-01","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (72603-107-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","72603-107-01","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Package (72603-103-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","72603-103-01","NDC","","","facility","both","1","EA","","125.7","125.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72485-423-01","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin Sodium: 10 Vial In 1 Carton (72485-422-10)  / 1 Injection, Powder, For Solution In 1 Vial (72485-422-01)","636","RC","72485-422-10","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sincalide: 5 Vial In 1 Package (72266-248-05)  / 5 Ml In 1 Vial (72266-248-01)","636","RC","72266-248-05","NDC","","","facility","both","1","EA","","37.38","37.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (72485-201-01)","636","RC","72485-201-01","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sincalide: 5 Vial In 1 Package (72266-248-05)  / 5 Ml In 1 Vial (72266-248-01)","636","RC","72266-248-05","NDC","","","facility","both","1","EA","","43.17","43.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-248-01","NDC","","","facility","both","1","EA","","43.27","43.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline: 5 Vial In 1 Carton (72266-237-05)  / 10 Ml In 1 Vial (72266-237-01)","636","RC","72266-237-05","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-237-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexrazoxane: 1 Vial In 1 Carton (72266-235-01)  / 25 Ml In 1 Vial","636","RC","72266-235-01","NDC","","","facility","both","1","EA","","78.53","78.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-248-01","NDC","","","facility","both","1","EA","","41.8","41.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (72485-201-01)","636","RC","72485-201-01","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Injection, Powder, Lyophilized, For Solution In 1 Carton (72485-201-01)","636","RC","72485-201-01","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72485-422-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin Sodium And Sulbactam Sodium: 1 Bottle In 1 Carton (72485-418-15)  / 15 G In 1 Bottle","636","RC","72485-418-15","NDC","","","facility","both","1","EA","","2.15","2.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72485-418-01","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72485-417-01","NDC","","","facility","both","1","EA","","2.61","2.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72485-416-01","NDC","","","facility","both","1","EA","","3.21","3.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 4 Vial In 1 Carton (72485-415-04)  / 20 Ml In 1 Vial","636","RC","72485-415-04","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72485-415-01","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meropenem: 1 Vial In 1 Carton (72485-412-01)  / 20 Ml In 1 Vial","636","RC","72485-412-01","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72485-409-01","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72485-406-01","NDC","","","facility","both","1","EA","","7.97","7.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72485-404-01","NDC","","","facility","both","1","EA","","1.87","1.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irinotecan Hydrochloride 40 Mg/2 Ml: 1 Vial In 1 Carton (72485-211-02)  / 2 Ml In 1 Vial","636","RC","72485-211-02","NDC","","","facility","both","1","EA","","3.19","3.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irinotecan Hydrochloride 40 Mg/2 Ml: 1 Vial In 1 Carton (72485-211-02)  / 2 Ml In 1 Vial","636","RC","72485-211-02","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-153-01","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-153-01","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Vial In 1 Carton (72603-505-10)  / 5 Ml In 1 Vial (72603-505-01)","636","RC","72603-505-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-505-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-474-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-474-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-474-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-454-01","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 10 Bottle In 1 Carton (72603-444-01)  / 1 Injection, Powder, For Solution In 1 Bottle","636","RC","72603-444-01","NDC","","","facility","both","1","EA","","2.44","2.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel Protein-Bound Particles For Injectable Suspension (Albumin-Bound): 1 Vial, Single-Use In 1 Carton (72603-408-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","72603-408-01","NDC","","","facility","both","1","EA","","8.87","8.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel Protein-Bound Particles For Injectable Suspension (Albumin-Bound): 1 Vial, Single-Use In 1 Carton (72603-408-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","72603-408-01","NDC","","","facility","both","1","EA","","8.92","8.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-363-01","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nafcillin: 1 Vial In 1 Box (72603-453-01)  / 8 Ml In 1 Vial","636","RC","72603-453-01","NDC","","","facility","both","1","EA","","8.68","8.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial, Pharmacy Bulk Package In 1 Box (72603-578-01)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","72603-578-01","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-590-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oncaspar: 1 Vial, Single-Use In 1 Carton (72694-954-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","72694-954-01","NDC","","","facility","both","1","EA","","33538.24","33538.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oncaspar: 1 Vial, Single-Use In 1 Carton (72694-954-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","72694-954-01","NDC","","","facility","both","1","EA","","33538.24","33538.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oncaspar: 1 Vial, Single-Use In 1 Carton (72694-954-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","72694-954-01","NDC","","","facility","both","1","EA","","33538.24","33538.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oncaspar: 1 Vial, Single-Use In 1 Carton (72694-954-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","72694-954-01","NDC","","","facility","both","1","EA","","33538.24","33538.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Asparlas: 1 Vial, Single-Use In 1 Carton (72694-515-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","72694-515-01","NDC","","","facility","both","1","EA","","93.28","93.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Asparlas: 1 Vial, Single-Use In 1 Carton (72694-515-01)  / 5 Ml In 1 Vial, Single-Use","636","RC","72694-515-01","NDC","","","facility","both","1","EA","","94.06","94.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72611-860-01","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72611-740-01","NDC","","","facility","both","1","EA","","1.49","1.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72611-719-01","NDC","","","facility","both","1","EA","","1.7","1.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexrazoxane: 1 Vial, Single-Dose In 1 Carton (72611-716-01)  / 50 Ml In 1 Vial, Single-Dose","636","RC","72611-716-01","NDC","","","facility","both","1","EA","","118.63","118.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexrazoxane: 1 Vial, Single-Dose In 1 Carton (72611-716-01)  / 50 Ml In 1 Vial, Single-Dose","636","RC","72611-716-01","NDC","","","facility","both","1","EA","","141.93","141.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-800-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-218-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Mg In 1 Bottle (72603-213-01)","636","RC","72603-213-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Mg In 1 Bottle (72603-212-01)","636","RC","72603-212-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-201-01","NDC","","","facility","both","1","EA","","13.87","13.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-219-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-179-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Maleate: 100 Tablet In 1 Bottle (72603-169-01)","636","RC","72603-169-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Maleate: 100 Tablet In 1 Bottle (72603-168-01)","636","RC","72603-168-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone: 100 Tablet In 1 Bottle (72603-189-01)","636","RC","72603-189-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropivacaine Hydrochloride: 25 Vial In 1 Carton (72603-219-25)  / 20 Ml In 1 Vial (72603-219-01)","636","RC","72603-219-25","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (72603-325-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","72603-325-01","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-267-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-251-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-251-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72603-221-01","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 1 Injection, Powder, For Solution In 1 Vial, Single-Dose (72603-220-01)","636","RC","72603-220-01","NDC","","","facility","both","1","EA","","3.12","3.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 24 Syringe, Glass In 1 Carton (76045-204-20)  / 2 Ml In 1 Syringe, Glass (76045-204-00)","636","RC","76045-204-20","NDC","","","facility","both","1","EA","","7.15","7.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","9999-1017-48","NDC","","","facility","both","1","EA","","535.83","535.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","9999-1017-48","NDC","","","facility","both","1","EA","","630.38","630.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","9999-1019-54","NDC","","","facility","both","1","EA","","3.57","3.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosaprepitant: 1 Vial In 1 Carton (83634-776-10)  / 5 Ml In 1 Vial","636","RC","83634-776-10","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosaprepitant: 1 Vial In 1 Carton (83634-776-10)  / 5 Ml In 1 Vial","636","RC","83634-776-10","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate In Water: 24 Pouch In 1 Carton (83634-500-81)  / 1 Bag In 1 Pouch (83634-500-41)  / 50 Ml In 1 Bag","636","RC","83634-500-81","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","83634-500-41","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","83634-400-41","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bivalirudin: 10 Vial, Single-Dose In 1 Carton (83634-400-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose (83634-400-41)","636","RC","83634-400-10","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eptifibatide: 1 Vial, Single-Dose In 1 Carton (83634-301-51)  / 100 Ml In 1 Vial, Single-Dose","636","RC","83634-301-51","NDC","","","facility","both","1","EA","","5.89","5.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","9999-3856-10","NDC","","","facility","both","1","EA","","3.35","3.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","9999-2009-85","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe","636","RC","83257-005-41","NDC","","","facility","both","1","EA","","215.25","215.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe","636","RC","83257-005-41","NDC","","","facility","both","1","EA","","229.97","229.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe","636","RC","83257-005-41","NDC","","","facility","both","1","EA","","230.96","230.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epkinly: 1 Vial, Glass In 1 Carton (82705-002-01)  / .8 Ml In 1 Vial, Glass","636","RC","82705-002-01","NDC","","","facility","both","1","EA","","98.35","98.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Floxuridine: 1 Vial In 1 Box, Unit-Dose (81643-9270-1)  / 5 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","81643-9270-1","NDC","","","facility","both","1","EA","","1802.66","1802.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Floxuridine: 1 Vial In 1 Box, Unit-Dose (81643-9270-1)  / 5 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","81643-9270-1","NDC","","","facility","both","1","EA","","2187.09","2187.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epkinly: 1 Vial, Glass In 1 Carton (82705-002-01)  / .8 Ml In 1 Vial, Glass","636","RC","82705-002-01","NDC","","","facility","both","1","EA","","98.19","98.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epkinly: 1 Vial, Glass In 1 Carton (82705-002-01)  / .8 Ml In 1 Vial, Glass","636","RC","82705-002-01","NDC","","","facility","both","1","EA","","96.94","96.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epkinly: 1 Vial, Glass In 1 Carton (82705-002-01)  / .8 Ml In 1 Vial, Glass","636","RC","82705-002-01","NDC","","","facility","both","1","EA","","95.05","95.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe","636","RC","83257-005-41","NDC","","","facility","both","1","EA","","231.24","231.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe","636","RC","83257-005-41","NDC","","","facility","both","1","EA","","231.67","231.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe","636","RC","83257-005-41","NDC","","","facility","both","1","EA","","231.67","231.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe","636","RC","83257-005-41","NDC","","","facility","both","1","EA","","231.67","231.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulphila: 1 Syringe In 1 Carton (83257-005-41)  / .6 Ml In 1 Syringe","636","RC","83257-005-41","NDC","","","facility","both","1","EA","","231.67","231.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ogivri: 1 Kit In 1 Carton (83257-004-12)  *  20 Ml In 1 Vial, Multi-Dose (83257-003-11)  *  20 Ml In 1 Vial (83257-002-11)","636","RC","83257-004-12","NDC","","","facility","both","1","EA","","72.6","72.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","83257-003-11","NDC","","","facility","both","1","EA","","75","75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (83090-011-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","83090-011-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (83090-011-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","83090-011-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bortezomib: 1 Vial, Single-Dose In 1 Carton (83090-008-01)  / 3.5 Ml In 1 Vial, Single-Dose","636","RC","83090-008-01","NDC","","","facility","both","1","EA","","14.06","14.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rytelo: 1 Vial, Single-Dose In 1 Carton (82959-112-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","82959-112-01","NDC","","","facility","both","1","EA","","78.93","78.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rytelo: 1 Vial, Single-Dose In 1 Carton (82959-111-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","82959-111-01","NDC","","","facility","both","1","EA","","68.34","68.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rytelo: 1 Vial, Single-Dose In 1 Carton (82959-111-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","82959-111-01","NDC","","","facility","both","1","EA","","71.9","71.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01)  / .8 Ml In 1 Vial, Glass","636","RC","82705-010-01","NDC","","","facility","both","1","EA","","79.56","79.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01)  / .8 Ml In 1 Vial, Glass","636","RC","82705-010-01","NDC","","","facility","both","1","EA","","79.75","79.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01)  / .8 Ml In 1 Vial, Glass","636","RC","82705-010-01","NDC","","","facility","both","1","EA","","80.97","80.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epkinly: 1 Vial, Glass In 1 Carton (82705-010-01)  / .8 Ml In 1 Vial, Glass","636","RC","82705-010-01","NDC","","","facility","both","1","EA","","81.13","81.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epkinly: 1 Vial, Glass In 1 Carton (82705-002-01)  / .8 Ml In 1 Vial, Glass","636","RC","82705-002-01","NDC","","","facility","both","1","EA","","95.05","95.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","99999-5101-50","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (72266-234-25)  / 1 Ml In 1 Vial (72266-234-01)","636","RC","72266-234-25","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","81298-8552-1","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 1 Vial In 1 Carton (76329-9060-0)  / 30 Ml In 1 Vial","636","RC","76329-9060-0","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","76329-8261-0","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Syringe In 1 Package (76329-3390-1)  / 5 Ml In 1 Syringe","636","RC","76329-3390-1","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 10 Carton In 1 Package (76329-3340-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe","636","RC","76329-3340-1","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 10 Carton In 1 Package (76329-3340-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe","636","RC","76329-3340-1","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 10 Carton In 1 Package (76329-3340-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe","636","RC","76329-3340-1","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 10 Carton In 1 Package (76329-3318-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe","636","RC","76329-3318-1","NDC","","","facility","both","1","EA","","1.86","1.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 10 Carton In 1 Package (76329-3318-1)  / 1 Syringe In 1 Carton / 10 Ml In 1 Syringe","636","RC","76329-3318-1","NDC","","","facility","both","1","EA","","1.9","1.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Chloride: 10 Syringe In 1 Package (76329-3304-1)  / 10 Ml In 1 Syringe","636","RC","76329-3304-1","NDC","","","facility","both","1","EA","","22.64","22.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose Monohydrate: 1 Syringe In 1 Carton (76329-3302-1)  / 50 Ml In 1 Syringe","636","RC","76329-3302-1","NDC","","","facility","both","1","EA","","20.44","20.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phytonadione: 1 Syringe In 1 Carton (76329-1240-1)  / .5 Ml In 1 Syringe","636","RC","76329-1240-1","NDC","","","facility","both","1","EA","","38.82","38.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Iron Sucrose: 10 Vial, Single-Dose In 1 Package (76329-9201-1)  / 5 Ml In 1 Vial, Single-Dose","636","RC","76329-9201-1","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Iron Sucrose: 10 Vial, Single-Dose In 1 Package (76329-9201-1)  / 5 Ml In 1 Vial, Single-Dose","636","RC","76329-9201-1","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Korlym: 28 Tablet In 1 Bottle (76346-073-01)","636","RC","76346-073-01","NDC","","","facility","both","1","EA","","449.1","449.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foscavir: 10 Carton In 1 Carton (76310-024-25)  / 1 Bottle In 1 Carton (76310-024-15)  / 250 Ml In 1 Bottle","636","RC","76310-024-25","NDC","","","facility","both","1","EA","","69.67","69.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","76075-103-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","76075-103-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","76075-103-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","76075-102-01","NDC","","","facility","both","1","EA","","100.01","100.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","76075-102-01","NDC","","","facility","both","1","EA","","100.45","100.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","76075-102-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","76075-102-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","76075-102-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","76075-102-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","76075-103-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-102-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","76075-102-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01)  / 30 Ml In 1 Vial, Single-Use","636","RC","76075-101-01","NDC","","","facility","both","1","EA","","99.94","99.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01)  / 30 Ml In 1 Vial, Single-Use","636","RC","76075-101-01","NDC","","","facility","both","1","EA","","100.39","100.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01)  / 30 Ml In 1 Vial, Single-Use","636","RC","76075-101-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01)  / 30 Ml In 1 Vial, Single-Use","636","RC","76075-101-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01)  / 30 Ml In 1 Vial, Single-Use","636","RC","76075-101-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01)  / 30 Ml In 1 Vial, Single-Use","636","RC","76075-101-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01)  / 30 Ml In 1 Vial, Single-Use","636","RC","76075-101-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01)  / 30 Ml In 1 Vial, Single-Use","636","RC","76075-101-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Use In 1 Carton (76075-101-01)  / 30 Ml In 1 Vial, Single-Use","636","RC","76075-101-01","NDC","","","facility","both","1","EA","","106.11","106.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","76075-103-01","NDC","","","facility","both","1","EA","","106.1","106.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","76075-103-01","NDC","","","facility","both","1","EA","","106.1","106.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","76075-103-01","NDC","","","facility","both","1","EA","","100.16","100.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","76310-024-15","NDC","","","facility","both","1","EA","","77.14","77.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","76310-024-15","NDC","","","facility","both","1","EA","","82.84","82.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide And Albuterol Sulfate: 30 Pouch In 1 Carton (76204-600-01)  / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule","636","RC","76204-600-01","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albuterol Sulfate: 30 Pouch In 1 Carton (76204-200-01)  / 1 Ampule In 1 Pouch / 3 Ml In 1 Ampule","636","RC","76204-200-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide: 1 Pouch In 1 Carton (76204-100-30)  / 30 Ampule In 1 Pouch / 2.5 Ml In 1 Ampule","636","RC","76204-100-30","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ipratropium Bromide: 30 Pouch In 1 Carton (76204-100-01)  / 1 Ampule In 1 Pouch / 2.5 Ml In 1 Ampule","636","RC","76204-100-01","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyprolis: 1 Vial, Single-Dose In 1 Carton (76075-103-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","76075-103-01","NDC","","","facility","both","1","EA","","100.08","100.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celestone Soluspan: 1 Vial, Multi-Dose In 1 Box (78206-118-01)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","78206-118-01","NDC","","","facility","both","1","EA","","9.42","9.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Renflexis: 1 Vial In 1 Carton (78206-162-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)","636","RC","78206-162-01","NDC","","","facility","both","1","EA","","68.03","68.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","81284-153-00","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","80830-2365-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propofol: 20 Vial In 1 Carton (80830-2364-8)  / 50 Ml In 1 Vial (80830-2364-1)","636","RC","80830-2364-8","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","81284-155-00","NDC","","","facility","both","1","EA","","3.87","3.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","81298-8552-1","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (81298-8114-1)  / 100 Ml In 1 Vial, Single-Dose","636","RC","81298-8114-1","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1 Vial, Glass In 1 Carton (81298-7500-1)  / 20 Ml In 1 Vial, Glass","636","RC","81298-7500-1","NDC","","","facility","both","1","EA","","13.4","13.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (81298-3890-1)  / 2 Ml In 1 Vial, Single-Dose","636","RC","81298-3890-1","NDC","","","facility","both","1","EA","","99.58","99.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (81298-3890-1)  / 2 Ml In 1 Vial, Single-Dose","636","RC","81298-3890-1","NDC","","","facility","both","1","EA","","99.58","99.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (81298-3890-1)  / 2 Ml In 1 Vial, Single-Dose","636","RC","81298-3890-1","NDC","","","facility","both","1","EA","","99.59","99.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dihydroergotamine Mesylate: 10 Ampule In 1 Carton (81284-411-10)  / 1 Ml In 1 Ampule (81284-411-00)","636","RC","81284-411-10","NDC","","","facility","both","1","EA","","38.04","38.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dihydroergotamine Mesylate: 5 Ampule In 1 Carton (81284-411-05)  / 1 Ml In 1 Ampule (81284-411-00)","636","RC","81284-411-05","NDC","","","facility","both","1","EA","","40.25","40.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","81284-411-00","NDC","","","facility","both","1","EA","","59.21","59.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bludigo: 5 Ampule In 1 Carton (81284-315-05)  / 5 Ml In 1 Ampule (81284-315-00)","636","RC","81284-315-05","NDC","","","facility","both","1","EA","","14.11","14.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bludigo: 5 Ampule In 1 Carton (81284-315-05)  / 5 Ml In 1 Ampule (81284-315-00)","636","RC","81284-315-05","NDC","","","facility","both","1","EA","","14.11","14.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","81284-315-00","NDC","","","facility","both","1","EA","","14.11","14.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propofol: 20 Vial In 1 Carton (80830-2364-8)  / 50 Ml In 1 Vial (80830-2364-1)","636","RC","80830-2364-8","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kimmtrak: 1 Vial, Glass In 1 Carton (80446-401-01)  / .5 Ml In 1 Vial, Glass","636","RC","80446-401-01","NDC","","","facility","both","1","EA","","371.52","371.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enjaymo: 1 Vial, Single-Dose In 1 Carton (80203-347-01)  / 22 Ml In 1 Vial, Single-Dose","636","RC","80203-347-01","NDC","","","facility","both","1","EA","","30.11","30.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zynlonta: 1 Vial, Single-Dose In 1 Carton (79952-110-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","79952-110-01","NDC","","","facility","both","1","EA","","2360.15","2360.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zynlonta: 1 Vial, Single-Dose In 1 Carton (79952-110-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","79952-110-01","NDC","","","facility","both","1","EA","","2547.7","2547.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zynlonta: 1 Vial, Single-Dose In 1 Carton (79952-110-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","79952-110-01","NDC","","","facility","both","1","EA","","2711.99","2711.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zynlonta: 1 Vial, Single-Dose In 1 Carton (79952-110-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","79952-110-01","NDC","","","facility","both","1","EA","","2868.37","2868.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","79672-613-03","NDC","","","facility","both","1","EA","","1.88","1.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kimmtrak: 1 Vial, Glass In 1 Carton (80446-401-01)  / .5 Ml In 1 Vial, Glass","636","RC","80446-401-01","NDC","","","facility","both","1","EA","","326.45","326.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","78206-162-99","NDC","","","facility","both","1","EA","","66.02","66.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","78206-162-99","NDC","","","facility","both","1","EA","","67.74","67.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","78206-162-99","NDC","","","facility","both","1","EA","","67.74","67.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","78206-162-99","NDC","","","facility","both","1","EA","","69.59","69.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Renflexis: 1 Vial In 1 Carton (78206-162-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)","636","RC","78206-162-01","NDC","","","facility","both","1","EA","","66.02","66.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Renflexis: 1 Vial In 1 Carton (78206-162-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)","636","RC","78206-162-01","NDC","","","facility","both","1","EA","","66.02","66.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Renflexis: 1 Vial In 1 Carton (78206-162-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (78206-162-99)","636","RC","78206-162-01","NDC","","","facility","both","1","EA","","67.92","67.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","78206-162-99","NDC","","","facility","both","1","EA","","66.02","66.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kimmtrak: 1 Vial, Glass In 1 Carton (80446-401-01)  / .5 Ml In 1 Vial, Glass","636","RC","80446-401-01","NDC","","","facility","both","1","EA","","323.21","323.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate: 24 Pouch In 1 Carton (80830-2363-9)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","80830-2363-9","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate: 24 Pouch In 1 Carton (80830-2363-9)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","80830-2363-9","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","80830-2363-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","80830-2363-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","80830-2363-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate: 24 Pouch In 1 Carton (80830-2362-9)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag","636","RC","80830-2362-9","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate: 24 Pouch In 1 Carton (80830-2362-9)  / 1 Bag In 1 Pouch / 50 Ml In 1 Bag","636","RC","80830-2362-9","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","80830-2362-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","80830-2362-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propofol: 10 Vial In 1 Carton (80830-1188-7)  / 20 Ml In 1 Vial (80830-1188-1)","636","RC","80830-1188-7","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","80830-1188-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fyarro: 1 Vial, Single-Use In 1 Carton (80803-153-50)  / 20 Ml In 1 Vial, Single-Use","636","RC","80803-153-50","NDC","","","facility","both","1","EA","","130.18","130.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","80777-113-09","NDC","","","facility","both","1","EA","","196.09","196.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","80830-2364-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (72266-234-25)  / 1 Ml In 1 Vial (72266-234-01)","636","RC","72266-234-25","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-234-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 1 Vial In 1 Carton (70700-315-27)  / 1 Ml In 1 Vial","636","RC","70700-315-27","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 1 Ml In 1 Container (70700-315-22)","636","RC","70700-315-22","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Testosterone Cypionate: 1 Vial In 1 Carton (70700-289-22)  / 1 Ml In 1 Vial","636","RC","70700-289-22","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Estradiol Valerate: 5 Ml In 1 Vial, Multi-Dose (70700-274-22)","636","RC","70700-274-22","NDC","","","facility","both","1","EA","","7.59","7.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Estradiol Valerate: 5 Ml In 1 Vial, Multi-Dose (70700-273-22)","636","RC","70700-273-22","NDC","","","facility","both","1","EA","","16.22","16.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (70700-189-22)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","70700-189-22","NDC","","","facility","both","1","EA","","1.86","1.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (70700-189-22)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","70700-189-22","NDC","","","facility","both","1","EA","","1.9","1.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fomepizole: 1 Vial In 1 Carton (70710-1478-1)  / 1.5 Ml In 1 Vial","636","RC","70710-1478-1","NDC","","","facility","both","1","EA","","8.47","8.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol Decanoate: 1 Vial, Single-Dose In 1 Carton (70710-1463-1)  / 1 Ml In 1 Vial, Single-Dose","636","RC","70710-1463-1","NDC","","","facility","both","1","EA","","11.46","11.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol Decanoate: 10 Vial, Single-Dose In 1 Carton (70710-1461-6)  / 1 Ml In 1 Vial, Single-Dose","636","RC","70710-1461-6","NDC","","","facility","both","1","EA","","10.71","10.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70710-1461-1","NDC","","","facility","both","1","EA","","12.73","12.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70710-1377-1","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70710-1359-1","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Childrens Allergy Relief: 1 Bottle In 1 Carton (70677-1268-1)  / 118 Ml In 1 Bottle","636","RC","70677-1268-1","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Childrens Allergy Relief: 1 Bottle In 1 Carton (70677-1012-1)  / 118 Ml In 1 Bottle","636","RC","70677-1012-1","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Children Allergy Relief Dye Free Cherry: 1 Bottle In 1 Carton (70677-0144-2)  / 236 Ml In 1 Bottle","636","RC","70677-0144-2","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Children Allergy Relief Dye Free Cherry: 1 Bottle In 1 Carton (70677-0144-1)  / 118 Ml In 1 Bottle","636","RC","70677-0144-1","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70594-111-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70594-111-01","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70594-090-01","NDC","","","facility","both","1","EA","","3.97","3.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70594-089-01","NDC","","","facility","both","1","EA","","4.66","4.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Use In 1 Carton (70594-034-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","70594-034-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Use In 1 Carton (70594-034-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","70594-034-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lanoxin: 10 Ampule In 1 Box (70515-262-10)  / 1 Ml In 1 Ampule","636","RC","70515-262-10","NDC","","","facility","both","1","EA","","68.59","68.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 4 Vial In 1 Carton (70594-111-02)  / 30 Ml In 1 Vial (70594-111-01)","636","RC","70594-111-02","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sleep Aid: 1 Bottle, Plastic In 1 Box (70677-1151-1)  / 32 Capsule In 1 Bottle, Plastic","636","RC","70677-1151-1","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70710-1516-2","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1530-1)  / 10 Ml In 1 Vial, Single-Dose","636","RC","70710-1530-1","NDC","","","facility","both","1","EA","","147.39","147.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1530-1)  / 10 Ml In 1 Vial, Single-Dose","636","RC","70710-1530-1","NDC","","","facility","both","1","EA","","84.19","84.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1530-1)  / 10 Ml In 1 Vial, Single-Dose","636","RC","70710-1530-1","NDC","","","facility","both","1","EA","","82.97","82.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 1 Vial In 1 Carton (70756-640-82)  / 2 Ml In 1 Vial","636","RC","70756-640-82","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol Decanoate: 1 Vial In 1 Carton (70756-616-81)  / 1 Ml In 1 Vial","636","RC","70756-616-81","NDC","","","facility","both","1","EA","","5.62","5.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol Decanoate: 10 Vial In 1 Carton (70756-616-10)  / 1 Ml In 1 Vial","636","RC","70756-616-10","NDC","","","facility","both","1","EA","","4.88","4.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol Decanoate: 1 Vial In 1 Carton (70756-615-81)  / 1 Ml In 1 Vial","636","RC","70756-615-81","NDC","","","facility","both","1","EA","","9.88","9.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol Decanoate: 10 Vial In 1 Carton (70756-615-10)  / 1 Ml In 1 Vial","636","RC","70756-615-10","NDC","","","facility","both","1","EA","","4.63","4.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70756-612-12","NDC","","","facility","both","1","EA","","2.86","2.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 14 Pouch In 1 Carton (70756-604-56)  / 4 Ampule In 1 Pouch (70756-604-44)  / 5 Ml In 1 Ampule","636","RC","70756-604-56","NDC","","","facility","both","1","EA","","7.67","7.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70756-604-44","NDC","","","facility","both","1","EA","","7.57","7.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70842-120-01","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70860-776-41","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 25 Vial, Single-Dose In 1 Carton (70860-776-02)  / 2 Ml In 1 Vial, Single-Dose (70860-776-41)","636","RC","70860-776-02","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70860-700-41","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70860-302-42","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fulvestrant: 2 Syringe, Glass In 1 Carton (70860-211-74)  / 5 Ml In 1 Syringe, Glass (70860-211-41)","636","RC","70860-211-74","NDC","","","facility","both","1","EA","","9.3","9.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial In 1 Carton (70860-200-50)  / 50 Ml In 1 Vial","636","RC","70860-200-50","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 1 Bottle In 1 Carton (70860-118-99)  / 100 Ml In 1 Bottle","636","RC","70860-118-99","NDC","","","facility","both","1","EA","","1.31","1.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70860-100-41","NDC","","","facility","both","1","EA","","4.75","4.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70842-160-01","NDC","","","facility","both","1","EA","","4.25","4.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vabomere: 6 Vial, Single-Dose In 1 Carton (70842-120-06)  / 2 G In 1 Vial, Single-Dose (70842-120-01)","636","RC","70842-120-06","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70842-120-01","NDC","","","facility","both","1","EA","","3.23","3.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 473 Ml In 1 Bottle, Plastic (70752-138-12)","636","RC","70752-138-12","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70512-843-01","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylene Blue: 5 Vial In 1 Carton (70710-1838-5)  / 10 Ml In 1 Vial (70710-1838-1)","636","RC","70710-1838-5","NDC","","","facility","both","1","EA","","2.06","2.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylene Blue: 5 Vial In 1 Carton (70710-1838-5)  / 10 Ml In 1 Vial (70710-1838-1)","636","RC","70710-1838-5","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70710-1838-1","NDC","","","facility","both","1","EA","","2.43","2.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70710-1838-1","NDC","","","facility","both","1","EA","","2.57","2.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nelarabine: 1 Vial, Single-Dose In 1 Carton (70710-1726-1)  / 50 Ml In 1 Vial, Single-Dose","636","RC","70710-1726-1","NDC","","","facility","both","1","EA","","57.41","57.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 10 Vial In 1 Carton (70710-1725-6)  / 5 Ml In 1 Vial","636","RC","70710-1725-6","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylene Blue: 5 Vial In 1 Carton (70710-1838-5)  / 10 Ml In 1 Vial (70710-1838-1)","636","RC","70710-1838-5","NDC","","","facility","both","1","EA","","2.01","2.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 10 Vial In 1 Carton (70710-1724-6)  / 5 Ml In 1 Vial","636","RC","70710-1724-6","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial In 1 Carton (70710-1724-1)  / 5 Ml In 1 Vial","636","RC","70710-1724-1","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1531-1)  / 25 Ml In 1 Vial, Single-Dose","636","RC","70710-1531-1","NDC","","","facility","both","1","EA","","84.53","84.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (70710-1531-1)  / 25 Ml In 1 Vial, Single-Dose","636","RC","70710-1531-1","NDC","","","facility","both","1","EA","","85.58","85.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial In 1 Carton (70710-1725-1)  / 5 Ml In 1 Vial","636","RC","70710-1725-1","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70710-1850-1","NDC","","","facility","both","1","EA","","11.34","11.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 25 Vial In 1 Carton (70710-1850-7)  / 2 Ml In 1 Vial (70710-1850-1)","636","RC","70710-1850-7","NDC","","","facility","both","1","EA","","13.23","13.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70748-323-02","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70748-323-02","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70748-323-02","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoladex: 1 Pouch In 1 Carton (70720-951-30)  / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe","636","RC","70720-951-30","NDC","","","facility","both","1","EA","","1595.31","1595.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoladex: 1 Pouch In 1 Carton (70720-951-30)  / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe","636","RC","70720-951-30","NDC","","","facility","both","1","EA","","1625.54","1625.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoladex: 1 Pouch In 1 Carton (70720-951-30)  / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe","636","RC","70720-951-30","NDC","","","facility","both","1","EA","","1700.71","1700.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoladex: 1 Pouch In 1 Carton (70720-951-30)  / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe","636","RC","70720-951-30","NDC","","","facility","both","1","EA","","1716.4","1716.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoladex: 1 Pouch In 1 Carton (70720-950-36)  / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe","636","RC","70720-950-36","NDC","","","facility","both","1","EA","","1722.77","1722.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoladex: 1 Pouch In 1 Carton (70720-950-36)  / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe","636","RC","70720-950-36","NDC","","","facility","both","1","EA","","1725.24","1725.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoladex: 1 Pouch In 1 Carton (70720-950-36)  / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe","636","RC","70720-950-36","NDC","","","facility","both","1","EA","","1797.9","1797.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoladex: 1 Pouch In 1 Carton (70720-950-36)  / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe","636","RC","70720-950-36","NDC","","","facility","both","1","EA","","1857.85","1857.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoladex: 1 Pouch In 1 Carton (70720-950-36)  / 1 Syringe In 1 Pouch / 1 Implant In 1 Syringe","636","RC","70720-950-36","NDC","","","facility","both","1","EA","","1861.7","1861.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prialt: 1 Vial, Glass In 1 Carton (70720-722-10)  / 5 Ml In 1 Vial, Glass","636","RC","70720-722-10","NDC","","","facility","both","1","EA","","13.9","13.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prialt: 1 Vial, Glass In 1 Carton (70720-720-10)  / 1 Ml In 1 Vial, Glass","636","RC","70720-720-10","NDC","","","facility","both","1","EA","","10.29","10.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70860-778-41","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (70095-080-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","70095-080-01","NDC","","","facility","both","1","EA","","93.76","93.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (70095-080-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","70095-080-01","NDC","","","facility","both","1","EA","","213.28","213.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 1 Vial In 1 Carton (70095-031-01)  / 10 Ml In 1 Vial","636","RC","70095-031-01","NDC","","","facility","both","1","EA","","13.07","13.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70095-026-01","NDC","","","facility","both","1","EA","","19.49","19.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Udenyca: 1 Syringe In 1 Carton (70114-101-01)  / .6 Ml In 1 Syringe","636","RC","70114-101-01","NDC","","","facility","both","1","EA","","260.55","260.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin Monohydrate: 10 Vial In 1 Carton (70095-025-02)  / 10 Ml In 1 Vial (70095-025-01)","636","RC","70095-025-02","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70095-025-01","NDC","","","facility","both","1","EA","","5.01","5.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-9599-07","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-9054-05","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-9053-05","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-2229-43","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70095-026-01","NDC","","","facility","both","1","EA","","21.79","21.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-2046-46","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Udenyca: 1 Syringe In 1 Carton (70114-101-01)  / .6 Ml In 1 Syringe","636","RC","70114-101-01","NDC","","","facility","both","1","EA","","255.73","255.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Udenyca: 1 Syringe In 1 Carton (70114-130-01)  / .6 Ml In 1 Syringe","636","RC","70114-130-01","NDC","","","facility","both","1","EA","","354.64","354.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe","636","RC","70121-1568-1","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe","636","RC","70121-1568-1","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe","636","RC","70121-1568-1","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe","636","RC","70121-1568-1","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe","636","RC","70121-1568-1","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Arsenic Trioxide: 10 Vial, Single-Dose In 1 Carton (70121-1483-7)  / 10 Ml In 1 Vial, Single-Dose (70121-1483-1)","636","RC","70121-1483-7","NDC","","","facility","both","1","EA","","6.48","6.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70121-1483-1","NDC","","","facility","both","1","EA","","6.4","6.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Udenyca: 1 Syringe In 1 Carton (70114-130-01)  / .6 Ml In 1 Syringe","636","RC","70114-130-01","NDC","","","facility","both","1","EA","","492.01","492.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70121-1483-1","NDC","","","facility","both","1","EA","","6.4","6.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docetaxel: 1 Vial, Glass In 1 Carton (70121-1223-1)  / 8 Ml In 1 Vial, Glass","636","RC","70121-1223-1","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Vial, Multi-Dose In 1 Carton (70121-1168-1)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","70121-1168-1","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 25 Vial In 1 Carton (70121-1049-5)  / 1 Ml In 1 Vial (70121-1049-1)","636","RC","70121-1049-5","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Vial In 1 Carton (70121-1049-2)  / 1 Ml In 1 Vial (70121-1049-1)","636","RC","70121-1049-2","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70121-1049-1","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70121-1049-1","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Udenyca: 1 Syringe In 1 Carton (70114-130-01)  / .6 Ml In 1 Syringe","636","RC","70114-130-01","NDC","","","facility","both","1","EA","","354.64","354.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Udenyca: 1 Syringe In 1 Carton (70114-130-01)  / .6 Ml In 1 Syringe","636","RC","70114-130-01","NDC","","","facility","both","1","EA","","354.64","354.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 1 Vial, Single-Dose In 1 Carton (70121-1240-1)  / 100 Ml In 1 Vial, Single-Dose","636","RC","70121-1240-1","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-2046-46","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1622-03","NDC","","","facility","both","1","EA","","6.03","6.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1093-37","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1086-44","NDC","","","facility","both","1","EA","","7.4","7.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1084-44","NDC","","","facility","both","1","EA","","4.91","4.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1068-07","NDC","","","facility","both","1","EA","","11.69","11.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1046-46","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1046-46","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1094-36","NDC","","","facility","both","1","EA","","33.35","33.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milrinone Lactate: 10 Vial In 1 Carton (70069-808-10)  / 20 Ml In 1 Vial (70069-808-01)","636","RC","70069-808-10","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70069-808-01","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1046-46","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1552-07","NDC","","","facility","both","1","EA","","11.71","11.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1485-46","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1485-46","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1475-50","NDC","","","facility","both","1","EA","","69.82","69.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1175-46","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70092-1133-43","NDC","","","facility","both","1","EA","","4.15","4.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe","636","RC","70121-1568-1","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe","636","RC","70121-1568-1","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1568-1)  / .5 Ml In 1 Syringe","636","RC","70121-1568-1","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 10 Syringe In 1 Box (70121-1568-7)  / .5 Ml In 1 Syringe","636","RC","70121-1568-7","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 10 Vial, Single-Dose In 1 Carton (70377-076-91)  / 10 Ml In 1 Vial, Single-Dose","636","RC","70377-076-91","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 473 Ml In 1 Bottle (70408-146-34)","636","RC","70408-146-34","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70257-563-20","NDC","","","facility","both","1","EA","","240.67","240.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70257-562-11","NDC","","","facility","both","1","EA","","39.84","39.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70257-560-20","NDC","","","facility","both","1","EA","","240.66","240.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70257-560-20","NDC","","","facility","both","1","EA","","240.66","240.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Varizig: 1 Vial, Glass In 1 Carton (70257-126-51)  / 1.2 Ml In 1 Vial, Glass (70257-126-11)","636","RC","70257-126-51","NDC","","","facility","both","1","EA","","1096.65","1096.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hepagam B: 1 Vial, Glass In 1 Carton (70257-051-51)  / 5 Ml In 1 Vial, Glass (70257-051-05)","636","RC","70257-051-51","NDC","","","facility","both","1","EA","","93.22","93.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70257-051-05","NDC","","","facility","both","1","EA","","93.22","93.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70257-563-20","NDC","","","facility","both","1","EA","","240.67","240.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dobutamine: 1 Vial, Single-Dose In 1 Carton (70436-203-80)  / 20 Ml In 1 Vial, Single-Dose","636","RC","70436-203-80","NDC","","","facility","both","1","EA","","3.03","3.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 30 Ml In 1 Vial (70436-110-36)","636","RC","70436-110-36","NDC","","","facility","both","1","EA","","3.95","3.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ganciclovir: 25 Vial In 1 Carton (70436-089-55)  / 10 Ml In 1 Vial","636","RC","70436-089-55","NDC","","","facility","both","1","EA","","25.26","25.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate: 10 Vial, Single-Dose In 1 Carton (70436-032-82)  / 10 Ml In 1 Vial, Single-Dose (70436-032-35)","636","RC","70436-032-82","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70436-032-35","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Injection, Powder, Lyophilized, For Solution In 1 Box (70436-029-80)","636","RC","70436-029-80","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Injection, Powder, Lyophilized, For Solution In 1 Box (70436-029-80)","636","RC","70436-029-80","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eptifibatide: 100 Ml In 1 Vial (70436-027-80)","636","RC","70436-027-80","NDC","","","facility","both","1","EA","","7.22","7.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 10 Vial In 1 Carton (70436-021-82)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","70436-021-82","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 10 Vial In 1 Box (70436-019-82)  / 5 Ml In 1 Vial","636","RC","70436-019-82","NDC","","","facility","both","1","EA","","3.62","3.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 1 Syringe, Glass In 1 Carton (70121-1706-1)  / 10 Ml In 1 Syringe, Glass","636","RC","70121-1706-1","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Plerixafor: 1 Vial, Single-Dose In 1 Carton (70121-1694-2)  / 1.2 Ml In 1 Vial, Single-Dose","636","RC","70121-1694-2","NDC","","","facility","both","1","EA","","13.62","13.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Plerixafor: 1 Vial, Single-Dose In 1 Carton (70121-1694-2)  / 1.2 Ml In 1 Vial, Single-Dose","636","RC","70121-1694-2","NDC","","","facility","both","1","EA","","13.62","13.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70121-1668-1","NDC","","","facility","both","1","EA","","375.26","375.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70121-1668-1","NDC","","","facility","both","1","EA","","426.48","426.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70121-1647-1","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70121-1647-1","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atropine Sulfate: 1 Syringe, Glass In 1 Carton (70121-1706-1)  / 10 Ml In 1 Syringe, Glass","636","RC","70121-1706-1","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tepadina: 1 Vial, Glass In 1 Box (70121-1631-1)  / 1 Injection, Powder, For Solution In 1 Vial, Glass","636","RC","70121-1631-1","NDC","","","facility","both","1","EA","","548.06","548.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe","636","RC","70121-1570-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe","636","RC","70121-1570-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe","636","RC","70121-1570-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe","636","RC","70121-1570-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe","636","RC","70121-1570-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe","636","RC","70121-1570-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe","636","RC","70121-1570-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 1 Syringe In 1 Box (70121-1570-1)  / .8 Ml In 1 Syringe","636","RC","70121-1570-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Releuko: 10 Syringe In 1 Box (70121-1570-7)  / .8 Ml In 1 Syringe","636","RC","70121-1570-7","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lioresal (Baclofen): 2 Ampule In 1 Box (70121-2505-2)  / 1 Kit In 1 Ampule","636","RC","70121-2505-2","NDC","","","facility","both","1","EA","","261","261","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lioresal (Baclofen): 2 Ampule In 1 Box (70121-2505-2)  / 1 Kit In 1 Ampule","636","RC","70121-2505-2","NDC","","","facility","both","1","EA","","261","261","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lioresal (Baclofen): 1 Ampule In 1 Box (70121-2503-1)  / 1 Kit In 1 Ampule","636","RC","70121-2503-1","NDC","","","facility","both","1","EA","","261","261","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lioresal (Baclofen): 1 Ampule In 1 Box (70121-2503-1)  / 1 Kit In 1 Ampule","636","RC","70121-2503-1","NDC","","","facility","both","1","EA","","261","261","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lioresal (Baclofen): 1 Ampule In 1 Box (70121-2501-1)  / 1 Kit In 1 Ampule","636","RC","70121-2501-1","NDC","","","facility","both","1","EA","","261","261","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lioresal (Baclofen): 1 Ampule In 1 Box (70121-2501-1)  / 1 Kit In 1 Ampule","636","RC","70121-2501-1","NDC","","","facility","both","1","EA","","261","261","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lioresal (Baclofen): 5 Ampule In 1 Box (70121-2496-5)  / 1 Ml In 1 Ampule","636","RC","70121-2496-5","NDC","","","facility","both","1","EA","","45","45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70121-2495-1","NDC","","","facility","both","1","EA","","261","261","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70121-1720-1","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70121-1719-1","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70121-1716-1","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","70860-781-41","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (70954-059-10)","636","RC","70954-059-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71773-050-01","NDC","","","facility","both","1","EA","","2.42","2.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xerava: 1 Vial, Glass In 1 Carton (71773-050-05)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass","636","RC","71773-050-05","NDC","","","facility","both","1","EA","","2.42","2.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71506-028-59","NDC","","","facility","both","1","EA","","9.29","9.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71506-016-59","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hcl: 100 Capsule In 1 Bottle (71399-8026-1)","636","RC","71399-8026-1","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71773-100-05","NDC","","","facility","both","1","EA","","2.1","2.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elzonris: 1 Vial, Single-Dose In 1 Carton (72187-0401-1)  / 1 Ml In 1 Vial, Single-Dose","636","RC","72187-0401-1","NDC","","","facility","both","1","EA","","426.56","426.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pombiliti Atga: 1 Vial, Glass In 1 Carton (71904-200-01)  / 105 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass","636","RC","71904-200-01","NDC","","","facility","both","1","EA","","134.31","134.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71839-124-01","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71839-124-01","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71837-5843-1","NDC","","","facility","both","1","EA","","105.68","105.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71837-5843-1","NDC","","","facility","both","1","EA","","107.67","107.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bizengri: 2 Vial, Glass In 1 Carton (71837-1000-2)  / 18.75 Ml In 1 Vial, Glass (71837-1000-1)","636","RC","71837-1000-2","NDC","","","facility","both","1","EA","","42.33","42.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71837-1000-1","NDC","","","facility","both","1","EA","","42.33","42.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hcl: 100 Capsule In 1 Bottle (71399-1028-1)","636","RC","71399-1028-1","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Succinylcholine Chloride: 25 Vial, Multi-Dose In 1 Carton (71288-719-11)  / 10 Ml In 1 Vial, Multi-Dose (71288-719-10)","636","RC","71288-719-11","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-716-11","NDC","","","facility","both","1","EA","","5.13","5.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-716-11","NDC","","","facility","both","1","EA","","6.26","6.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rocuronium Bromide: 10 Vial, Multi-Dose In 1 Carton (71288-700-06)  / 5 Ml In 1 Vial, Multi-Dose (71288-700-05)","636","RC","71288-700-06","NDC","","","facility","both","1","EA","","3.88","3.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (71288-721-11)  / 10 Ml In 1 Vial, Single-Dose","636","RC","71288-721-11","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 10 Vial, Single-Dose In 1 Carton (71288-600-11)  / 10 Ml In 1 Vial, Single-Dose (71288-600-10)","636","RC","71288-600-11","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-600-10","NDC","","","facility","both","1","EA","","1.81","1.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-438-93","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (71288-437-92)  / .8 Ml In 1 Syringe (71288-437-91)","636","RC","71288-437-92","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-437-91","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-700-05","NDC","","","facility","both","1","EA","","2.66","2.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (71288-728-32)  / 30 Ml In 1 Vial, Single-Dose","636","RC","71288-728-32","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71390-011-00","NDC","","","facility","both","1","EA","","3.52","3.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amvuttra: 1 Syringe, Glass In 1 Carton (71336-1003-1)  / .5 Ml In 1 Syringe, Glass","636","RC","71336-1003-1","NDC","","","facility","both","1","EA","","5251.44","5251.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amvuttra: 1 Syringe, Glass In 1 Carton (71336-1003-1)  / .5 Ml In 1 Syringe, Glass","636","RC","71336-1003-1","NDC","","","facility","both","1","EA","","5251.44","5251.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-807-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 4 Vial, Single-Dose In 1 Carton (71288-803-21)  / 20 Ml In 1 Vial, Single-Dose (71288-803-20)","636","RC","71288-803-21","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-803-20","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-803-20","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elzonris: 1 Vial, Single-Dose In 1 Carton (72187-0401-1)  / 1 Ml In 1 Vial, Single-Dose","636","RC","72187-0401-1","NDC","","","facility","both","1","EA","","400.07","400.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (72266-118-25)  / 1 Ml In 1 Vial (72266-118-01)","636","RC","72266-118-25","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-118-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-118-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-118-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (72266-118-25)  / 1 Ml In 1 Vial (72266-118-01)","636","RC","72266-118-25","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (72266-103-01)  / 40 Ml In 1 Vial, Multi-Dose","636","RC","72266-103-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexrazoxane: 1 Vial In 1 Carton (72266-101-01)  / 50 Ml In 1 Vial","636","RC","72266-101-01","NDC","","","facility","both","1","EA","","108.58","108.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexrazoxane: 1 Vial In 1 Carton (72266-101-01)  / 50 Ml In 1 Vial","636","RC","72266-101-01","NDC","","","facility","both","1","EA","","108.75","108.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexrazoxane: 1 Vial In 1 Carton (72266-101-01)  / 50 Ml In 1 Vial","636","RC","72266-101-01","NDC","","","facility","both","1","EA","","126.92","126.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (72266-102-01)  / 20 Ml In 1 Vial, Multi-Dose","636","RC","72266-102-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial In 1 Carton (72266-118-25)  / 1 Ml In 1 Vial (72266-118-01)","636","RC","72266-118-25","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-234-01","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-234-01","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Edisylate: 10 Vial In 1 Carton (72266-204-10)  / 2 Ml In 1 Vial (72266-204-01)","636","RC","72266-204-10","NDC","","","facility","both","1","EA","","2.82","2.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-204-01","NDC","","","facility","both","1","EA","","2.39","2.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 6 Vial, Pharmacy Bulk Package In 1 Carton (72266-163-06)  / 30 Ml In 1 Vial, Pharmacy Bulk Package (72266-163-01)","636","RC","72266-163-06","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-163-01","NDC","","","facility","both","1","EA","","4.48","4.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone Mesylate: 10 Vial, Single-Dose In 1 Carton (72266-160-10)  / 1 Ml In 1 Vial, Single-Dose (72266-160-01)","636","RC","72266-160-10","NDC","","","facility","both","1","EA","","10.1","10.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-160-01","NDC","","","facility","both","1","EA","","10.1","10.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoledronic Acid: 1 Bag In 1 Carton (72266-152-01)  / 100 Ml In 1 Bag","636","RC","72266-152-01","NDC","","","facility","both","1","EA","","6.98","6.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoledronic Acid: 1 Bag In 1 Carton (72266-152-01)  / 100 Ml In 1 Bag","636","RC","72266-152-01","NDC","","","facility","both","1","EA","","6.98","6.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-146-01","NDC","","","facility","both","1","EA","","3.79","3.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Vial, Single-Dose In 1 Carton (72266-131-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","72266-131-01","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Vial, Single-Dose In 1 Carton (72266-131-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","72266-131-01","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicyclomine Hydrochloride: 5 Vial, Single-Dose In 1 Carton (72266-127-05)  / 2 Ml In 1 Vial, Single-Dose (72266-127-01)","636","RC","72266-127-05","NDC","","","facility","both","1","EA","","13.03","13.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72266-127-01","NDC","","","facility","both","1","EA","","13.03","13.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 1 Vial In 1 Carton (72266-124-01)  / 20 Ml In 1 Vial","636","RC","72266-124-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosaprepitant: 1 Vial, Single-Dose In 1 Carton (72205-054-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","72205-054-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial, Glass In 1 Box (72205-046-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass","636","RC","72205-046-01","NDC","","","facility","both","1","EA","","8.43","8.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (72205-036-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","72205-036-01","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (72205-036-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","72205-036-01","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Use In 1 Carton (72205-031-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","72205-031-01","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Use In 1 Carton (72205-031-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","72205-031-01","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72196-6074-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72196-6044-1","NDC","","","facility","both","1","EA","","7.5","7.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Use In 1 Carton (72205-031-01)  / 20 Ml In 1 Vial, Single-Use","636","RC","72205-031-01","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sirolimus: 1 Bottle, Glass In 1 Carton (72205-099-78)  / 60 Ml In 1 Bottle, Glass","636","RC","72205-099-78","NDC","","","facility","both","1","EA","","11.41","11.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Decanoate: 1 Vial, Multi-Dose In 1 Carton (72205-100-01)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","72205-100-01","NDC","","","facility","both","1","EA","","10.98","10.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carmustine: 1 Kit In 1 Carton (72205-198-01)  *  3 Ml In 1 Vial (72205-196-01)  *  30 Ml In 1 Vial, Single-Dose (72205-197-01)","636","RC","72205-198-01","NDC","","","facility","both","1","EA","","152.67","152.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72205-102-01","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72205-102-01","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72205-101-01","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","72205-101-01","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (71288-436-89)  / 1 Ml In 1 Syringe (71288-436-88)","636","RC","71288-436-89","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-436-88","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71285-6044-1","NDC","","","facility","both","1","EA","","6.3","6.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71266-8515-3","NDC","","","facility","both","1","EA","","39.1","39.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71266-8006-1","NDC","","","facility","both","1","EA","","274.88","274.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71266-5083-1","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71266-5083-1","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71266-5082-1","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71266-5040-1","NDC","","","facility","both","1","EA","","41.08","41.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71127-5100-1","NDC","","","facility","both","1","EA","","3.14","3.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71285-6064-1","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71285-6074-1","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-019-10","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-019-10","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Daptomycin: 1 Vial, Single-Dose In 1 Carton (71288-016-15)  / 10 Ml In 1 Vial, Single-Dose","636","RC","71288-016-15","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71286-6011-1","NDC","","","facility","both","1","EA","","5.88","5.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71286-6007-1","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71286-2071-5","NDC","","","facility","both","1","EA","","3.84","3.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71285-8093-1","NDC","","","facility","both","1","EA","","2.07","2.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71285-6176-1","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71286-6007-1","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71127-5100-1","NDC","","","facility","both","1","EA","","3.34","3.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevenfact: 1 Kit In 1 Package (71127-5000-1)  *  5 Ml In 1 Vial, Single-Dose (71127-5100-1)  *  5.2 Ml In 1 Syringe (71127-5200-1)","636","RC","71127-5000-1","NDC","","","facility","both","1","EA","","3.03","3.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevenfact: 1 Kit In 1 Package (71127-5000-1)  *  5 Ml In 1 Vial, Single-Dose (71127-5100-1)  *  5.2 Ml In 1 Syringe (71127-5200-1)","636","RC","71127-5000-1","NDC","","","facility","both","1","EA","","3.42","3.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 473 Ml In 1 Bottle (70954-188-10)","636","RC","70954-188-10","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71127-2100-1","NDC","","","facility","both","1","EA","","3.42","3.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71127-1100-1","NDC","","","facility","both","1","EA","","3.36","3.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71127-1100-1","NDC","","","facility","both","1","EA","","3.42","3.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevenfact: 1 Kit In 1 Package (71127-1000-1)  *  1 Ml In 1 Vial, Single-Dose (71127-1100-1)  *  1.1 Ml In 1 Syringe (71127-1200-1)","636","RC","71127-1000-1","NDC","","","facility","both","1","EA","","3.31","3.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevenfact: 1 Kit In 1 Package (71127-1000-1)  *  1 Ml In 1 Vial, Single-Dose (71127-1100-1)  *  1.1 Ml In 1 Syringe (71127-1200-1)","636","RC","71127-1000-1","NDC","","","facility","both","1","EA","","3.33","3.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71019-263-20","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71019-263-20","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71019-263-20","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71019-029-03","NDC","","","facility","both","1","EA","","2.79","2.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71019-014-07","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-023-20","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Vial, Single-Dose In 1 Carton (71288-027-30)  / 20 Ml In 1 Vial, Single-Dose","636","RC","71288-027-30","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 1 Vial, Single-Dose In 1 Carton (71288-027-30)  / 20 Ml In 1 Vial, Single-Dose","636","RC","71288-027-30","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (71288-402-31)  / 30 Ml In 1 Vial, Multi-Dose (71288-402-30)","636","RC","71288-402-31","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Multi-Dose In 1 Carton (71288-402-11)  / 10 Ml In 1 Vial, Multi-Dose (71288-402-10)","636","RC","71288-402-11","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-402-10","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Single-Dose In 1 Carton (71288-400-03)  / 2 Ml In 1 Vial, Single-Dose (71288-400-02)","636","RC","71288-400-03","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-403-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-400-02","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyanocobalamin: 25 Vial, Multi-Dose In 1 Carton (71288-303-02)  / 1 Ml In 1 Vial, Multi-Dose (71288-303-01)","636","RC","71288-303-02","NDC","","","facility","both","1","EA","","1.58","1.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-303-01","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-203-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-203-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-203-10","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-203-02","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial, Single-Dose In 1 Carton (71288-403-02)  / 1 Ml In 1 Vial, Single-Dose (71288-403-01)","636","RC","71288-403-02","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-411-82","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (71288-435-87)  / .8 Ml In 1 Syringe (71288-435-86)","636","RC","71288-435-87","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-435-86","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (71288-434-85)  / .6 Ml In 1 Syringe (71288-434-84)","636","RC","71288-434-85","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-434-84","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (71288-433-83)  / .4 Ml In 1 Syringe (71288-433-82)","636","RC","71288-433-83","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-433-82","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Syringe In 1 Carton (71288-432-81)  / .3 Ml In 1 Syringe (71288-432-80)","636","RC","71288-432-81","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-432-80","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bivalirudin: 10 Vial, Single-Dose In 1 Carton (71288-427-11)  / 5 Ml In 1 Vial, Single-Dose (71288-427-10)","636","RC","71288-427-11","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-427-10","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 1 Vial, Multi-Dose In 1 Carton (71288-426-03)  / 3 Ml In 1 Vial, Multi-Dose","636","RC","71288-426-03","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eptifibatide: 1 Vial, Single-Dose In 1 Carton (71288-413-51)  / 100 Ml In 1 Vial, Single-Dose","636","RC","71288-413-51","NDC","","","facility","both","1","EA","","6.26","6.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-203-02","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Vial, Single-Dose In 1 Carton (71288-115-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","71288-115-30","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial, Single-Dose In 1 Carton (71288-109-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","71288-109-20","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial, Single-Dose In 1 Carton (71288-109-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","71288-109-20","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial, Single-Dose In 1 Carton (71288-109-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","71288-109-20","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bleomycin: 1 Vial, Single-Dose In 1 Carton (71288-106-10)  / 15 Powder, For Solution In 1 Vial, Single-Dose","636","RC","71288-106-10","NDC","","","facility","both","1","EA","","28.69","28.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bleomycin: 1 Vial, Single-Dose In 1 Carton (71288-106-10)  / 15 Powder, For Solution In 1 Vial, Single-Dose","636","RC","71288-106-10","NDC","","","facility","both","1","EA","","33.4","33.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 1 Bottle In 1 Carton (71288-033-75)  / 1 Injection, Powder, For Solution In 1 Bottle","636","RC","71288-033-75","NDC","","","facility","both","1","EA","","3.28","3.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Vial, Single-Dose In 1 Carton (71288-115-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","71288-115-30","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-031-20","NDC","","","facility","both","1","EA","","3.62","3.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 1 Vial, Single-Dose In 1 Carton (71288-029-12)  / 5 Ml In 1 Vial, Single-Dose (71288-029-10)","636","RC","71288-029-12","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-029-10","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Micafungin: 10 Vial, Single-Dose In 1 Carton (71288-028-11)  / 5 Ml In 1 Vial, Single-Dose (71288-028-10)","636","RC","71288-028-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-028-10","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-032-20","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-116-10","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Busulfan: 8 Vial, Single-Dose In 1 Carton (71288-116-11)  / 10 Ml In 1 Vial, Single-Dose (71288-116-10)","636","RC","71288-116-11","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (71288-119-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","71288-119-20","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Regadenoson: 1 Syringe, Plastic In 1 Carton (71288-201-85)  / 5 Ml In 1 Syringe, Plastic","636","RC","71288-201-85","NDC","","","facility","both","1","EA","","2.91","2.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Regadenoson: 1 Syringe, Plastic In 1 Carton (71288-201-85)  / 5 Ml In 1 Syringe, Plastic","636","RC","71288-201-85","NDC","","","facility","both","1","EA","","5.54","5.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel Protein-Bound Particles For Injectable Suspension (Albumin-Bound): 1 Vial, Single-Use In 1 Carton (71288-183-50)  / 20 Ml In 1 Vial, Single-Use","636","RC","71288-183-50","NDC","","","facility","both","1","EA","","23.56","23.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel Protein-Bound Particles For Injectable Suspension (Albumin-Bound): 1 Vial, Single-Use In 1 Carton (71288-183-50)  / 20 Ml In 1 Vial, Single-Use","636","RC","71288-183-50","NDC","","","facility","both","1","EA","","23.6","23.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50)  / 50 Ml In 1 Vial, Single-Dose","636","RC","71288-167-50","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-167-50)  / 50 Ml In 1 Vial, Single-Dose","636","RC","71288-167-50","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-166-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","71288-166-10","NDC","","","facility","both","1","EA","","1.89","1.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pemetrexed: 1 Vial, Single-Dose In 1 Carton (71288-166-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","71288-166-10","NDC","","","facility","both","1","EA","","1.89","1.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nelarabine: 1 Vial, Single-Dose In 1 Carton (71288-165-54)  / 50 Ml In 1 Vial, Single-Dose (71288-165-52)","636","RC","71288-165-54","NDC","","","facility","both","1","EA","","53.34","53.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-165-52","NDC","","","facility","both","1","EA","","48.43","48.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial, Single-Dose In 1 Carton (71288-157-10)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","71288-157-10","NDC","","","facility","both","1","EA","","9.13","9.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial, Single-Dose In 1 Carton (71288-157-10)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","71288-157-10","NDC","","","facility","both","1","EA","","17.5","17.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thiotepa: 1 Vial, Single-Dose In 1 Carton (71288-156-05)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","71288-156-05","NDC","","","facility","both","1","EA","","44.26","44.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Plerixafor: 1 Vial, Single-Dose In 1 Carton (71288-155-01)  / 1.2 Ml In 1 Vial, Single-Dose","636","RC","71288-155-01","NDC","","","facility","both","1","EA","","34.57","34.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (71288-154-76)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","71288-154-76","NDC","","","facility","both","1","EA","","4.6","4.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial, Single-Dose In 1 Carton (71288-138-50)  / 40 Ml In 1 Vial, Single-Dose","636","RC","71288-138-50","NDC","","","facility","both","1","EA","","158.72","158.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitomycin: 1 Vial, Single-Dose In 1 Carton (71288-137-20)  / 10 Ml In 1 Vial, Single-Dose","636","RC","71288-137-20","NDC","","","facility","both","1","EA","","161.83","161.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (71288-119-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","71288-119-20","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Dose In 1 Carton (71288-119-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","71288-119-20","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","71288-203-02","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kanjinti: 1 Vial, Multi-Dose In 1 Carton (55513-132-01)  / 20 Ml In 1 Vial, Multi-Dose","636","RC","55513-132-01","NDC","","","facility","both","1","EA","","109.12","109.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-126-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-126-01","NDC","","","facility","both","1","EA","","2.9","2.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","9.66","9.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","9.73","9.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","10.3","10.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","10.49","10.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","12.43","12.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","13.22","13.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kanjinti: 1 Vial, Multi-Dose In 1 Carton (55513-132-01)  / 20 Ml In 1 Vial, Multi-Dose","636","RC","55513-132-01","NDC","","","facility","both","1","EA","","108.82","108.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-103-01","NDC","","","facility","both","1","EA","","2700","2700","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-103-01","NDC","","","facility","both","1","EA","","2700","2700","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imlygic: 1 Vial In 1 Carton (55513-079-01)  / 1 Ml In 1 Vial","636","RC","55513-079-01","NDC","","","facility","both","1","EA","","102.86","102.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imlygic: 1 Vial In 1 Carton (55513-079-01)  / 1 Ml In 1 Vial","636","RC","55513-079-01","NDC","","","facility","both","1","EA","","124.02","124.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-111-01)  / 1 Syringe In 1 Blister Pack / .6 Ml In 1 Syringe","636","RC","55513-111-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imlygic: 1 Vial In 1 Carton (55513-079-01)  / 1 Ml In 1 Vial","636","RC","55513-079-01","NDC","","","facility","both","1","EA","","124.34","124.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-148-01","NDC","","","facility","both","1","EA","","2.91","2.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neulasta: 1 Kit In 1 Carton (55513-192-01)  *  .6 Ml In 1 Syringe","636","RC","55513-192-01","NDC","","","facility","both","1","EA","","625.65","625.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neulasta: 1 Kit In 1 Carton (55513-192-01)  *  .6 Ml In 1 Syringe","636","RC","55513-192-01","NDC","","","facility","both","1","EA","","625.65","625.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neulasta: 1 Kit In 1 Carton (55513-192-01)  *  .6 Ml In 1 Syringe","636","RC","55513-192-01","NDC","","","facility","both","1","EA","","625.65","625.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neulasta: 1 Kit In 1 Carton (55513-192-01)  *  .6 Ml In 1 Syringe","636","RC","55513-192-01","NDC","","","facility","both","1","EA","","625.65","625.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neulasta: 1 Kit In 1 Carton (55513-192-01)  *  .6 Ml In 1 Syringe","636","RC","55513-192-01","NDC","","","facility","both","1","EA","","625.65","625.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neulasta: 1 Kit In 1 Carton (55513-192-01)  *  .6 Ml In 1 Syringe","636","RC","55513-192-01","NDC","","","facility","both","1","EA","","625.65","625.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neulasta: 1 Syringe In 1 Carton (55513-190-01)  / .6 Ml In 1 Syringe","636","RC","55513-190-01","NDC","","","facility","both","1","EA","","621.61","621.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neulasta: 1 Syringe In 1 Carton (55513-190-01)  / .6 Ml In 1 Syringe","636","RC","55513-190-01","NDC","","","facility","both","1","EA","","624.37","624.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neulasta: 1 Syringe In 1 Carton (55513-190-01)  / .6 Ml In 1 Syringe","636","RC","55513-190-01","NDC","","","facility","both","1","EA","","625.65","625.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neulasta: 1 Syringe In 1 Carton (55513-190-01)  / .6 Ml In 1 Syringe","636","RC","55513-190-01","NDC","","","facility","both","1","EA","","625.65","625.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-148-01","NDC","","","facility","both","1","EA","","2.91","2.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Blincyto: 1 Kit In 1 Package (55513-160-01)  *  3.088 Ml In 1 Vial (55513-150-01)  *  10.6 Ml In 1 Vial (55513-155-01)","636","RC","55513-160-01","NDC","","","facility","both","1","EA","","264.58","264.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Blincyto: 1 Kit In 1 Package (55513-160-01)  *  3.088 Ml In 1 Vial (55513-150-01)  *  10.6 Ml In 1 Vial (55513-155-01)","636","RC","55513-160-01","NDC","","","facility","both","1","EA","","269.87","269.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Blincyto: 1 Kit In 1 Package (55513-160-01)  *  3.088 Ml In 1 Vial (55513-150-01)  *  10.6 Ml In 1 Vial (55513-155-01)","636","RC","55513-160-01","NDC","","","facility","both","1","EA","","285.24","285.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Blincyto: 1 Kit In 1 Package (55513-160-01)  *  3.088 Ml In 1 Vial (55513-150-01)  *  10.6 Ml In 1 Vial (55513-155-01)","636","RC","55513-160-01","NDC","","","facility","both","1","EA","","285.75","285.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Blincyto: 1 Kit In 1 Package (55513-160-01)  *  3.088 Ml In 1 Vial (55513-150-01)  *  10.6 Ml In 1 Vial (55513-155-01)","636","RC","55513-160-01","NDC","","","facility","both","1","EA","","286.62","286.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-150-01","NDC","","","facility","both","1","EA","","259.36","259.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-150-01","NDC","","","facility","both","1","EA","","264.58","264.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-150-01","NDC","","","facility","both","1","EA","","283.26","283.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Blincyto: 1 Kit In 1 Package (55513-160-01)  *  3.088 Ml In 1 Vial (55513-150-01)  *  10.6 Ml In 1 Vial (55513-155-01)","636","RC","55513-160-01","NDC","","","facility","both","1","EA","","267.05","267.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imlygic: 1 Vial In 1 Carton (55513-078-01)  / 1 Ml In 1 Vial","636","RC","55513-078-01","NDC","","","facility","both","1","EA","","69.17","69.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imlygic: 1 Vial In 1 Carton (55513-078-01)  / 1 Ml In 1 Vial","636","RC","55513-078-01","NDC","","","facility","both","1","EA","","125.75","125.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imdelltra (Amg757): 1 Kit In 1 Package (55513-077-01)  *  10 Mg In 1 Vial (55513-069-01)  *  7 Ml In 1 Vial (55513-068-01)","636","RC","55513-077-01","NDC","","","facility","both","1","EA","","2300","2300","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","11.37","11.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","10.94","10.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-025-01","NDC","","","facility","both","1","EA","","7.09","7.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-025-01","NDC","","","facility","both","1","EA","","10.3","10.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-025-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-023-01","NDC","","","facility","both","1","EA","","7.09","7.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-023-01","NDC","","","facility","both","1","EA","","7.09","7.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","10.89","10.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","9.66","9.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","9.54","9.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imdelltra (Amg757): 1 Kit In 1 Package (55513-077-01)  *  10 Mg In 1 Vial (55513-069-01)  *  7 Ml In 1 Vial (55513-068-01)","636","RC","55513-077-01","NDC","","","facility","both","1","EA","","2300","2300","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-069-01","NDC","","","facility","both","1","EA","","2300","2300","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-069-01","NDC","","","facility","both","1","EA","","2300","2300","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-069-01","NDC","","","facility","both","1","EA","","2300","2300","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Imdelltra (Amg757): 1 Kit In 1 Package (55513-059-01)  *  1 Mg In 1 Vial (55513-103-01)  *  7 Ml In 1 Vial (55513-068-01)","636","RC","55513-059-01","NDC","","","facility","both","1","EA","","2700","2700","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-057-01","NDC","","","facility","both","1","EA","","11.05","11.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-057-01","NDC","","","facility","both","1","EA","","12.86","12.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-057-01","NDC","","","facility","both","1","EA","","13.36","13.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-057-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-032-01)  / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe","636","RC","55513-032-01","NDC","","","facility","both","1","EA","","10.94","10.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-032-01)  / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe","636","RC","55513-032-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-032-01)  / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe","636","RC","55513-032-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-032-01)  / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe","636","RC","55513-032-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-032-01)  / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe","636","RC","55513-032-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-032-01)  / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe","636","RC","55513-032-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-032-01)  / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe","636","RC","55513-032-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-032-01)  / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe","636","RC","55513-032-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-032-01)  / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe","636","RC","55513-032-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-032-01)  / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe","636","RC","55513-032-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-032-01)  / 1 Syringe In 1 Blister Pack / 1 Ml In 1 Syringe","636","RC","55513-032-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-028-01)  / 1 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe","636","RC","55513-028-01","NDC","","","facility","both","1","EA","","8.99","8.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-206-01)  / 4 Ml In 1 Vial","636","RC","55513-206-01","NDC","","","facility","both","1","EA","","93.35","93.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-023-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-206-01)  / 4 Ml In 1 Vial","636","RC","55513-206-01","NDC","","","facility","both","1","EA","","92.42","92.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-206-01)  / 4 Ml In 1 Vial","636","RC","55513-206-01","NDC","","","facility","both","1","EA","","86.17","86.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ddavp: 10 Ampule In 1 Carton (55566-2200-0)  / 1 Ml In 1 Ampule","636","RC","55566-2200-0","NDC","","","facility","both","1","EA","","33.67","33.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ddavp: 10 Ampule In 1 Carton (55566-2200-0)  / 1 Ml In 1 Ampule","636","RC","55566-2200-0","NDC","","","facility","both","1","EA","","33.67","33.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adstiladrin: 4 Vial In 1 Carton (55566-1050-1)  / 20 Ml In 1 Vial (55566-1050-0)","636","RC","55566-1050-1","NDC","","","facility","both","1","EA","","64250","64250","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55566-1050-0","NDC","","","facility","both","1","EA","","64250","64250","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55566-1050-0","NDC","","","facility","both","1","EA","","64250","64250","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-956-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","55513-956-01","NDC","","","facility","both","1","EA","","300.91","300.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Firmagon: 1 Kit In 1 Carton (55566-8303-1)  *  4 Ml In 1 Vial, Glass *  4.2 Ml In 1 Syringe","636","RC","55566-8303-1","NDC","","","facility","both","1","EA","","7.24","7.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-956-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","55513-956-01","NDC","","","facility","both","1","EA","","308.75","308.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-956-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","55513-956-01","NDC","","","facility","both","1","EA","","309.6","309.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-956-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","55513-956-01","NDC","","","facility","both","1","EA","","316.28","316.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-956-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","55513-956-01","NDC","","","facility","both","1","EA","","316.28","316.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-954-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","55513-954-01","NDC","","","facility","both","1","EA","","307.09","307.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-954-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","55513-954-01","NDC","","","facility","both","1","EA","","314.4","314.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-954-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","55513-954-01","NDC","","","facility","both","1","EA","","316.28","316.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-954-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","55513-954-01","NDC","","","facility","both","1","EA","","316.28","316.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-954-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","55513-954-01","NDC","","","facility","both","1","EA","","316.28","316.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vectibix: 1 Vial, Single-Dose In 1 Carton (55513-956-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","55513-956-01","NDC","","","facility","both","1","EA","","309.36","309.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Firmagon: 1 Kit In 1 Carton (55566-8403-1)  *  3 Ml In 1 Syringe *  3 Ml In 1 Vial, Glass","636","RC","55566-8403-1","NDC","","","facility","both","1","EA","","7.5","7.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rebyota: 1 Carton In 1 Carton (55566-9800-2)  / 1 Bag In 1 Carton (55566-9800-1)  / 150 Ml In 1 Bag (55566-9800-0)","636","RC","55566-9800-2","NDC","","","facility","both","1","EA","","16443","16443","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 3 Blister Pack In 1 Carton (57237-078-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","636","RC","57237-078-10","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 3 Blister Pack In 1 Carton (57237-077-10)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","636","RC","57237-077-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Firmagon: 1 Kit In 1 Carton (55566-8403-1)  *  3 Ml In 1 Syringe *  3 Ml In 1 Vial, Glass","636","RC","55566-8403-1","NDC","","","facility","both","1","EA","","7.5","7.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (57237-075-30)","636","RC","57237-075-30","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-267-01","NDC","","","facility","both","1","EA","","2.9","2.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-267-01","NDC","","","facility","both","1","EA","","2.94","2.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Riabni: 1 Vial, Single-Dose In 1 Carton (55513-224-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55513-224-01","NDC","","","facility","both","1","EA","","84.57","84.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nplate: 1 Vial, Single-Dose In 1 Carton (55513-223-01)  / .25 Ml In 1 Vial, Single-Dose","636","RC","55513-223-01","NDC","","","facility","both","1","EA","","20.84","20.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nplate: 1 Vial, Single-Dose In 1 Carton (55513-223-01)  / .25 Ml In 1 Vial, Single-Dose","636","RC","55513-223-01","NDC","","","facility","both","1","EA","","21.71","21.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nplate: 1 Vial In 1 Carton (55513-222-01)  / 1 Ml In 1 Vial","636","RC","55513-222-01","NDC","","","facility","both","1","EA","","20.25","20.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial","636","RC","55513-207-01","NDC","","","facility","both","1","EA","","83.36","83.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial","636","RC","55513-207-01","NDC","","","facility","both","1","EA","","83.36","83.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial","636","RC","55513-207-01","NDC","","","facility","both","1","EA","","86.65","86.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial","636","RC","55513-207-01","NDC","","","facility","both","1","EA","","87.32","87.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial","636","RC","55513-207-01","NDC","","","facility","both","1","EA","","94.31","94.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial","636","RC","55513-207-01","NDC","","","facility","both","1","EA","","95.04","95.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-206-01)  / 4 Ml In 1 Vial","636","RC","55513-206-01","NDC","","","facility","both","1","EA","","83.36","83.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-206-01)  / 4 Ml In 1 Vial","636","RC","55513-206-01","NDC","","","facility","both","1","EA","","83.36","83.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-206-01)  / 4 Ml In 1 Vial","636","RC","55513-206-01","NDC","","","facility","both","1","EA","","83.36","83.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-207-01)  / 16 Ml In 1 Vial","636","RC","55513-207-01","NDC","","","facility","both","1","EA","","83.36","83.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Riabni: 1 Vial, Single-Dose In 1 Carton (55513-326-01)  / 50 Ml In 1 Vial, Single-Dose","636","RC","55513-326-01","NDC","","","facility","both","1","EA","","84.54","84.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Riabni: 1 Vial, Single-Dose In 1 Carton (55513-326-01)  / 50 Ml In 1 Vial, Single-Dose","636","RC","55513-326-01","NDC","","","facility","both","1","EA","","83.42","83.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01)  / 1.7 Ml In 1 Vial, Single-Use","636","RC","55513-730-01","NDC","","","facility","both","1","EA","","48.46","48.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01)  / 1.7 Ml In 1 Vial, Single-Use","636","RC","55513-730-01","NDC","","","facility","both","1","EA","","48.61","48.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01)  / 1.7 Ml In 1 Vial, Single-Use","636","RC","55513-730-01","NDC","","","facility","both","1","EA","","50.19","50.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01)  / 1.7 Ml In 1 Vial, Single-Use","636","RC","55513-730-01","NDC","","","facility","both","1","EA","","50.19","50.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01)  / 1.7 Ml In 1 Vial, Single-Use","636","RC","55513-730-01","NDC","","","facility","both","1","EA","","50.19","50.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xgeva: 1 Vial, Single-Use In 1 Carton (55513-730-01)  / 1.7 Ml In 1 Vial, Single-Use","636","RC","55513-730-01","NDC","","","facility","both","1","EA","","50.19","50.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prolia: 1 Syringe In 1 Carton (55513-710-21)  / 1 Ml In 1 Syringe","636","RC","55513-710-21","NDC","","","facility","both","1","EA","","52.9","52.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prolia: 1 Syringe In 1 Carton (55513-710-21)  / 1 Ml In 1 Syringe","636","RC","55513-710-21","NDC","","","facility","both","1","EA","","53.09","53.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prolia: 1 Syringe In 1 Carton (55513-710-21)  / 1 Ml In 1 Syringe","636","RC","55513-710-21","NDC","","","facility","both","1","EA","","54.57","54.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prolia: 1 Syringe In 1 Carton (55513-710-21)  / 1 Ml In 1 Syringe","636","RC","55513-710-21","NDC","","","facility","both","1","EA","","54.57","54.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prolia: 1 Syringe In 1 Carton (55513-710-21)  / 1 Ml In 1 Syringe","636","RC","55513-710-21","NDC","","","facility","both","1","EA","","54.57","54.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prolia: 1 Syringe In 1 Carton (55513-710-01)  / 1 Ml In 1 Syringe","636","RC","55513-710-01","NDC","","","facility","both","1","EA","","51.98","51.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prolia: 1 Syringe In 1 Carton (55513-710-01)  / 1 Ml In 1 Syringe","636","RC","55513-710-01","NDC","","","facility","both","1","EA","","51.98","51.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prolia: 1 Syringe In 1 Carton (55513-710-01)  / 1 Ml In 1 Syringe","636","RC","55513-710-01","NDC","","","facility","both","1","EA","","54.25","54.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avsola: 1 Vial, Single-Dose In 1 Carton (55513-670-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55513-670-01","NDC","","","facility","both","1","EA","","78.17","78.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avsola: 1 Vial, Single-Dose In 1 Carton (55513-670-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55513-670-01","NDC","","","facility","both","1","EA","","78.17","78.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avsola: 1 Vial, Single-Dose In 1 Carton (55513-670-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55513-670-01","NDC","","","facility","both","1","EA","","78.17","78.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avsola: 1 Vial, Single-Dose In 1 Carton (55513-670-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55513-670-01","NDC","","","facility","both","1","EA","","78.17","78.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Avsola: 1 Vial, Single-Dose In 1 Carton (55513-670-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55513-670-01","NDC","","","facility","both","1","EA","","82.83","82.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mvasi: 1 Vial In 1 Carton (55513-206-01)  / 4 Ml In 1 Vial","636","RC","55513-206-01","NDC","","","facility","both","1","EA","","88.89","88.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-023-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-023-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-023-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-170-30)  / 30 Ml In 1 Vial, Single-Dose","636","RC","55150-170-30","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-169-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-169-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-169-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-169-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-169-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-169-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-168-30)  / 30 Ml In 1 Vial, Single-Dose","636","RC","55150-168-30","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-168-30)  / 30 Ml In 1 Vial, Single-Dose","636","RC","55150-168-30","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-168-30)  / 30 Ml In 1 Vial, Single-Dose","636","RC","55150-168-30","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-168-30)  / 30 Ml In 1 Vial, Single-Dose","636","RC","55150-168-30","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-167-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-167-10","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-167-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-167-10","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-167-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-167-10","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-165-05)  / 5 Ml In 1 Vial, Single-Dose","636","RC","55150-165-05","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 1 Vial, Single-Dose In 1 Carton (55150-163-30)  / 30 Ml In 1 Vial, Single-Dose","636","RC","55150-163-30","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-162-05)  / 5 Ml In 1 Vial, Single-Dose","636","RC","55150-162-05","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-171-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-171-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-171-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-171-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 10 Vial, Single-Dose In 1 Carton (55150-202-10)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose (55150-202-00)","636","RC","55150-202-10","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-202-00","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-201-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","55150-201-20","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-195-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","55150-195-20","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esmolol Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-194-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-194-10","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esmolol Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-194-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-194-10","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 10 Vial, Single-Dose In 1 Carton (55150-177-05)  / 5 Ml In 1 Vial, Single-Dose","636","RC","55150-177-05","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 10 Vial, Single-Dose In 1 Carton (55150-174-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","55150-174-10","NDC","","","facility","both","1","EA","","3.11","3.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-172-30)  / 30 Ml In 1 Vial, Single-Dose","636","RC","55150-172-30","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupivacaine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (55150-171-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-171-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trodelvy: 1 Vial In 1 Box (55135-132-01)  / 1 Powder, For Solution In 1 Vial","636","RC","55135-132-01","NDC","","","facility","both","1","EA","","62.1","62.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trodelvy: 1 Vial In 1 Box (55135-132-01)  / 1 Powder, For Solution In 1 Vial","636","RC","55135-132-01","NDC","","","facility","both","1","EA","","62.75","62.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trodelvy: 1 Vial In 1 Box (55135-132-01)  / 1 Powder, For Solution In 1 Vial","636","RC","55135-132-01","NDC","","","facility","both","1","EA","","62.83","62.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trodelvy: 1 Vial In 1 Box (55135-132-01)  / 1 Powder, For Solution In 1 Vial","636","RC","55135-132-01","NDC","","","facility","both","1","EA","","63.07","63.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trodelvy: 1 Vial In 1 Box (55135-132-01)  / 1 Powder, For Solution In 1 Vial","636","RC","55135-132-01","NDC","","","facility","both","1","EA","","63.91","63.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoledronic Acid: 1 Vial, Glass In 1 Carton (55111-685-07)  / 5 Ml In 1 Vial, Glass","636","RC","55111-685-07","NDC","","","facility","both","1","EA","","2.09","2.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoledronic Acid: 1 Vial, Glass In 1 Carton (55111-685-07)  / 5 Ml In 1 Vial, Glass","636","RC","55111-685-07","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zoledronic Acid: 1 Vial, Glass In 1 Carton (55111-685-07)  / 5 Ml In 1 Vial, Glass","636","RC","55111-685-07","NDC","","","facility","both","1","EA","","2.25","2.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55111-681-11","NDC","","","facility","both","1","EA","","4.51","4.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trodelvy: 1 Vial In 1 Box (55135-132-01)  / 1 Powder, For Solution In 1 Vial","636","RC","55135-132-01","NDC","","","facility","both","1","EA","","61.91","61.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fondaparinux Sodium: 10 Syringe In 1 Carton (55111-681-10)  / .8 Ml In 1 Syringe (55111-681-11)","636","RC","55111-681-10","NDC","","","facility","both","1","EA","","4.59","4.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55111-680-11","NDC","","","facility","both","1","EA","","6.01","6.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fondaparinux Sodium: 10 Syringe In 1 Carton (55111-680-10)  / .6 Ml In 1 Syringe (55111-680-11)","636","RC","55111-680-10","NDC","","","facility","both","1","EA","","6.2","6.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fondaparinux Sodium: 10 Syringe In 1 Carton (55111-679-10)  / .4 Ml In 1 Syringe (55111-679-11)","636","RC","55111-679-10","NDC","","","facility","both","1","EA","","2.58","2.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55111-678-11","NDC","","","facility","both","1","EA","","2.64","2.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fondaparinux Sodium: 10 Syringe In 1 Carton (55111-678-10)  / .5 Ml In 1 Syringe (55111-678-11)","636","RC","55111-678-10","NDC","","","facility","both","1","EA","","2.64","2.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin: 10 Vial In 1 Box (55150-114-20)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","55150-114-20","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (55150-116-20)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","55150-116-20","NDC","","","facility","both","1","EA","","3.16","3.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 10 Vial, Single-Dose In 1 Carton (55150-161-02)  / 2 Ml In 1 Vial, Single-Dose","636","RC","55150-161-02","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir Sodium: 10 Vial, Single-Dose In 1 Carton (55150-155-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","55150-155-20","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir Sodium: 10 Vial, Single-Dose In 1 Carton (55150-154-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-154-10","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxacillin: 10 Vial In 1 Box (55150-128-24)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","55150-128-24","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nafcillin: 10 Vial In 1 Box (55150-123-15)  / 8 Ml In 1 Vial","636","RC","55150-123-15","NDC","","","facility","both","1","EA","","9.67","9.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-121-50)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","55150-121-50","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-120-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","55150-120-30","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Piperacillin And Tazobactam: 10 Vial In 1 Box (55150-119-30)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","55150-119-30","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 1 Vial, Pharmacy Bulk Package In 1 Carton (55150-118-99)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","55150-118-99","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ampicillin And Sulbactam: 10 Vial In 1 Carton (55150-117-20)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","55150-117-20","NDC","","","facility","both","1","EA","","3.03","3.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meropenem: 10 Vial In 1 Carton (55150-207-20)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","55150-207-20","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-435-01","NDC","","","facility","both","1","EA","","79.7","79.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-432-01","NDC","","","facility","both","1","EA","","81.39","81.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dactinomycin: 1 Vial, Single-Dose In 1 Carton (55150-431-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","55150-431-01","NDC","","","facility","both","1","EA","","627.39","627.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-403-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gentamicin: 25 Vial, Multi-Dose In 1 Carton (55150-402-25)  / 2 Ml In 1 Vial, Multi-Dose (55150-402-01)","636","RC","55150-402-25","NDC","","","facility","both","1","EA","","2.62","2.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-402-01","NDC","","","facility","both","1","EA","","2.55","2.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin: 25 Vial, Multi-Dose In 1 Carton (55150-370-25)  / 1 Ml In 1 Vial, Multi-Dose","636","RC","55150-370-25","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin: 1 Vial, Multi-Dose In 1 Carton (55150-370-01)  / 1 Ml In 1 Vial, Multi-Dose","636","RC","55150-370-01","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin: 1 Vial, Multi-Dose In 1 Carton (55150-370-01)  / 1 Ml In 1 Vial, Multi-Dose","636","RC","55150-370-01","NDC","","","facility","both","1","EA","","3.77","3.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (55150-365-01)  / 12.5 Ml In 1 Vial, Single-Dose","636","RC","55150-365-01","NDC","","","facility","both","1","EA","","30.77","30.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (55150-365-01)  / 12.5 Ml In 1 Vial, Single-Dose","636","RC","55150-365-01","NDC","","","facility","both","1","EA","","30.9","30.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-400-01","NDC","","","facility","both","1","EA","","2.55","2.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-023-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Blister Pack In 1 Package (55513-021-04)  / 4 Syringe In 1 Blister Pack / .4 Ml In 1 Syringe (55513-021-01)","636","RC","55513-021-04","NDC","","","facility","both","1","EA","","7.1","7.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-021-01","NDC","","","facility","both","1","EA","","7.1","7.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-021-01","NDC","","","facility","both","1","EA","","9.02","9.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-021-01","NDC","","","facility","both","1","EA","","10.34","10.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-021-01","NDC","","","facility","both","1","EA","","11.37","11.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-021-01","NDC","","","facility","both","1","EA","","12.59","12.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-021-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-021-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-021-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-021-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-021-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aranesp: 1 Vial, Single-Dose In 1 Package (55513-006-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","55513-006-01","NDC","","","facility","both","1","EA","","13.5","13.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55513-005-01","NDC","","","facility","both","1","EA","","6.88","6.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 1 VIAL, MULTI-DOSE in 1 BOX (55390-121-01)  / 20 mL in 1 VIAL, MULTI-DOSE","636","RC","55390-121-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enjaymo: 1 Vial, Single-Dose In 1 Carton (55292-820-01)  / 22 Ml In 1 Vial, Single-Dose","636","RC","55292-820-01","NDC","","","facility","both","1","EA","","30.84","30.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Panhematin: 1 Vial In 1 Carton (55292-702-55)  / 48 Ml In 1 Vial (55292-702-54)","636","RC","55292-702-55","NDC","","","facility","both","1","EA","","51.6","51.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55292-702-54","NDC","","","facility","both","1","EA","","51.6","51.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 10 Syringe In 1 Box (55150-345-10)  / 2 Ml In 1 Syringe","636","RC","55150-345-10","NDC","","","facility","both","1","EA","","10.81","10.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 25 Vial, Single-Dose In 1 Carton (55150-237-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","55150-237-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-236-01","NDC","","","facility","both","1","EA","","36.01","36.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vecuronium Bromide: 10 Vial In 1 Carton (55150-235-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (55150-235-01)","636","RC","55150-235-10","NDC","","","facility","both","1","EA","","14.85","14.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-235-01","NDC","","","facility","both","1","EA","","8.71","8.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-233-00","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 10 Pouch In 1 Carton (55150-242-51)  / 1 Bag In 1 Pouch / 300 Ml In 1 Bag","636","RC","55150-242-51","NDC","","","facility","both","1","EA","","4.03","4.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-232-00","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-230-00","NDC","","","facility","both","1","EA","","2.18","2.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 25 Vial, Single-Dose In 1 Carton (55150-223-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-223-10","NDC","","","facility","both","1","EA","","3.56","3.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 25 Vial, Single-Dose In 1 Carton (55150-223-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-223-10","NDC","","","facility","both","1","EA","","4.04","4.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etomidate: 10 Vial, Single-Dose In 1 Carton (55150-221-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","55150-221-10","NDC","","","facility","both","1","EA","","3.93","3.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meropenem: 10 Vial In 1 Carton (55150-208-30)  / 1 Injection, Powder, For Solution In 1 Vial","636","RC","55150-208-30","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 10 Pouch In 1 Carton (55150-248-47)  / 1 Bag In 1 Pouch / 100 Ml In 1 Bag","636","RC","55150-248-47","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carboplatin: 1 Vial, Multi-Dose In 1 Carton (55150-335-01)  / 45 Ml In 1 Vial, Multi-Dose","636","RC","55150-335-01","NDC","","","facility","both","1","EA","","4.99","4.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 1 Vial, Single-Dose In 1 Carton (55150-329-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","55150-329-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-328-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-323-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-323-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-323-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-319-01","NDC","","","facility","both","1","EA","","16.46","16.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-318-01","NDC","","","facility","both","1","EA","","57.82","57.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 24 Vial, Single-Dose In 1 Carton (55150-307-24)  / 100 Ml In 1 Vial, Single-Dose (55150-307-01)","636","RC","55150-307-24","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","55150-287-01","NDC","","","facility","both","1","EA","","2.2","2.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ertapenem: 10 Vial, Single-Dose In 1 Carton (55150-282-20)  / 1 Injection In 1 Vial, Single-Dose","636","RC","55150-282-20","NDC","","","facility","both","1","EA","","21.09","21.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Decanoate: 1 Vial, Multi-Dose In 1 Carton (55150-267-05)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","55150-267-05","NDC","","","facility","both","1","EA","","12.17","12.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 4 Vial, Single-Dose In 1 Carton (55150-259-30)  / 30 Ml In 1 Vial, Single-Dose","636","RC","55150-259-30","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 4 Vial, Single-Dose In 1 Carton (55150-259-30)  / 30 Ml In 1 Vial, Single-Dose","636","RC","55150-259-30","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 25 Vial, Multi-Dose In 1 Carton (55150-256-50)  / 50 Ml In 1 Vial, Multi-Dose","636","RC","55150-256-50","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naloxone Hydrochloride: 1 Syringe In 1 Box (55150-345-01)  / 2 Ml In 1 Syringe","636","RC","55150-345-01","NDC","","","facility","both","1","EA","","10.77","10.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (59651-489-01)","636","RC","59651-489-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (59651-488-01)","636","RC","59651-488-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (59651-486-01)","636","RC","59651-486-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (59651-485-01)","636","RC","59651-485-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (59651-484-01)","636","RC","59651-484-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fetroja: 10 Vial, Single-Use In 1 Carton (59630-266-10)  / 10 Ml In 1 Vial, Single-Use (59630-266-01)","636","RC","59630-266-10","NDC","","","facility","both","1","EA","","3.65","3.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59630-266-01","NDC","","","facility","both","1","EA","","3.81","3.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59630-266-01","NDC","","","facility","both","1","EA","","3.86","3.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paragard T 380A: 1 Pouch In 1 Carton (59365-5128-1)  / 1 Intrauterine Device In 1 Pouch","636","RC","59365-5128-1","NDC","","","facility","both","1","EA","","1984.65","1984.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59267-4438-1","NDC","","","facility","both","1","EA","","124.74","124.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59267-4426-1","NDC","","","facility","both","1","EA","","93.15","93.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abilify Maintena: 1 Kit In 1 Carton (59148-072-80)  *  1.9 Ml In 1 Syringe *  5 Ml In 1 Syringe","636","RC","59148-072-80","NDC","","","facility","both","1","EA","","11.54","11.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abilify Maintena: 1 Kit In 1 Carton (59148-072-80)  *  1.9 Ml In 1 Syringe *  5 Ml In 1 Syringe","636","RC","59148-072-80","NDC","","","facility","both","1","EA","","11.54","11.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paragard T 380A: 1 Pouch In 1 Carton (59365-5129-1)  / 1 Intrauterine Device In 1 Pouch","636","RC","59365-5129-1","NDC","","","facility","both","1","EA","","2050.2","2050.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abilify Maintena: 1 Kit In 1 Carton (59148-045-80)  *  1.5 Ml In 1 Syringe *  5 Ml In 1 Syringe","636","RC","59148-045-80","NDC","","","facility","both","1","EA","","11.55","11.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abilify Maintena: 1 Kit In 1 Carton (59148-045-80)  *  1.5 Ml In 1 Syringe *  5 Ml In 1 Syringe","636","RC","59148-045-80","NDC","","","facility","both","1","EA","","11.57","11.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Istodax: 1 Kit In 1 Carton (59572-984-01)  *  2.2 Ml In 1 Vial, Glass (59572-962-10)  *  2.4 Ml In 1 Vial, Glass (59572-973-02)","636","RC","59572-984-01","NDC","","","facility","both","1","EA","","57.58","57.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Istodax: 1 Kit In 1 Carton (59572-984-01)  *  2.2 Ml In 1 Vial, Glass (59572-962-10)  *  2.4 Ml In 1 Vial, Glass (59572-973-02)","636","RC","59572-984-01","NDC","","","facility","both","1","EA","","57.58","57.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Istodax: 1 Kit In 1 Carton (59572-984-01)  *  2.2 Ml In 1 Vial, Glass (59572-962-10)  *  2.4 Ml In 1 Vial, Glass (59572-973-02)","636","RC","59572-984-01","NDC","","","facility","both","1","EA","","57.58","57.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Istodax: 1 Kit In 1 Carton (59572-984-01)  *  2.2 Ml In 1 Vial, Glass (59572-962-10)  *  2.4 Ml In 1 Vial, Glass (59572-973-02)","636","RC","59572-984-01","NDC","","","facility","both","1","EA","","57.58","57.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Istodax: 1 Kit In 1 Carton (59572-984-01)  *  2.2 Ml In 1 Vial, Glass (59572-962-10)  *  2.4 Ml In 1 Vial, Glass (59572-973-02)","636","RC","59572-984-01","NDC","","","facility","both","1","EA","","57.58","57.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59572-962-10","NDC","","","facility","both","1","EA","","57.58","57.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Reblozyl: 1 Vial, Glass In 1 Carton (59572-711-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass","636","RC","59572-711-01","NDC","","","facility","both","1","EA","","56.08","56.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Reblozyl: 1 Vial, Glass In 1 Carton (59572-711-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass","636","RC","59572-711-01","NDC","","","facility","both","1","EA","","57.06","57.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Reblozyl: 1 Vial, Glass In 1 Carton (59572-711-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass","636","RC","59572-711-01","NDC","","","facility","both","1","EA","","57.53","57.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Reblozyl: 1 Vial, Glass In 1 Carton (59572-711-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass","636","RC","59572-711-01","NDC","","","facility","both","1","EA","","64.19","64.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59385-023-01","NDC","","","facility","both","1","EA","","19.52","19.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone: 50 Tablet In 1 Bottle (59762-0050-1)","636","RC","59762-0050-1","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone: 25 Tablet In 1 Bottle (59762-0049-1)","636","RC","59762-0049-1","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Tablet In 1 Bottle (59746-175-06)","636","RC","59746-175-06","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Maleate: 100 Tablet In 1 Bottle (59746-115-06)","636","RC","59746-115-06","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prochlorperazine Maleate: 100 Tablet In 1 Bottle (59746-113-06)","636","RC","59746-113-06","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Terbutaline Sulfate: 5 Vial, Single-Use In 1 Carton (59923-615-05)  / 1 Ml In 1 Vial, Single-Use (59923-615-01)","636","RC","59923-615-05","NDC","","","facility","both","1","EA","","33.19","33.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59923-615-01","NDC","","","facility","both","1","EA","","33.19","33.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 1 Bottle In 1 Carton (59762-3140-1)  / 30 Ml In 1 Bottle","636","RC","59762-3140-1","NDC","","","facility","both","1","EA","","2.89","2.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabergoline: 8 Tablet In 1 Bottle (59762-1005-1)","636","RC","59762-1005-1","NDC","","","facility","both","1","EA","","4.86","4.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sirolimus: 100 Tablet, Sugar Coated In 1 Bottle (59762-1003-1)","636","RC","59762-1003-1","NDC","","","facility","both","1","EA","","11.56","11.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sirolimus: 100 Tablet, Sugar Coated In 1 Bottle (59762-1002-1)","636","RC","59762-1002-1","NDC","","","facility","both","1","EA","","11.52","11.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sirolimus: 100 Tablet, Sugar Coated In 1 Bottle (59762-1001-1)","636","RC","59762-1001-1","NDC","","","facility","both","1","EA","","6.25","6.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59676-304-00","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procrit: 6 Vial, Single-Dose In 1 Carton (59676-303-01)  / 1 Ml In 1 Vial, Single-Dose (59676-303-00)","636","RC","59676-303-01","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59676-303-00","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59676-303-00","NDC","","","facility","both","1","EA","","4.96","4.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procrit: 6 Vial, Single-Dose In 1 Carton (59676-302-01)  / 1 Ml In 1 Vial, Single-Dose (59676-302-00)","636","RC","59676-302-01","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59676-302-00","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59676-304-00","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59676-302-00","NDC","","","facility","both","1","EA","","5.38","5.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 1 Bottle In 1 Carton (59651-646-26)  / 225 Ml In 1 Bottle","636","RC","59651-646-26","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procrit: 6 Vial, Single-Dose In 1 Carton (59676-304-01)  / 1 Ml In 1 Vial, Single-Dose (59676-304-00)","636","RC","59676-304-01","NDC","","","facility","both","1","EA","","4.62","4.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59676-310-00","NDC","","","facility","both","1","EA","","25.2","25.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yondelis: 20 Ml In 1 Vial, Single-Use (59676-610-01)","636","RC","59676-610-01","NDC","","","facility","both","1","EA","","489.49","489.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yondelis: 20 Ml In 1 Vial, Single-Use (59676-610-01)","636","RC","59676-610-01","NDC","","","facility","both","1","EA","","494.4","494.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yondelis: 20 Ml In 1 Vial, Single-Use (59676-610-01)","636","RC","59676-610-01","NDC","","","facility","both","1","EA","","552.11","552.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procrit: 4 Vial, Single-Dose In 1 Carton (59676-340-01)  / 1 Ml In 1 Vial, Single-Dose (59676-340-00)","636","RC","59676-340-01","NDC","","","facility","both","1","EA","","2.71","2.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procrit: 4 Vial, Single-Dose In 1 Carton (59676-340-01)  / 1 Ml In 1 Vial, Single-Dose (59676-340-00)","636","RC","59676-340-01","NDC","","","facility","both","1","EA","","4.58","4.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procrit: 4 Vial, Single-Dose In 1 Carton (59676-340-01)  / 1 Ml In 1 Vial, Single-Dose (59676-340-00)","636","RC","59676-340-01","NDC","","","facility","both","1","EA","","9.3","9.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procrit: 4 Vial, Single-Dose In 1 Carton (59676-340-01)  / 1 Ml In 1 Vial, Single-Dose (59676-340-00)","636","RC","59676-340-01","NDC","","","facility","both","1","EA","","17.16","17.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59676-320-00","NDC","","","facility","both","1","EA","","25.2","25.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procrit: 6 Vial, Single-Dose In 1 Carton (59676-310-01)  / 1 Ml In 1 Vial, Single-Dose (59676-310-00)","636","RC","59676-310-01","NDC","","","facility","both","1","EA","","2.52","2.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Procrit: 6 Vial, Single-Dose In 1 Carton (59676-310-01)  / 1 Ml In 1 Vial, Single-Dose (59676-310-00)","636","RC","59676-310-01","NDC","","","facility","both","1","EA","","3.8","3.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59676-310-00","NDC","","","facility","both","1","EA","","2.52","2.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59676-310-00","NDC","","","facility","both","1","EA","","2.56","2.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","59676-310-00","NDC","","","facility","both","1","EA","","2.78","2.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Use In 1 Carton (55111-556-10)  / 10 Ml In 1 Vial, Single-Use","636","RC","55111-556-10","NDC","","","facility","both","1","EA","","19.6","19.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tremfya: 1 Vial, Single-Dose In 1 Carton (57894-650-02)  / 20 Ml In 1 Vial, Single-Dose (57894-650-01)","636","RC","57894-650-02","NDC","","","facility","both","1","EA","","112.8","112.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tremfya: 1 Vial, Single-Dose In 1 Carton (57894-650-02)  / 20 Ml In 1 Vial, Single-Dose (57894-650-01)","636","RC","57894-650-02","NDC","","","facility","both","1","EA","","112.8","112.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tremfya: 1 Vial, Single-Dose In 1 Carton (57894-650-02)  / 20 Ml In 1 Vial, Single-Dose (57894-650-01)","636","RC","57894-650-02","NDC","","","facility","both","1","EA","","112.8","112.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","57894-505-20","NDC","","","facility","both","1","EA","","126.02","126.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","57894-505-20","NDC","","","facility","both","1","EA","","128.73","128.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","57894-505-20","NDC","","","facility","both","1","EA","","137.45","137.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-05)  / 5 Ml In 1 Vial, Single-Dose","636","RC","57894-505-05","NDC","","","facility","both","1","EA","","131.7","131.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-05)  / 5 Ml In 1 Vial, Single-Dose","636","RC","57894-505-05","NDC","","","facility","both","1","EA","","131.7","131.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-05)  / 5 Ml In 1 Vial, Single-Dose","636","RC","57894-505-05","NDC","","","facility","both","1","EA","","138.87","138.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-05)  / 5 Ml In 1 Vial, Single-Dose","636","RC","57894-505-05","NDC","","","facility","both","1","EA","","138.92","138.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","57894-503-01","NDC","","","facility","both","1","EA","","96.82","96.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","57894-503-01","NDC","","","facility","both","1","EA","","99.73","99.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","57894-503-01","NDC","","","facility","both","1","EA","","99.73","99.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Iv: 1 Vial, Single-Dose In 1 Box (57894-505-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","57894-505-20","NDC","","","facility","both","1","EA","","125.58","125.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","57894-503-01","NDC","","","facility","both","1","EA","","102.14","102.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","57894-503-01","NDC","","","facility","both","1","EA","","102.26","102.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","57894-503-01","NDC","","","facility","both","1","EA","","102.88","102.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-449-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","57894-449-01","NDC","","","facility","both","1","EA","","42.91","42.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simponi Aria: 1 Vial, Single-Dose In 1 Carton (57894-350-01)  / 4 Ml In 1 Vial, Single-Dose","636","RC","57894-350-01","NDC","","","facility","both","1","EA","","69.6","69.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simponi Aria: 1 Vial, Single-Dose In 1 Carton (57894-350-01)  / 4 Ml In 1 Vial, Single-Dose","636","RC","57894-350-01","NDC","","","facility","both","1","EA","","69.63","69.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simponi Aria: 1 Vial, Single-Dose In 1 Carton (57894-350-01)  / 4 Ml In 1 Vial, Single-Dose","636","RC","57894-350-01","NDC","","","facility","both","1","EA","","71.4","71.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-449-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","57894-449-01","NDC","","","facility","both","1","EA","","42.82","42.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stelara: 1 Vial, Single-Use In 1 Box (57894-054-27)  / 26 Ml In 1 Vial, Single-Use","636","RC","57894-054-27","NDC","","","facility","both","1","EA","","28.02","28.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Remicade: 1 Vial, Single-Use In 1 Box (57894-030-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","57894-030-01","NDC","","","facility","both","1","EA","","177.22","177.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Remicade: 1 Vial, Single-Use In 1 Box (57894-030-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","57894-030-01","NDC","","","facility","both","1","EA","","189.87","189.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Remicade: 1 Vial, Single-Use In 1 Box (57894-030-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","57894-030-01","NDC","","","facility","both","1","EA","","191.23","191.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Remicade: 1 Vial, Single-Use In 1 Box (57894-030-01)  / 10 Ml In 1 Vial, Single-Use","636","RC","57894-030-01","NDC","","","facility","both","1","EA","","174.76","174.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-449-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","57894-449-01","NDC","","","facility","both","1","EA","","42.44","42.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-449-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","57894-449-01","NDC","","","facility","both","1","EA","","42.42","42.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-449-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","57894-449-01","NDC","","","facility","both","1","EA","","42.25","42.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","57894-503-01","NDC","","","facility","both","1","EA","","102.88","102.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","57894-503-01","NDC","","","facility","both","1","EA","","102.88","102.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex Faspro: 1 Vial, Single-Dose In 1 Box (57894-503-01)  / 15 Ml In 1 Vial, Single-Dose","636","RC","57894-503-01","NDC","","","facility","both","1","EA","","102.88","102.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex: 1 Vial In 1 Carton (57894-502-05)  / 5 Ml In 1 Vial","636","RC","57894-502-05","NDC","","","facility","both","1","EA","","119.82","119.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darzalex: 1 Vial In 1 Carton (57894-502-05)  / 5 Ml In 1 Vial","636","RC","57894-502-05","NDC","","","facility","both","1","EA","","119.82","119.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Talvey: 1 Vial, Single-Dose In 1 Carton (57894-470-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","57894-470-01","NDC","","","facility","both","1","EA","","82.89","82.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Talvey: 1 Vial, Single-Dose In 1 Carton (57894-470-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","57894-470-01","NDC","","","facility","both","1","EA","","83.09","83.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Talvey: 1 Vial, Single-Dose In 1 Carton (57894-470-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","57894-470-01","NDC","","","facility","both","1","EA","","89.54","89.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Talvey: 1 Vial, Single-Dose In 1 Carton (57894-469-01)  / 1.5 Ml In 1 Vial, Single-Dose","636","RC","57894-469-01","NDC","","","facility","both","1","EA","","85.83","85.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Talvey: 1 Vial, Single-Dose In 1 Carton (57894-469-01)  / 1.5 Ml In 1 Vial, Single-Dose","636","RC","57894-469-01","NDC","","","facility","both","1","EA","","86.12","86.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Talvey: 1 Vial, Single-Dose In 1 Carton (57894-469-01)  / 1.5 Ml In 1 Vial, Single-Dose","636","RC","57894-469-01","NDC","","","facility","both","1","EA","","96.99","96.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01)  / 1.7 Ml In 1 Vial, Single-Dose","636","RC","57894-450-01","NDC","","","facility","both","1","EA","","41.93","41.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01)  / 1.7 Ml In 1 Vial, Single-Dose","636","RC","57894-450-01","NDC","","","facility","both","1","EA","","42.05","42.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01)  / 1.7 Ml In 1 Vial, Single-Dose","636","RC","57894-450-01","NDC","","","facility","both","1","EA","","42.14","42.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01)  / 1.7 Ml In 1 Vial, Single-Dose","636","RC","57894-450-01","NDC","","","facility","both","1","EA","","42.41","42.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01)  / 1.7 Ml In 1 Vial, Single-Dose","636","RC","57894-450-01","NDC","","","facility","both","1","EA","","42.41","42.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01)  / 1.7 Ml In 1 Vial, Single-Dose","636","RC","57894-450-01","NDC","","","facility","both","1","EA","","42.68","42.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01)  / 1.7 Ml In 1 Vial, Single-Dose","636","RC","57894-450-01","NDC","","","facility","both","1","EA","","42.73","42.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-450-01)  / 1.7 Ml In 1 Vial, Single-Dose","636","RC","57894-450-01","NDC","","","facility","both","1","EA","","42.93","42.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-449-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","57894-449-01","NDC","","","facility","both","1","EA","","41.76","41.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-449-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","57894-449-01","NDC","","","facility","both","1","EA","","41.83","41.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tecvayli: 1 Vial, Single-Dose In 1 Carton (57894-449-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","57894-449-01","NDC","","","facility","both","1","EA","","42.24","42.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cerezyme: 1 Vial, Glass In 1 Carton (58468-4663-1)  / 10 Ml In 1 Vial, Glass","636","RC","58468-4663-1","NDC","","","facility","both","1","EA","","57.83","57.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58468-0227-1","NDC","","","facility","both","1","EA","","1341.95","1341.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cablivi: 1 Kit In 1 Carton (58468-0225-1)  *  1 Ml In 1 Vial, Glass (58468-0227-1)  *  1 Ml In 1 Syringe, Glass (58468-0229-1)","636","RC","58468-0225-1","NDC","","","facility","both","1","EA","","1341.95","1341.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thymoglobulin: 1 Vial, Glass In 1 Carton (58468-0080-1)  / 5 Ml In 1 Vial, Glass","636","RC","58468-0080-1","NDC","","","facility","both","1","EA","","1571.49","1571.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thymoglobulin: 1 Vial, Glass In 1 Carton (58468-0080-1)  / 5 Ml In 1 Vial, Glass","636","RC","58468-0080-1","NDC","","","facility","both","1","EA","","1612.05","1612.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Thymoglobulin: 1 Vial, Glass In 1 Carton (58468-0080-1)  / 5 Ml In 1 Vial, Glass","636","RC","58468-0080-1","NDC","","","facility","both","1","EA","","1615.2","1615.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fabrazyme: 1 Vial, Glass In 1 Carton (58468-0041-1)  / 1 Ml In 1 Vial, Glass","636","RC","58468-0041-1","NDC","","","facility","both","1","EA","","388.65","388.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58468-0030-1","NDC","","","facility","both","1","EA","","3628.89","3628.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58468-0030-1","NDC","","","facility","both","1","EA","","3629.73","3629.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58406-021-01","NDC","","","facility","both","1","EA","","878.96","878.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58406-010-01","NDC","","","facility","both","1","EA","","760.59","760.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58406-010-01","NDC","","","facility","both","1","EA","","1780.4","1780.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benefix: 1 Kit In 1 Carton (58394-637-03)  *  5 Ml In 1 Vial, Single-Use (58394-137-03)  *  5 Ml In 1 Syringe (58394-041-11)  *  1 Ml In 1 Packet (0069-1111-01)","636","RC","58394-637-03","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benefix: 1 Kit In 1 Carton (58394-637-03)  *  5 Ml In 1 Vial, Single-Use (58394-137-03)  *  5 Ml In 1 Syringe (58394-041-11)  *  1 Ml In 1 Packet (0069-1111-01)","636","RC","58394-637-03","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benefix: 1 Kit In 1 Carton (58394-636-03)  *  5 Ml In 1 Syringe (58394-041-11)  *  1 Ml In 1 Packet (0069-1111-01)  *  5 Ml In 1 Vial, Single-Use (58394-136-03)","636","RC","58394-636-03","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benefix: 1 Kit In 1 Carton (58394-636-03)  *  5 Ml In 1 Syringe (58394-041-11)  *  1 Ml In 1 Packet (0069-1111-01)  *  5 Ml In 1 Vial, Single-Use (58394-136-03)","636","RC","58394-636-03","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fabrazyme: 1 Vial, Glass In 1 Carton (58468-0040-1)  / 7 Ml In 1 Vial, Glass","636","RC","58468-0040-1","NDC","","","facility","both","1","EA","","375.66","375.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"M-Dryl: 120 Ml In 1 Bottle (58657-528-04)","636","RC","58657-528-04","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benefix: 1 Kit In 1 Carton (58394-635-03)  *  5 Ml In 1 Syringe (58394-041-11)  *  1 Ml In 1 Packet (0069-1111-01)  *  5 Ml In 1 Vial, Single-Use (58394-135-03)","636","RC","58394-635-03","NDC","","","facility","both","1","EA","","1.82","1.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benefix: 1 Kit In 1 Carton (58394-635-03)  *  5 Ml In 1 Syringe (58394-041-11)  *  1 Ml In 1 Packet (0069-1111-01)  *  5 Ml In 1 Vial, Single-Use (58394-135-03)","636","RC","58394-635-03","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benefix: 1 Kit In 1 Carton (58394-634-03)  *  5 Ml In 1 Syringe (58394-041-11)  *  1 Ml In 1 Packet (0069-1111-01)  *  5 Ml In 1 Vial, Single-Use (58394-134-03)","636","RC","58394-634-03","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-828-03","NDC","","","facility","both","1","EA","","349.72","349.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-827-03","NDC","","","facility","both","1","EA","","200.36","200.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-826-43","NDC","","","facility","both","1","EA","","124.77","124.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-825-43","NDC","","","facility","both","1","EA","","53.11","53.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Shingrix: 1 Kit In 1 Carton (58160-823-11)  *  .5 Ml In 1 Vial (58160-828-03)  *  .5 Ml In 1 Vial (58160-829-03)","636","RC","58160-823-11","NDC","","","facility","both","1","EA","","349.07","349.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-821-01","NDC","","","facility","both","1","EA","","77.61","77.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-842-01","NDC","","","facility","both","1","EA","","66.11","66.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-820-43","NDC","","","facility","both","1","EA","","35.84","35.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-740-02","NDC","","","facility","both","1","EA","","199.11","199.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Engerix-B: 10 Syringe In 1 Carton (58160-820-52)  / .5 Ml In 1 Syringe (58160-820-43)","636","RC","58160-820-52","NDC","","","facility","both","1","EA","","36.08","36.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-842-34","NDC","","","facility","both","1","EA","","56.93","56.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-842-43","NDC","","","facility","both","1","EA","","67.97","67.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-842-43","NDC","","","facility","both","1","EA","","67.61","67.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benefix: 1 Kit In 1 Carton (58394-633-03)  *  5 Ml In 1 Syringe (58394-041-11)  *  1 Ml In 1 Packet (0069-1111-01)  *  5 Ml In 1 Vial, Single-Use (58394-133-03)","636","RC","58394-633-03","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benefix: 1 Kit In 1 Carton (58394-633-03)  *  5 Ml In 1 Syringe (58394-041-11)  *  1 Ml In 1 Packet (0069-1111-01)  *  5 Ml In 1 Vial, Single-Use (58394-133-03)","636","RC","58394-633-03","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brixadi: 1 Syringe, Glass In 1 Carton (58284-296-01)  / .27 Ml In 1 Syringe, Glass","636","RC","58284-296-01","NDC","","","facility","both","1","EA","","2085.48","2085.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brixadi: 1 Syringe, Glass In 1 Carton (58284-264-01)  / .18 Ml In 1 Syringe, Glass","636","RC","58284-264-01","NDC","","","facility","both","1","EA","","2090.49","2090.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brixadi: 1 Syringe, Glass In 1 Carton (58284-232-01)  / .64 Ml In 1 Syringe, Glass","636","RC","58284-232-01","NDC","","","facility","both","1","EA","","548.62","548.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58284-228-91","NDC","","","facility","both","1","EA","","2106.06","2106.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brixadi: 1 Syringe, Glass In 1 Carton (58284-228-01)  / .36 Ml In 1 Syringe, Glass","636","RC","58284-228-01","NDC","","","facility","both","1","EA","","2106.06","2106.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58284-224-91","NDC","","","facility","both","1","EA","","545.83","545.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brixadi: 1 Syringe, Glass In 1 Carton (58284-224-01)  / .48 Ml In 1 Syringe, Glass","636","RC","58284-224-01","NDC","","","facility","both","1","EA","","545.83","545.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brixadi: 1 Syringe, Glass In 1 Carton (58284-208-01)  / .16 Ml In 1 Syringe, Glass","636","RC","58284-208-01","NDC","","","facility","both","1","EA","","547.36","547.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bexsero: 10 Syringe In 1 Carton (58160-976-20)  / .5 Ml In 1 Syringe (58160-976-02)","636","RC","58160-976-20","NDC","","","facility","both","1","EA","","150.43","150.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-976-02","NDC","","","facility","both","1","EA","","151.97","151.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-958-01","NDC","","","facility","both","1","EA","","201.06","201.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-912-41","NDC","","","facility","both","1","EA","","24.3","24.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Boostrix: 10 Syringe In 1 Carton (58160-842-52)  / .5 Ml In 1 Syringe (58160-842-43)","636","RC","58160-842-52","NDC","","","facility","both","1","EA","","66.11","66.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Boostrix: 10 Syringe In 1 Carton (58160-842-52)  / .5 Ml In 1 Syringe (58160-842-43)","636","RC","58160-842-52","NDC","","","facility","both","1","EA","","67.54","67.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","58160-842-43","NDC","","","facility","both","1","EA","","67.58","67.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benefix: 1 Kit In 1 Carton (58394-634-03)  *  5 Ml In 1 Syringe (58394-041-11)  *  1 Ml In 1 Packet (0069-1111-01)  *  5 Ml In 1 Vial, Single-Use (58394-134-03)","636","RC","58394-634-03","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abiraterone Acetate: 120 Tablet In 1 Bottle (60219-1165-7)","636","RC","60219-1165-7","NDC","","","facility","both","1","EA","","6.57","6.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Use In 1 Carton (55111-556-10)  / 10 Ml In 1 Vial, Single-Use","636","RC","55111-556-10","NDC","","","facility","both","1","EA","","19.73","19.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Invega Sustenna: 1 Syringe In 1 Kit (50458-564-01)  / 1.5 Ml In 1 Syringe","636","RC","50458-564-01","NDC","","","facility","both","1","EA","","24.18","24.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Invega Sustenna: 1 Syringe In 1 Kit (50458-564-01)  / 1.5 Ml In 1 Syringe","636","RC","50458-564-01","NDC","","","facility","both","1","EA","","25.05","25.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Invega Sustenna: 1 Syringe In 1 Kit (50458-564-01)  / 1.5 Ml In 1 Syringe","636","RC","50458-564-01","NDC","","","facility","both","1","EA","","25.11","25.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Invega Sustenna: 1 Syringe In 1 Kit (50458-563-01)  / 1 Ml In 1 Syringe","636","RC","50458-563-01","NDC","","","facility","both","1","EA","","24.69","24.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Invega Sustenna: 1 Syringe In 1 Kit (50458-563-01)  / 1 Ml In 1 Syringe","636","RC","50458-563-01","NDC","","","facility","both","1","EA","","24.96","24.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Invega Sustenna: 1 Syringe In 1 Kit (50458-562-01)  / .75 Ml In 1 Syringe","636","RC","50458-562-01","NDC","","","facility","both","1","EA","","25.15","25.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Invega Sustenna: 1 Syringe In 1 Kit (50458-562-01)  / .75 Ml In 1 Syringe","636","RC","50458-562-01","NDC","","","facility","both","1","EA","","25.18","25.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Invega Sustenna: 1 Syringe In 1 Kit (50458-561-01)  / .5 Ml In 1 Syringe","636","RC","50458-561-01","NDC","","","facility","both","1","EA","","24.18","24.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Invega Sustenna: 1 Syringe In 1 Kit (50458-560-01)  / .25 Ml In 1 Syringe","636","RC","50458-560-01","NDC","","","facility","both","1","EA","","24.56","24.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Invega Sustenna: 1 Syringe In 1 Kit (50458-560-01)  / .25 Ml In 1 Syringe","636","RC","50458-560-01","NDC","","","facility","both","1","EA","","24.99","24.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperdal Consta: 1 Kit In 1 Box (50458-309-11)  *  2 Ml In 1 Vial *  2 Ml In 1 Syringe (50458-309-01)","636","RC","50458-309-11","NDC","","","facility","both","1","EA","","21.2","21.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50458-309-01","NDC","","","facility","both","1","EA","","19.99","19.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50458-309-01","NDC","","","facility","both","1","EA","","20.95","20.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperdal Consta: 1 Kit In 1 Box (50458-308-11)  *  2 Ml In 1 Vial *  2 Ml In 1 Syringe (50458-308-01)","636","RC","50458-308-11","NDC","","","facility","both","1","EA","","20.85","20.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperdal Consta: 1 Kit In 1 Box (50458-308-11)  *  2 Ml In 1 Vial *  2 Ml In 1 Syringe (50458-308-01)","636","RC","50458-308-11","NDC","","","facility","both","1","EA","","21.01","21.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperdal Consta: 1 Kit In 1 Box (50458-307-11)  *  2 Ml In 1 Vial *  2 Ml In 1 Syringe (50458-307-01)","636","RC","50458-307-11","NDC","","","facility","both","1","EA","","21.16","21.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperdal Consta: 1 Kit In 1 Box (50458-307-11)  *  2 Ml In 1 Vial *  2 Ml In 1 Syringe (50458-307-01)","636","RC","50458-307-11","NDC","","","facility","both","1","EA","","21.24","21.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50458-307-01","NDC","","","facility","both","1","EA","","20.99","20.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50458-307-01","NDC","","","facility","both","1","EA","","21.22","21.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperdal Consta: 1 Kit In 1 Box (50458-306-11)  *  2 Ml In 1 Syringe (50458-306-01)  *  2 Ml In 1 Vial","636","RC","50458-306-11","NDC","","","facility","both","1","EA","","21.03","21.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperdal Consta: 1 Kit In 1 Box (50458-309-11)  *  2 Ml In 1 Vial *  2 Ml In 1 Syringe (50458-309-01)","636","RC","50458-309-11","NDC","","","facility","both","1","EA","","21.14","21.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperdal Consta: 1 Kit In 1 Box (50458-306-11)  *  2 Ml In 1 Syringe (50458-306-01)  *  2 Ml In 1 Vial","636","RC","50458-306-11","NDC","","","facility","both","1","EA","","21.1","21.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50458-306-01","NDC","","","facility","both","1","EA","","21.42","21.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisolone: 1 BOTTLE in 1 CARTON (50383-042-48)  / 480 mL in 1 BOTTLE","636","RC","50383-042-48","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine Hydrochloride: 30 Tablet In 1 Bottle (50383-924-93)","636","RC","50383-924-93","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spravato: 3 Blister Pack In 1 Kit (50458-028-03)  / 1 Vial, Single-Use In 1 Blister Pack / .2 Ml In 1 Vial, Single-Use (50458-028-00)","636","RC","50458-028-03","NDC","","","facility","both","1","EA","","1948.04","1948.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spravato: 2 Blister Pack In 1 Kit (50458-028-02)  / 1 Vial, Single-Use In 1 Blister Pack / .2 Ml In 1 Vial, Single-Use (50458-028-00)","636","RC","50458-028-02","NDC","","","facility","both","1","EA","","1211.41","1211.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50458-028-00","NDC","","","facility","both","1","EA","","1461.21","1461.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kyleena: 1 Intrauterine Device In 1 Carton (50419-424-01)","636","RC","50419-424-01","NDC","","","facility","both","1","EA","","2177.66","2177.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirena: 1 Intrauterine Device In 1 Carton (50419-423-01)","636","RC","50419-423-01","NDC","","","facility","both","1","EA","","1458.92","1458.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirena: 1 Intrauterine Device In 1 Carton (50419-423-01)","636","RC","50419-423-01","NDC","","","facility","both","1","EA","","1628.2","1628.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Skyla: 1 Intrauterine Device In 1 Carton (50419-422-01)","636","RC","50419-422-01","NDC","","","facility","both","1","EA","","1820.49","1820.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50474-970-63","NDC","","","facility","both","1","EA","","8.38","8.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50474-970-63","NDC","","","facility","both","1","EA","","8.21","8.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51079-028-01","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Niktimvo: 1 Vial, Single-Use In 1 Carton (50881-034-12)  / .18 Ml In 1 Vial, Single-Use","636","RC","50881-034-12","NDC","","","facility","both","1","EA","","92.35","92.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Niktimvo: 1 Vial, Single-Use In 1 Carton (50881-023-11)  / .44 Ml In 1 Vial, Single-Use","636","RC","50881-023-11","NDC","","","facility","both","1","EA","","89.6","89.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Monjuvi: 1 Vial In 1 Carton (50881-013-03)  / 5 Ml In 1 Vial","636","RC","50881-013-03","NDC","","","facility","both","1","EA","","24.63","24.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Monjuvi: 1 Vial In 1 Carton (50881-013-03)  / 5 Ml In 1 Vial","636","RC","50881-013-03","NDC","","","facility","both","1","EA","","24.63","24.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Monjuvi: 1 Vial In 1 Carton (50881-013-03)  / 5 Ml In 1 Vial","636","RC","50881-013-03","NDC","","","facility","both","1","EA","","24.98","24.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jakafi: 60 Tablet In 1 Bottle, Plastic (50881-010-60)","636","RC","50881-010-60","NDC","","","facility","both","1","EA","","499.53","499.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50632-013-01","NDC","","","facility","both","1","EA","","626.69","626.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50632-013-01","NDC","","","facility","both","1","EA","","644.84","644.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rabavert: 1 Kit In 1 Carton (50632-010-01)  *  1 Ml In 1 Syringe (50632-011-01)  *  1 Ml In 1 Vial, Glass (50632-013-01)","636","RC","50632-010-01","NDC","","","facility","both","1","EA","","582.09","582.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rabavert: 1 Kit In 1 Carton (50632-010-01)  *  1 Ml In 1 Syringe (50632-011-01)  *  1 Ml In 1 Vial, Glass (50632-013-01)","636","RC","50632-010-01","NDC","","","facility","both","1","EA","","583.43","583.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cabergoline: 8 Tablet In 1 Bottle (50742-118-08)","636","RC","50742-118-08","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50268-398-11","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50268-399-11","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorpromazine Hydrochloride: 50 Blister Pack In 1 Box (50268-163-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-163-11)","636","RC","50268-163-15","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50268-163-11","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50268-162-11","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine: 50 Blister Pack In 1 Box (50268-128-15)  / 1 Tablet In 1 Blister Pack (50268-128-11)","636","RC","50268-128-15","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50268-685-11","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50268-684-11","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50268-647-11","NDC","","","facility","both","1","EA","","3.36","3.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50268-557-11","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 50 Blister Pack In 1 Box (50268-557-15)  / 1 Capsule In 1 Blister Pack (50268-557-11)","636","RC","50268-557-15","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50268-622-11","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","50268-621-11","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51991-381-99","NDC","","","facility","both","1","EA","","3.57","3.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Everolimus: 60 Blister Pack In 1 Carton (51991-381-60)  / 10 Tablet In 1 Blister Pack (51991-381-99)","636","RC","51991-381-60","NDC","","","facility","both","1","EA","","2.99","2.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51991-379-99","NDC","","","facility","both","1","EA","","5.77","5.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51991-144-99","NDC","","","facility","both","1","EA","","27.3","27.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51991-380-99","NDC","","","facility","both","1","EA","","4.16","4.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xatmep: 60 Ml In 1 Bottle (52652-2001-6)","636","RC","52652-2001-6","NDC","","","facility","both","1","EA","","36.33","36.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xatmep: 120 Ml In 1 Bottle (52652-2001-1)","636","RC","52652-2001-1","NDC","","","facility","both","1","EA","","28.88","28.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1 Vial, Glass In 1 Carton (51991-002-98)  / 20 Ml In 1 Vial, Glass","636","RC","51991-002-98","NDC","","","facility","both","1","EA","","11.08","11.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51862-460-01","NDC","","","facility","both","1","EA","","3","3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glyrx-Pf: 10 Syringe, Plastic In 1 Carton (51754-6015-3)  / 5 Ml In 1 Syringe, Plastic","636","RC","51754-6015-3","NDC","","","facility","both","1","EA","","2.07","2.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glyrx-Pf: 10 Syringe, Plastic In 1 Carton (51754-6015-3)  / 5 Ml In 1 Syringe, Plastic","636","RC","51754-6015-3","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51754-6015-1","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51754-6015-1","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51754-6015-1","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Caffeine Citrate: 1 Vial In 1 Carton (51754-0500-1)  / 3 Ml In 1 Vial","636","RC","51754-0500-1","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carnitor: 5 Vial In 1 Carton (54482-147-01)  / 5 Ml In 1 Vial","636","RC","54482-147-01","NDC","","","facility","both","1","EA","","64.53","64.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carboplatin: 1 Vial, Multi-Dose In 1 Carton (54288-166-01)  / 45 Ml In 1 Vial, Multi-Dose","636","RC","54288-166-01","NDC","","","facility","both","1","EA","","11.97","11.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 1 Vial In 1 Carton (54288-152-01)  / 30 Ml In 1 Vial","636","RC","54288-152-01","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Papaverine Hydrochloride: 10 Vial In 1 Carton (54288-142-10)  / 2 Ml In 1 Vial (54288-142-01)","636","RC","54288-142-10","NDC","","","facility","both","1","EA","","28.22","28.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","54288-142-01","NDC","","","facility","both","1","EA","","22.64","22.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","54288-141-01","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","54288-136-01","NDC","","","facility","both","1","EA","","21.2","21.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 100 Tablet In 1 Bottle (53746-745-01)","636","RC","53746-745-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 1 Vial In 1 Carton (54288-120-01)  / 10 Ml In 1 Vial","636","RC","54288-120-01","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 25 Vial In 1 Carton (54288-119-25)  / 1 Ml In 1 Vial","636","RC","54288-119-25","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 25 Vial In 1 Carton (54288-119-25)  / 1 Ml In 1 Vial","636","RC","54288-119-25","NDC","","","facility","both","1","EA","","2.24","2.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","54288-119-01","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","54288-103-01","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elaprase: 1 Vial, Glass In 1 Box (54092-700-01)  / 3 Ml In 1 Vial, Glass","636","RC","54092-700-01","NDC","","","facility","both","1","EA","","637.36","637.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Elaprase: 1 Vial, Glass In 1 Box (54092-700-01)  / 3 Ml In 1 Vial, Glass","636","RC","54092-700-01","NDC","","","facility","both","1","EA","","650.32","650.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Decitabine: 1 Vial, Single-Use In 1 Carton (55111-556-10)  / 10 Ml In 1 Vial, Single-Use","636","RC","55111-556-10","NDC","","","facility","both","1","EA","","20.11","20.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51079-519-01","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51079-517-01","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51079-516-01","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51079-721-01","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51079-670-01","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51079-379-01","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phentolamine Mesylate: 1 Vial In 1 Carton (51224-012-20)  / 1 Injection In 1 Vial","636","RC","51224-012-20","NDC","","","facility","both","1","EA","","529.47","529.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phentolamine Mesylate: 1 Vial In 1 Carton (51224-012-20)  / 1 Injection In 1 Vial","636","RC","51224-012-20","NDC","","","facility","both","1","EA","","529.47","529.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01)  / 10.5 Ml In 1 Vial, Single-Dose","636","RC","51144-050-01","NDC","","","facility","both","1","EA","","176.97","176.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01)  / 10.5 Ml In 1 Vial, Single-Dose","636","RC","51144-050-01","NDC","","","facility","both","1","EA","","189.27","189.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01)  / 10.5 Ml In 1 Vial, Single-Dose","636","RC","51144-050-01","NDC","","","facility","both","1","EA","","191.37","191.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01)  / 10.5 Ml In 1 Vial, Single-Dose","636","RC","51144-050-01","NDC","","","facility","both","1","EA","","205.86","205.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01)  / 10.5 Ml In 1 Vial, Single-Dose","636","RC","51144-050-01","NDC","","","facility","both","1","EA","","219.24","219.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adcetris: 1 Vial, Single-Dose In 1 Box (51144-050-01)  / 10.5 Ml In 1 Vial, Single-Dose","636","RC","51144-050-01","NDC","","","facility","both","1","EA","","219.24","219.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-030-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","51144-030-01","NDC","","","facility","both","1","EA","","58.13","58.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-030-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","51144-030-01","NDC","","","facility","both","1","EA","","59.73","59.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-030-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","51144-030-01","NDC","","","facility","both","1","EA","","60.62","60.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-030-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","51144-030-01","NDC","","","facility","both","1","EA","","61.24","61.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","51144-020-01","NDC","","","facility","both","1","EA","","58.53","58.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","51079-818-01","NDC","","","facility","both","1","EA","","1.91","1.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","51144-020-01","NDC","","","facility","both","1","EA","","62.06","62.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","51144-020-01","NDC","","","facility","both","1","EA","","62.08","62.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","51144-020-01","NDC","","","facility","both","1","EA","","62.68","62.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","51144-020-01","NDC","","","facility","both","1","EA","","63.2","63.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","51144-020-01","NDC","","","facility","both","1","EA","","63.2","63.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","51144-020-01","NDC","","","facility","both","1","EA","","63.2","63.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","51144-020-01","NDC","","","facility","both","1","EA","","63.2","63.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-020-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","51144-020-01","NDC","","","facility","both","1","EA","","63.2","63.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tivdak: 1 Vial In 1 Carton (51144-003-01)  / 4 Ml In 1 Vial","636","RC","51144-003-01","NDC","","","facility","both","1","EA","","256.65","256.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Padcev Ejfv: 1 Vial, Single-Dose In 1 Box (51144-030-01)  / 3 Ml In 1 Vial, Single-Dose","636","RC","51144-030-01","NDC","","","facility","both","1","EA","","63.2","63.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-229-01","NDC","","","facility","both","1","EA","","3.38","3.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 25 Vial, Single-Dose In 1 Tray (63323-208-05)  / 5 Ml In 1 Vial, Single-Dose (63323-208-01)","636","RC","63323-208-05","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-208-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 25 Vial In 1 Tray (63323-201-10)  / 10 Ml In 1 Vial (63323-201-03)","636","RC","63323-201-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 25 Vial In 1 Tray (63323-201-10)  / 10 Ml In 1 Vial (63323-201-03)","636","RC","63323-201-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Protamine Sulfate: 25 Vial, Single-Dose In 1 Tray (63323-229-05)  / 5 Ml In 1 Vial, Single-Dose (63323-229-01)","636","RC","63323-229-05","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-186-01","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folic Acid: 1 Vial, Multi-Dose In 1 Carton (63323-184-10)  / 10 Ml In 1 Vial, Multi-Dose","636","RC","63323-184-10","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fludarabine: 1 Vial In 1 Box (63323-192-02)  / 2 Ml In 1 Vial","636","RC","63323-192-02","NDC","","","facility","both","1","EA","","57.27","57.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diprivan: 10 Vial In 1 Box (63323-269-67)  / 100 Ml In 1 Vial (63323-269-21)","636","RC","63323-269-67","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diprivan: 10 Vial In 1 Box (63323-269-65)  / 100 Ml In 1 Vial (63323-269-35)","636","RC","63323-269-65","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diprivan: 20 Vial In 1 Box (63323-269-50)  / 50 Ml In 1 Vial (63323-269-30)","636","RC","63323-269-50","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-269-35","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-269-30","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Protamine Sulfate: 1 Vial, Single-Dose In 1 Box (63323-229-30)  / 25 Ml In 1 Vial, Single-Dose","636","RC","63323-229-30","NDC","","","facility","both","1","EA","","2.17","2.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diprivan: 10 Vial In 1 Box (63323-269-29)  / 20 Ml In 1 Vial (63323-269-22)","636","RC","63323-269-29","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-269-22","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Vial, Multi-Dose In 1 Carton (63323-265-30)  / 16 Ml In 1 Vial, Multi-Dose","636","RC","63323-265-30","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylprednisolone Sodium Succinate: 1 Vial, Multi-Dose In 1 Carton (63323-265-30)  / 16 Ml In 1 Vial, Multi-Dose","636","RC","63323-265-30","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Tray (63323-262-06)  / 1 Ml In 1 Vial (63323-262-03)","636","RC","63323-262-06","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-262-03","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Tray (63323-262-01)  / 1 Ml In 1 Vial","636","RC","63323-262-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-180-00","NDC","","","facility","both","1","EA","","9.21","9.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial, Single-Dose In 1 Carton (63323-120-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","63323-120-20","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-61)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","63323-117-61","NDC","","","facility","both","1","EA","","2.72","2.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-61)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","63323-117-61","NDC","","","facility","both","1","EA","","2.72","2.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (63323-117-61)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","63323-117-61","NDC","","","facility","both","1","EA","","3.37","3.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 10 Vial, Single-Dose In 1 Tray (63323-117-20)  / 20 Ml In 1 Vial, Single-Dose (63323-117-01)","636","RC","63323-117-20","NDC","","","facility","both","1","EA","","2.79","2.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 10 Vial, Single-Dose In 1 Tray (63323-117-20)  / 20 Ml In 1 Vial, Single-Dose (63323-117-01)","636","RC","63323-117-20","NDC","","","facility","both","1","EA","","3.05","3.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 10 Vial, Single-Dose In 1 Tray (63323-117-10)  / 10 Ml In 1 Vial, Single-Dose (63323-117-00)","636","RC","63323-117-10","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 10 Vial, Single-Dose In 1 Tray (63323-117-10)  / 10 Ml In 1 Vial, Single-Dose (63323-117-00)","636","RC","63323-117-10","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial, Single-Dose In 1 Carton (63323-120-20)  / 20 Ml In 1 Vial, Single-Dose","636","RC","63323-120-20","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-117-01","NDC","","","facility","both","1","EA","","3.16","3.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-117-01","NDC","","","facility","both","1","EA","","5.06","5.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-117-00","NDC","","","facility","both","1","EA","","1.9","1.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-117-00","NDC","","","facility","both","1","EA","","1.98","1.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 24 Bag In 1 Case (63323-106-15)  / 500 Ml In 1 Bag","636","RC","63323-106-15","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-106-02","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-117-01","NDC","","","facility","both","1","EA","","3.24","3.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-128-00","NDC","","","facility","both","1","EA","","12.07","12.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-128-00","NDC","","","facility","both","1","EA","","9.26","9.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-128-00","NDC","","","facility","both","1","EA","","9.2","9.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 25 Vial, Multi-Dose In 1 Tray (63323-165-05)  / 5 Ml In 1 Vial, Multi-Dose (63323-165-03)","636","RC","63323-165-05","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 25 Vial In 1 Tray (63323-165-01)  / 1 Ml In 1 Vial (63323-165-02)","636","RC","63323-165-01","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-162-01)  / 1 Ml In 1 Vial, Single-Use (63323-162-00)","636","RC","63323-162-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-162-00","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-162-00","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-162-00","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketorolac Tromethamine: 25 Vial, Single-Use In 1 Tray (63323-161-01)  / 1 Ml In 1 Vial, Single-Use (63323-161-00)","636","RC","63323-161-01","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-161-00","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-161-00","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ifosfamide: 1 Vial, Single-Dose In 1 Box (63323-142-10)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","63323-142-10","NDC","","","facility","both","1","EA","","96.27","96.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitoxantrone: 1 Vial, Multi-Dose In 1 Box (63323-132-10)  / 10 Ml In 1 Vial, Multi-Dose","636","RC","63323-132-10","NDC","","","facility","both","1","EA","","37.19","37.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-130-02","NDC","","","facility","both","1","EA","","26.62","26.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dacarbazine: 10 Vial, Single-Dose In 1 Tray (63323-128-20)  / 20 Ml In 1 Vial, Single-Dose (63323-128-00)","636","RC","63323-128-20","NDC","","","facility","both","1","EA","","9.18","9.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diprivan: 10 Vial In 1 Box (63323-269-69)  / 100 Ml In 1 Vial (63323-269-41)","636","RC","63323-269-69","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-276-01","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-322-41","NDC","","","facility","both","1","EA","","8.97","8.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-322-01","NDC","","","facility","both","1","EA","","8.78","8.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Granisetron: 1 VIAL in 1 BOX (63323-319-04)  / 4 mL in 1 VIAL","636","RC","63323-319-04","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ganciclovir: 25 Vial In 1 Tray (63323-315-10)  / 10 Ml In 1 Vial (63323-315-01)","636","RC","63323-315-10","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ganciclovir: 25 Vial In 1 Tray (63323-315-10)  / 10 Ml In 1 Vial (63323-315-01)","636","RC","63323-315-10","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 1 Bottle In 1 Carton (63323-314-61)  / 100 Ml In 1 Bottle","636","RC","63323-314-61","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-325-03","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-306-05","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-306-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-306-01","NDC","","","facility","both","1","EA","","2.17","2.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 6 Vial, Pharmacy Bulk Package In 1 Tray (63323-303-51)  / 30 Ml In 1 Vial, Pharmacy Bulk Package (63323-303-01)","636","RC","63323-303-51","NDC","","","facility","both","1","EA","","6.21","6.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polocaine-Mpf: 25 Vial, Single-Dose In 1 Tray (63323-293-37)  / 30 Ml In 1 Vial, Single-Dose (63323-293-01)","636","RC","63323-293-37","NDC","","","facility","both","1","EA","","4.29","4.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tobramycin: 10 Vial, Multi-Dose In 1 Tray (63323-306-30)  / 30 Ml In 1 Vial, Multi-Dose (63323-306-05)","636","RC","63323-306-30","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Octreotide: 10 Vial, Single-Dose In 1 Tray (63323-377-01)  / 1 Ml In 1 Vial, Single-Dose (63323-377-00)","636","RC","63323-377-01","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-377-00","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Octreotide: 10 Vial, Single-Dose In 1 Tray (63323-376-01)  / 1 Ml In 1 Vial, Single-Dose (63323-376-00)","636","RC","63323-376-01","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-376-00","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-376-00","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 1 Vial In 1 Box (63323-374-20)  / 20 Ml In 1 Vial","636","RC","63323-374-20","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 1 Vial In 1 Box (63323-374-20)  / 20 Ml In 1 Vial","636","RC","63323-374-20","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate: 25 Vial, Plastic In 1 Tray (63323-360-59)  / 50 Ml In 1 Vial, Plastic (63323-360-03)","636","RC","63323-360-59","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-325-09","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Gluconate: 25 Vial, Plastic In 1 Tray (63323-360-19)  / 10 Ml In 1 Vial, Plastic (63323-360-01)","636","RC","63323-360-19","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-360-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-360-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-360-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-349-01","NDC","","","facility","both","1","EA","","10.31","10.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 10 Vial, Single-Dose In 1 Tray (63323-325-20)  / 20 Ml In 1 Vial, Single-Dose (63323-325-09)","636","RC","63323-325-20","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 10 Vial, Single-Dose In 1 Tray (63323-325-10)  / 10 Ml In 1 Vial, Single-Dose (63323-325-03)","636","RC","63323-325-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-288-11)  / 10 Ml In 1 Vial, Single-Dose (63323-288-03)","636","RC","63323-288-11","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-288-07","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Tray (63323-280-10)  / 10 Ml In 1 Vial (63323-280-05)","636","RC","63323-280-10","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Tray (63323-280-10)  / 10 Ml In 1 Vial (63323-280-05)","636","RC","63323-280-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Tray (63323-280-10)  / 10 Ml In 1 Vial (63323-280-05)","636","RC","63323-280-10","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-280-05","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-280-05","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-280-05","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 1 Vial In 1 Box (63323-281-10)  / 10 Ml In 1 Vial","636","RC","63323-281-10","NDC","","","facility","both","1","EA","","18.41","18.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Tray (63323-280-04)  / 4 Ml In 1 Vial (63323-280-03)","636","RC","63323-280-04","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Tray (63323-280-02)  / 2 Ml In 1 Vial (63323-280-01)","636","RC","63323-280-02","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Tray (63323-280-02)  / 2 Ml In 1 Vial (63323-280-01)","636","RC","63323-280-02","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Tray (63323-280-02)  / 2 Ml In 1 Vial (63323-280-01)","636","RC","63323-280-02","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vinblastine Sulfate: 1 Vial, Multi-Dose In 1 Box (63323-278-10)  / 10 Ml In 1 Vial, Multi-Dose","636","RC","63323-278-10","NDC","","","facility","both","1","EA","","8.7","8.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Tray (63323-276-02)  / 2 Ml In 1 Vial (63323-276-01)","636","RC","63323-276-02","NDC","","","facility","both","1","EA","","4.37","4.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 25 Vial In 1 Tray (63323-280-04)  / 4 Ml In 1 Vial (63323-280-03)","636","RC","63323-280-04","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 1 Vial In 1 Box (63323-281-10)  / 10 Ml In 1 Vial","636","RC","63323-281-10","NDC","","","facility","both","1","EA","","18.21","18.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 1 Vial In 1 Box (63323-281-10)  / 10 Ml In 1 Vial","636","RC","63323-281-10","NDC","","","facility","both","1","EA","","17.47","17.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-288-03","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-286-35)  / 30 Ml In 1 Vial, Single-Dose (63323-286-11)","636","RC","63323-286-35","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naropin: 1 Vial, Single-Dose In 1 Box (63323-286-30)  / 30 Ml In 1 Vial, Single-Dose","636","RC","63323-286-30","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-286-11","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naropin: 12 Bottle In 1 Case (63323-285-64)  / 200 Ml In 1 Bottle (63323-285-57)","636","RC","63323-285-64","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naropin: 24 Bag In 1 Case (63323-285-61)  / 100 Ml In 1 Bag (63323-285-02)","636","RC","63323-285-61","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-285-57","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naropin: 25 Vial, Single-Dose In 1 Carton (63323-285-23)  / 20 Ml In 1 Vial, Single-Dose (63323-285-07)","636","RC","63323-285-23","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-285-07","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-284-01","NDC","","","facility","both","1","EA","","3.41","3.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin: 25 VIAL in 1 TRAY (63323-282-04)  / 4 mL in 1 VIAL","636","RC","63323-282-04","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin: 25 VIAL in 1 TRAY (63323-282-02)  / 2 mL in 1 VIAL","636","RC","63323-282-02","NDC","","","facility","both","1","EA","","2.37","2.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Decanoate: 1 Vial, Multi-Dose In 1 Carton (63323-272-05)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","63323-272-05","NDC","","","facility","both","1","EA","","47.55","47.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 24 Bag In 1 Case (63323-106-01)  / 100 Ml In 1 Bag (63323-106-00)","636","RC","63323-106-01","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-106-00","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (62332-779-31)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","62332-779-31","NDC","","","facility","both","1","EA","","6.69","6.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (62332-779-31)  / 100 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","62332-779-31","NDC","","","facility","both","1","EA","","9.66","9.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (62332-751-50)  / 50 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","62332-751-50","NDC","","","facility","both","1","EA","","7.67","7.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorouracil: 1 Vial, Pharmacy Bulk Package In 1 Carton (62332-751-50)  / 50 Ml In 1 Vial, Pharmacy Bulk Package","636","RC","62332-751-50","NDC","","","facility","both","1","EA","","8.44","8.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (62756-233-01)  / 1 Injectable, Liposomal In 1 Vial, Single-Dose","636","RC","62756-233-01","NDC","","","facility","both","1","EA","","67.37","67.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amphotericin B: 1 Vial, Single-Dose In 1 Carton (62756-233-01)  / 1 Injectable, Liposomal In 1 Vial, Single-Dose","636","RC","62756-233-01","NDC","","","facility","both","1","EA","","67.37","67.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","62332-627-02","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","62332-627-02","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","62332-627-02","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 100 Capsule In 1 Bottle (62332-619-31)","636","RC","62332-619-31","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclophosphamide: 100 Capsule In 1 Bottle (62332-618-31)","636","RC","62332-618-31","NDC","","","facility","both","1","EA","","2.24","2.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","62332-599-01","NDC","","","facility","both","1","EA","","2.99","2.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","62332-599-01","NDC","","","facility","both","1","EA","","3.14","3.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 25 Vial, Single-Dose In 1 Tray (63323-064-02)  / 2 Ml In 1 Vial, Single-Dose","636","RC","63323-064-02","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-064-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-044-00","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mannitol: 25 Vial, Single-Dose In 1 Tray (63323-024-25)  / 50 Ml In 1 Vial, Single-Dose (63323-024-01)","636","RC","63323-024-25","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-024-01","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 25 Vial, Single-Dose In 1 Carton (63323-064-03)  / 2 Ml In 1 Vial, Single-Dose (63323-064-01)","636","RC","63323-064-03","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-013-01","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-012-17","NDC","","","facility","both","1","EA","","2.4","2.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxytocin: 25 Vial In 1 Tray (63323-012-11)  / 1 Ml In 1 Vial (63323-012-03)","636","RC","63323-012-11","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-012-06","NDC","","","facility","both","1","EA","","1.7","1.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-012-03","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gentamicin: 25 Vial In 1 Tray (63323-010-20)  / 20 Ml In 1 Vial (63323-010-03)","636","RC","63323-010-20","NDC","","","facility","both","1","EA","","4.14","4.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-010-03","NDC","","","facility","both","1","EA","","2.96","2.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-064-04","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Sulfate: 25 Vial, Single-Dose In 1 Tray (63323-064-10)  / 10 Ml In 1 Vial, Single-Dose","636","RC","63323-064-10","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial, Multi-Dose In 1 Carton (63323-104-25)  / 25 Ml In 1 Vial, Multi-Dose","636","RC","63323-104-25","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etoposide: 1 Vial, Multi-Dose In 1 Carton (63323-104-06)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","63323-104-06","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-104-01","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisplatin: 1 Vial In 1 Carton (63323-103-65)  / 100 Ml In 1 Vial","636","RC","63323-103-65","NDC","","","facility","both","1","EA","","5.38","5.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisplatin: 1 Vial In 1 Carton (63323-103-64)  / 200 Ml In 1 Vial","636","RC","63323-103-64","NDC","","","facility","both","1","EA","","5.6","5.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisplatin: 1 Vial In 1 Carton (63323-103-51)  / 50 Ml In 1 Vial","636","RC","63323-103-51","NDC","","","facility","both","1","EA","","5.39","5.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (63323-101-61)  / 100 Ml In 1 Vial, Multi-Dose","636","RC","63323-101-61","NDC","","","facility","both","1","EA","","4.17","4.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-095-02","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-093-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-010-01","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-385-01","NDC","","","facility","both","1","EA","","16.65","16.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-461-50)  / .375 Ml In 1 Syringe","636","RC","62935-461-50","NDC","","","facility","both","1","EA","","201.75","201.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-306-40)  / .5 Ml In 1 Syringe","636","RC","62935-306-40","NDC","","","facility","both","1","EA","","156.02","156.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-306-40)  / .5 Ml In 1 Syringe","636","RC","62935-306-40","NDC","","","facility","both","1","EA","","209.11","209.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-306-40)  / .5 Ml In 1 Syringe","636","RC","62935-306-40","NDC","","","facility","both","1","EA","","215.77","215.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-227-10)  / .375 Ml In 1 Syringe","636","RC","62935-227-10","NDC","","","facility","both","1","EA","","156.02","156.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-227-10)  / .375 Ml In 1 Syringe","636","RC","62935-227-10","NDC","","","facility","both","1","EA","","156.02","156.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-227-10)  / .375 Ml In 1 Syringe","636","RC","62935-227-10","NDC","","","facility","both","1","EA","","200.51","200.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-227-10)  / .375 Ml In 1 Syringe","636","RC","62935-227-10","NDC","","","facility","both","1","EA","","200.66","200.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-227-10)  / .375 Ml In 1 Syringe","636","RC","62935-227-10","NDC","","","facility","both","1","EA","","202.5","202.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-461-50)  / .375 Ml In 1 Syringe","636","RC","62935-461-50","NDC","","","facility","both","1","EA","","200.84","200.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Halaven: 1 Vial, Single-Dose In 1 Carton (62856-389-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","62856-389-01","NDC","","","facility","both","1","EA","","250.81","250.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Halaven: 1 Vial, Single-Dose In 1 Carton (62856-389-01)  / 2 Ml In 1 Vial, Single-Dose","636","RC","62856-389-01","NDC","","","facility","both","1","EA","","253.8","253.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-461-50)  / .375 Ml In 1 Syringe","636","RC","62935-461-50","NDC","","","facility","both","1","EA","","193.63","193.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-461-50)  / .375 Ml In 1 Syringe","636","RC","62935-461-50","NDC","","","facility","both","1","EA","","189.22","189.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-461-50)  / .375 Ml In 1 Syringe","636","RC","62935-461-50","NDC","","","facility","both","1","EA","","156.02","156.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 30 Tablet, Film Coated In 1 Bottle (63304-458-30)","636","RC","63304-458-30","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63037-101-05","NDC","","","facility","both","1","EA","","3.24","3.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Iclusig: 30 Tablet, Film Coated In 1 Bottle (63020-536-30)","636","RC","63020-536-30","NDC","","","facility","both","1","EA","","1074.78","1074.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Iclusig: 30 Tablet, Film Coated In 1 Bottle (63020-535-30)","636","RC","63020-535-30","NDC","","","facility","both","1","EA","","1074.78","1074.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Iclusig: 30 Tablet, Film Coated In 1 Bottle (63020-533-30)","636","RC","63020-533-30","NDC","","","facility","both","1","EA","","1074.78","1074.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Velcade: 1 Vial In 1 Carton (63020-049-01)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial","636","RC","63020-049-01","NDC","","","facility","both","1","EA","","81.66","81.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-756-80)  / .25 Ml In 1 Syringe","636","RC","62935-756-80","NDC","","","facility","both","1","EA","","156.03","156.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-756-80)  / .25 Ml In 1 Syringe","636","RC","62935-756-80","NDC","","","facility","both","1","EA","","156.03","156.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-756-80)  / .25 Ml In 1 Syringe","636","RC","62935-756-80","NDC","","","facility","both","1","EA","","206.91","206.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-756-80)  / .25 Ml In 1 Syringe","636","RC","62935-756-80","NDC","","","facility","both","1","EA","","215.73","215.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eligard: 1 Syringe In 1 Carton (62935-461-50)  / .375 Ml In 1 Syringe","636","RC","62935-461-50","NDC","","","facility","both","1","EA","","156.02","156.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefotetan: 10 Vial In 1 Carton (63323-385-10)  / 10 Ml In 1 Vial (63323-385-01)","636","RC","63323-385-10","NDC","","","facility","both","1","EA","","33.25","33.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-386-01","NDC","","","facility","both","1","EA","","32.82","32.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10)  / 10 Ml In 1 Vial, Single-Use","636","RC","63459-103-10","NDC","","","facility","both","1","EA","","88.12","88.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brovana: 30 POUCH in 1 CARTON (63402-911-30)  / 1 VIAL, SINGLE-DOSE in 1 POUCH (63402-911-01)  / 2 mL in 1 VIAL, SINGLE-DOSE","636","RC","63402-911-30","NDC","","","facility","both","1","EA","","7.81","7.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10)  / 10 Ml In 1 Vial, Single-Use","636","RC","63459-103-10","NDC","","","facility","both","1","EA","","88.11","88.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vaxelis: 10 Syringe In 1 Package (63361-243-15)  / .5 Ml In 1 Syringe (63361-243-88)","636","RC","63361-243-15","NDC","","","facility","both","1","EA","","251.29","251.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 25 Vial, Multi-Dose In 1 Tray (63323-967-30)  / 30 Ml In 1 Vial, Multi-Dose (63323-967-01)","636","RC","63323-967-30","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-967-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 25 Vial, Single-Dose In 1 Tray (63323-965-20)  / 20 Ml In 1 Vial, Single-Dose (63323-965-02)","636","RC","63323-965-20","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 25 Vial, Single-Dose In 1 Tray (63323-965-10)  / 10 Ml In 1 Vial, Single-Dose (63323-965-03)","636","RC","63323-965-10","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 25 Vial, Single-Dose In 1 Tray (63323-965-05)  / 5 Ml In 1 Vial, Single-Dose (63323-965-01)","636","RC","63323-965-05","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63361-243-88","NDC","","","facility","both","1","EA","","257.46","257.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10)  / 10 Ml In 1 Vial, Single-Use","636","RC","63459-103-10","NDC","","","facility","both","1","EA","","88.08","88.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-103-10)  / 10 Ml In 1 Vial, Single-Use","636","RC","63459-103-10","NDC","","","facility","both","1","EA","","88.06","88.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bendeka: 1 Vial, Multi-Dose In 1 Carton (63459-348-04)  / 4 Ml In 1 Vial, Multi-Dose","636","RC","63459-348-04","NDC","","","facility","both","1","EA","","24.6","24.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50)  / 50 Ml In 1 Vial, Single-Use","636","RC","63459-104-50","NDC","","","facility","both","1","EA","","87.78","87.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50)  / 50 Ml In 1 Vial, Single-Use","636","RC","63459-104-50","NDC","","","facility","both","1","EA","","88.11","88.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50)  / 50 Ml In 1 Vial, Single-Use","636","RC","63459-104-50","NDC","","","facility","both","1","EA","","88.11","88.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50)  / 50 Ml In 1 Vial, Single-Use","636","RC","63459-104-50","NDC","","","facility","both","1","EA","","88.12","88.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Truxima: 1 Vial, Single-Use In 1 Carton (63459-104-50)  / 50 Ml In 1 Vial, Single-Use","636","RC","63459-104-50","NDC","","","facility","both","1","EA","","88.12","88.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bendeka: 1 Vial, Multi-Dose In 1 Carton (63459-348-04)  / 4 Ml In 1 Vial, Multi-Dose","636","RC","63459-348-04","NDC","","","facility","both","1","EA","","24.26","24.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-965-03","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-965-02","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-853-03","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-853-03","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 50 Ml In 1 Vial, Single-Dose (63323-851-50)","636","RC","63323-851-50","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 50 Ml In 1 Vial, Single-Dose (63323-851-50)","636","RC","63323-851-50","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 50 Ml In 1 Vial, Single-Dose (63323-851-50)","636","RC","63323-851-50","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 10 Vial, Single-Dose In 1 Carton (63323-851-10)  / 1 Ml In 1 Vial, Single-Dose (63323-851-03)","636","RC","63323-851-10","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-851-07","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-851-03","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-850-74","NDC","","","facility","both","1","EA","","13.95","13.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-824-25","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-813-01","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-851-07","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-853-03","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-854-03","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitonin Salmon: 1 Vial, Multi-Dose In 1 Carton (63323-865-02)  / 2 Ml In 1 Vial, Multi-Dose","636","RC","63323-865-02","NDC","","","facility","both","1","EA","","598.73","598.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-965-01","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tigecycline: 10 Vial, Single-Dose In 1 Carton (63323-960-10)  / 5 Ml In 1 Vial, Single-Dose (63323-960-01)","636","RC","63323-960-10","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vasopressin: 25 Vial, Single-Dose In 1 Tray (63323-930-01)  / 1 Ml In 1 Vial, Single-Dose (63323-930-00)","636","RC","63323-930-01","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-930-00","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Romidepsin: 1 Kit In 1 Carton (63323-926-88)  *  2 Ml In 1 Vial, Single-Dose (63323-925-17)  *  2.2 Ml In 1 Vial, Single-Dose (63323-922-03)","636","RC","63323-926-88","NDC","","","facility","both","1","EA","","52.28","52.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Romidepsin: 1 Kit In 1 Carton (63323-926-88)  *  2 Ml In 1 Vial, Single-Dose (63323-925-17)  *  2.2 Ml In 1 Vial, Single-Dose (63323-922-03)","636","RC","63323-926-88","NDC","","","facility","both","1","EA","","52.28","52.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Romidepsin: 1 Kit In 1 Carton (63323-926-88)  *  2 Ml In 1 Vial, Single-Dose (63323-925-17)  *  2.2 Ml In 1 Vial, Single-Dose (63323-922-03)","636","RC","63323-926-88","NDC","","","facility","both","1","EA","","52.28","52.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Romidepsin: 1 Kit In 1 Carton (63323-926-88)  *  2 Ml In 1 Vial, Single-Dose (63323-925-17)  *  2.2 Ml In 1 Vial, Single-Dose (63323-922-03)","636","RC","63323-926-88","NDC","","","facility","both","1","EA","","52.28","52.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-925-17","NDC","","","facility","both","1","EA","","52.28","52.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-925-17","NDC","","","facility","both","1","EA","","52.28","52.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (63323-883-30)  / 25 Ml In 1 Vial, Single-Dose","636","RC","63323-883-30","NDC","","","facility","both","1","EA","","2.73","2.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxorubicin Hydrochloride: 1 Vial, Single-Dose In 1 Carton (63323-883-30)  / 25 Ml In 1 Vial, Single-Dose","636","RC","63323-883-30","NDC","","","facility","both","1","EA","","3.16","3.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nebupent: 1 Vial, Single-Dose In 1 Carton (63323-877-15)  / 6 Ml In 1 Vial, Single-Dose","636","RC","63323-877-15","NDC","","","facility","both","1","EA","","160.75","160.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63739-953-11","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63739-170-13","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxacillin: 10 Vial, Single-Dose In 1 Carton (63323-812-20)  / 20 Ml In 1 Vial, Single-Dose (63323-812-01)","636","RC","63323-812-20","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-812-01","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Carton (63323-492-57)  / 5 Ml In 1 Vial, Single-Dose (63323-492-09)","636","RC","63323-492-57","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine Mpf: 25 Vial, Single-Dose In 1 Carton (63323-492-27)  / 2 Ml In 1 Vial, Single-Dose (63323-492-04)","636","RC","63323-492-27","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-492-09","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-492-07","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-486-57)  / 50 Ml In 1 Vial, Multi-Dose (63323-486-05)","636","RC","63323-486-57","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-486-27)  / 20 Ml In 1 Vial, Multi-Dose (63323-486-02)","636","RC","63323-486-27","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xylocaine: 25 Vial, Multi-Dose In 1 Tray (63323-486-17)  / 10 Ml In 1 Vial, Multi-Dose (63323-486-01)","636","RC","63323-486-17","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-486-05","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-485-03","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-544-01","NDC","","","facility","both","1","EA","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heparin Sodium: 25 Vial In 1 Tray (63323-540-11)  / 10 Ml In 1 Vial","636","RC","63323-540-11","NDC","","","facility","both","1","EA","","1.2","1.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-533-01","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Chloride: 20 Bag In 1 Case (63323-530-75)  / 500 Ml In 1 Bag (63323-530-21)","636","RC","63323-530-75","NDC","","","facility","both","1","EA","","3.5","3.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-530-21","NDC","","","facility","both","1","EA","","3.43","3.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-523-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 10 Vial In 1 Tray (63323-516-10)  / 10 Ml In 1 Vial (63323-516-01)","636","RC","63323-516-10","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meropenem: 10 Vial In 1 Carton (63323-508-30)  / 20 Ml In 1 Vial (63323-508-01)","636","RC","63323-508-30","NDC","","","facility","both","1","EA","","1.23","1.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-508-01","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-507-01","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 25 Vial In 1 Tray (63323-506-01)  / 1 Ml In 1 Vial (63323-506-00)","636","RC","63323-506-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-517-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-415-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-412-18","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-403-04","NDC","","","facility","both","1","EA","","3.73","3.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-403-04","NDC","","","facility","both","1","EA","","3.74","3.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-403-04","NDC","","","facility","both","1","EA","","3.83","3.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aztreonam: 10 Vial In 1 Tray (63323-402-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (63323-402-01)","636","RC","63323-402-20","NDC","","","facility","both","1","EA","","3.74","3.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-402-01","NDC","","","facility","both","1","EA","","3.67","3.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-401-01","NDC","","","facility","both","1","EA","","3.63","3.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Colistimethate: 1 Vial In 1 Box (63323-393-06)  / 2 Ml In 1 Vial","636","RC","63323-393-06","NDC","","","facility","both","1","EA","","15.8","15.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefotetan: 10 Vial In 1 Carton (63323-386-20)  / 20 Ml In 1 Vial (63323-386-01)","636","RC","63323-386-20","NDC","","","facility","both","1","EA","","33.32","33.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aztreonam: 10 Vial In 1 Tray (63323-402-20)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial (63323-402-01)","636","RC","63323-402-20","NDC","","","facility","both","1","EA","","3.74","3.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flumazenil: 1 Vial, Multi-Dose In 1 Carton (63323-424-10)  / 10 Ml In 1 Vial, Multi-Dose","636","RC","63323-424-10","NDC","","","facility","both","1","EA","","9.65","9.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 20 Bag In 1 Case (63323-434-00)  / 100 Ml In 1 Bag (63323-434-41)","636","RC","63323-434-00","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-478-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nesacaine: 25 Vial, Multi-Dose In 1 Tray (63323-476-37)  / 30 Ml In 1 Vial, Multi-Dose (63323-476-01)","636","RC","63323-476-37","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nesacaine: 25 Vial, Multi-Dose In 1 Tray (63323-475-37)  / 30 Ml In 1 Vial, Multi-Dose (63323-475-01)","636","RC","63323-475-37","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-475-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 25 Vial In 1 Tray (63323-474-01)  / 1 Ml In 1 Vial (63323-474-00)","636","RC","63323-474-01","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-474-00","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-472-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol Decanoate: 1 Vial In 1 Carton (63323-471-01)  / 1 Ml In 1 Vial","636","RC","63323-471-01","NDC","","","facility","both","1","EA","","6.46","6.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol Decanoate: 1 Vial In 1 Carton (63323-469-01)  / 1 Ml In 1 Vial","636","RC","63323-469-01","NDC","","","facility","both","1","EA","","8.68","8.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-464-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-464-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 25 Vial, Single-Dose In 1 Box (63323-451-01)  / 1 Ml In 1 Vial, Single-Dose (63323-451-00)","636","RC","63323-451-01","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-451-00","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-434-41","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-545-05","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-559-21","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-729-01","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 1 Vial In 1 Box (63323-710-50)  / 20 Ml In 1 Vial","636","RC","63323-710-50","NDC","","","facility","both","1","EA","","6.13","6.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epinephrine: 1 Vial, Multi-Dose In 1 Carton (63323-698-30)  / 30 Ml In 1 Vial, Multi-Dose","636","RC","63323-698-30","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-696-02","NDC","","","facility","both","1","EA","","1.49","1.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-695-22","NDC","","","facility","both","1","EA","","17.44","17.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (63323-692-10)  / 10 Ml In 1 Vial (63323-692-22)","636","RC","63323-692-10","NDC","","","facility","both","1","EA","","8.67","8.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-694-22","NDC","","","facility","both","1","EA","","19.66","19.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-738-06","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-806-14","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-806-13","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-806-12","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-781-21","NDC","","","facility","both","1","EA","","8.42","8.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-778-21","NDC","","","facility","both","1","EA","","7.21","7.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-778-21","NDC","","","facility","both","1","EA","","8.04","8.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Vial, Single-Dose In 1 Carton (63323-771-39)  / 30 Ml In 1 Vial, Single-Dose","636","RC","63323-771-39","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Vial, Single-Dose In 1 Carton (63323-771-39)  / 30 Ml In 1 Vial, Single-Dose","636","RC","63323-771-39","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azacitidine: 1 Vial, Single-Dose In 1 Carton (63323-771-39)  / 30 Ml In 1 Vial, Single-Dose","636","RC","63323-771-39","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial, Multi-Dose In 1 Carton (63323-763-50)  / 50 Ml In 1 Vial, Multi-Dose","636","RC","63323-763-50","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Topotecan Hydrochloride: 1 Vial In 1 Box (63323-762-10)  / 4 Ml In 1 Vial","636","RC","63323-762-10","NDC","","","facility","both","1","EA","","1.58","1.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 25 Vial, Single-Dose In 1 Tray (63323-739-12)  / 2 Ml In 1 Vial, Single-Dose (63323-739-11)","636","RC","63323-739-12","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 25 Vial, Single-Dose In 1 Tray (63323-739-12)  / 2 Ml In 1 Vial, Single-Dose (63323-739-11)","636","RC","63323-739-12","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-739-11","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-739-11","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (63323-691-30)  / 30 Ml In 1 Vial (63323-691-22)","636","RC","63323-691-30","NDC","","","facility","both","1","EA","","7.04","7.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetylcysteine: 3 Vial In 1 Carton (63323-690-30)  / 30 Ml In 1 Vial (63323-690-22)","636","RC","63323-690-30","NDC","","","facility","both","1","EA","","4.45","4.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol: 10 Vial, Single-Dose In 1 Tray (63323-604-01)  / 1 Ml In 1 Vial, Single-Dose","636","RC","63323-604-01","NDC","","","facility","both","1","EA","","2.86","2.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-604-00","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferoxamine: 1 Vial In 1 Box (63323-599-30)  / 21.1 Ml In 1 Vial","636","RC","63323-599-30","NDC","","","facility","both","1","EA","","10.16","10.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferoxamine: 1 Vial In 1 Box (63323-599-30)  / 21.1 Ml In 1 Vial","636","RC","63323-599-30","NDC","","","facility","both","1","EA","","10.2","10.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferoxamine: 1 Vial In 1 Box (63323-597-10)  / 5.3 Ml In 1 Vial","636","RC","63323-597-10","NDC","","","facility","both","1","EA","","22.02","22.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-596-03","NDC","","","facility","both","1","EA","","167.34","167.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-596-03","NDC","","","facility","both","1","EA","","176.18","176.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-596-03","NDC","","","facility","both","1","EA","","204.75","204.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-614-00","NDC","","","facility","both","1","EA","","2.71","2.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glucagon: 1 Kit In 1 Carton (63323-593-03)  *  1 Ml In 1 Vial, Single-Dose (63323-596-03)  *  1 Ml In 1 Vial, Single-Dose (63323-185-03)","636","RC","63323-593-03","NDC","","","facility","both","1","EA","","142.42","142.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glucagon: 1 Kit In 1 Carton (63323-593-03)  *  1 Ml In 1 Vial, Single-Dose (63323-596-03)  *  1 Ml In 1 Vial, Single-Dose (63323-185-03)","636","RC","63323-593-03","NDC","","","facility","both","1","EA","","159.79","159.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-589-21","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-586-21","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-584-21","NDC","","","facility","both","1","EA","","1.4","1.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-566-21","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-564-21","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enoxaparin Sodium: 10 Blister Pack In 1 Carton (63323-559-93)  / 1 Syringe In 1 Blister Pack (63323-559-21)  / .3 Ml In 1 Syringe","636","RC","63323-559-93","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 25 Vial, Single-Dose In 1 Carton (63323-614-01)  / 1 Ml In 1 Vial, Single-Dose (63323-614-00)","636","RC","63323-614-01","NDC","","","facility","both","1","EA","","2.81","2.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-616-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 1 Vial, Single-Dose In 1 Carton (63323-685-17)  / 16.7 Ml In 1 Vial, Single-Dose","636","RC","63323-685-17","NDC","","","facility","both","1","EA","","414.91","414.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Terbutaline Sulfate: 25 Vial, Single-Use In 1 Tray (63323-665-01)  / 1 Ml In 1 Vial, Single-Use (63323-665-00)","636","RC","63323-665-01","NDC","","","facility","both","1","EA","","2.5","2.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-665-00","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine: 25 Vial, Single-Dose In 1 Tray (63323-664-01)  / 1 Ml In 1 Vial, Single-Dose (63323-664-00)","636","RC","63323-664-01","NDC","","","facility","both","1","EA","","2.99","2.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-664-00","NDC","","","facility","both","1","EA","","3.51","3.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-660-01","NDC","","","facility","both","1","EA","","3.54","3.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide: 1 Vial In 1 Box (63323-658-20)  / 18 Ml In 1 Vial","636","RC","63323-658-20","NDC","","","facility","both","1","EA","","33.23","33.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorothiazide: 1 Vial In 1 Box (63323-658-20)  / 18 Ml In 1 Vial","636","RC","63323-658-20","NDC","","","facility","both","1","EA","","67.6","67.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-655-21","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-651-00","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextrose: 50 Bag In 1 Case (63323-624-61)  / 100 Ml In 1 Bag (63323-624-06)","636","RC","63323-624-61","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","63323-624-03","NDC","","","facility","both","1","EA","","5.4","5.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amiodarone Hydrochloride: 10 Vial, Single-Dose In 1 Tray (63323-616-09)  / 9 Ml In 1 Vial, Single-Dose (63323-616-02)","636","RC","63323-616-09","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amiodarone Hydrochloride: 25 Vial, Single-Dose In 1 Tray (63323-616-03)  / 3 Ml In 1 Vial, Single-Dose (63323-616-01)","636","RC","63323-616-03","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-375-11","NDC","","","facility","both","1","EA","","11.75","11.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-386-11","NDC","","","facility","both","1","EA","","11.88","11.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-395-79","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-394-79","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-252-40","NDC","","","facility","both","1","EA","","3.96","3.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-494-11","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-463-11","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-438-11","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mycophenolate Mofetil: 100 Blister Pack In 1 Box, Unit-Dose (60687-438-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-438-11)","636","RC","60687-438-01","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-430-11","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-441-11","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-452-11","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclosporine, Modfied: 30 Blister Pack In 1 Carton (60505-4632-3)  / 6 Capsule, Liquid Filled In 1 Blister Pack","636","RC","60505-4632-3","NDC","","","facility","both","1","EA","","7.3","7.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6147-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","60505-6147-0","NDC","","","facility","both","1","EA","","2.39","2.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 10 Vial, Single-Dose In 1 Carton (60505-6146-4)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","60505-6146-4","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6146-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","60505-6146-0","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60505-6142-0","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxaliplatin: 1 Vial In 1 Carton (60505-6132-7)  / 20 Ml In 1 Vial","636","RC","60505-6132-7","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxaliplatin: 1 Vial In 1 Carton (60505-6132-7)  / 20 Ml In 1 Vial","636","RC","60505-6132-7","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxaliplatin: 1 Vial In 1 Carton (60505-6132-6)  / 10 Ml In 1 Vial","636","RC","60505-6132-6","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 25 Vial, Single-Use In 1 Carton (60505-6130-5)  / 2 Ml In 1 Vial, Single-Use (60505-6130-0)","636","RC","60505-6130-5","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ondansetron: 25 Vial, Single-Use In 1 Carton (60505-6130-5)  / 2 Ml In 1 Vial, Single-Use (60505-6130-0)","636","RC","60505-6130-5","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60505-6130-0","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irinotecan Hydrochloride: 1 Vial, Single-Use In 1 Carton (60505-6128-1)  / 5 Ml In 1 Vial, Single-Use","636","RC","60505-6128-1","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irinotecan Hydrochloride: 1 Vial, Single-Use In 1 Carton (60505-6128-1)  / 5 Ml In 1 Vial, Single-Use","636","RC","60505-6128-1","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irinotecan Hydrochloride: 1 Vial, Single-Use In 1 Carton (60505-6128-1)  / 5 Ml In 1 Vial, Single-Use","636","RC","60505-6128-1","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxaliplatin: 1 Vial In 1 Carton (60505-6132-7)  / 20 Ml In 1 Vial","636","RC","60505-6132-7","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"PROMETHAZINE HYDROCHLORIDE: 473 mL in 1 BOTTLE, PLASTIC (60432-608-16) ","636","RC","60432-608-16","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azathioprine: 100 Tablet In 1 Bottle (60219-2036-1)","636","RC","60219-2036-1","NDC","","","facility","both","1","EA","","9.92","9.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefoxitin: 25 VIAL in 1 CARTON (60505-0759-5)  / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL (60505-0759-1) ","636","RC","60505-0759-5","NDC","","","facility","both","1","EA","","1.27","1.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone: 10 VIAL in 1 CARTON (60505-0750-4)  / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL (60505-0750-1) ","636","RC","60505-0750-4","NDC","","","facility","both","1","EA","","3.35","3.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 1 Vial, Single-Dose In 1 Carton (60505-6147-0)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","60505-6147-0","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefepime: 10 Vial, Single-Dose In 1 Carton (60505-6147-4)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","60505-6147-4","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60505-6149-0","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (60505-6289-0)  / 2 Ml In 1 Vial, Single-Dose","636","RC","60505-6289-0","NDC","","","facility","both","1","EA","","78.54","78.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eribulin Mesylate: 1 Vial, Single-Dose In 1 Carton (60505-6289-0)  / 2 Ml In 1 Vial, Single-Dose","636","RC","60505-6289-0","NDC","","","facility","both","1","EA","","84.76","84.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cisplatin: 1 Vial, Multi-Dose In 1 Carton (60505-6277-0)  / 50 Ml In 1 Vial, Multi-Dose","636","RC","60505-6277-0","NDC","","","facility","both","1","EA","","8.91","8.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferoxamine Mesylate: 4 Injection, Powder, Lyophilized, For Solution In 1 Carton (60505-6236-6)","636","RC","60505-6236-6","NDC","","","facility","both","1","EA","","13.03","13.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60505-6236-0","NDC","","","facility","both","1","EA","","17.14","17.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bendamustine Hydrochloride: 1 Vial, Multi-Dose In 1 Carton (60505-6228-0)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","60505-6228-0","NDC","","","facility","both","1","EA","","16.88","16.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Palonosetron: 1 Vial In 1 Carton (60505-6193-1)  / 5 Ml In 1 Vial","636","RC","60505-6193-1","NDC","","","facility","both","1","EA","","2.99","2.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Teriparatide: 1 Syringe In 1 Carton (60505-6188-0)  / 2.4 Ml In 1 Syringe","636","RC","60505-6188-0","NDC","","","facility","both","1","EA","","24.85","24.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60505-6159-0","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60505-6157-0","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60505-6156-0","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone Sodium: 1 Vial, Single-Use In 1 Carton (60505-6152-4)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Use","636","RC","60505-6152-4","NDC","","","facility","both","1","EA","","2.28","2.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ceftriaxone Sodium: 1 Vial, Pharmacy Bulk Package In 1 Carton (60505-6150-5)  / 1 Injection, Powder, For Solution In 1 Vial, Pharmacy Bulk Package","636","RC","60505-6150-5","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60505-6196-0","NDC","","","facility","both","1","EA","","24.9","24.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-145-11","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Blister Pack In 1 Box, Unit-Dose (60687-145-01)  / 1 Tablet In 1 Blister Pack (60687-145-11)","636","RC","60687-145-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-134-11","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-122-11","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Blister Pack In 1 Box, Unit-Dose (60687-122-01)  / 1 Tablet In 1 Blister Pack (60687-122-11)","636","RC","60687-122-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zarxio: 1 Blister Pack In 1 Carton (61314-318-01)  / 1 Syringe In 1 Blister Pack / .5 Ml In 1 Syringe","636","RC","61314-318-01","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zarxio: 1 Blister Pack In 1 Carton (61314-318-01)  / 1 Syringe In 1 Blister Pack / .5 Ml In 1 Syringe","636","RC","61314-318-01","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bicillin L-A: 10 Syringe In 1 Package (60793-702-10)  / 4 Ml In 1 Syringe (60793-702-04)","636","RC","60793-702-10","NDC","","","facility","both","1","EA","","43.22","43.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bicillin L-A: 10 Syringe In 1 Package (60793-702-10)  / 4 Ml In 1 Syringe (60793-702-04)","636","RC","60793-702-10","NDC","","","facility","both","1","EA","","45.07","45.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60793-702-04","NDC","","","facility","both","1","EA","","47.93","47.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60793-702-04","NDC","","","facility","both","1","EA","","48.04","48.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60793-702-04","NDC","","","facility","both","1","EA","","52.3","52.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zarxio: 1 Blister Pack In 1 Carton (61314-318-01)  / 1 Syringe In 1 Blister Pack / .5 Ml In 1 Syringe","636","RC","61314-318-01","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zarxio: 2 Blister Pack In 1 Carton (61314-326-10)  / 5 Syringe In 1 Blister Pack (61314-326-05)  / .8 Ml In 1 Syringe","636","RC","61314-326-10","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zarxio: 2 Blister Pack In 1 Carton (61314-326-10)  / 5 Syringe In 1 Blister Pack (61314-326-05)  / .8 Ml In 1 Syringe","636","RC","61314-326-10","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zarxio: 2 Blister Pack In 1 Carton (61314-326-10)  / 5 Syringe In 1 Blister Pack (61314-326-05)  / .8 Ml In 1 Syringe","636","RC","61314-326-10","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61314-326-05","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61314-326-05","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61314-326-05","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61314-326-05","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61314-326-05","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zarxio: 1 Blister Pack In 1 Carton (61314-318-01)  / 1 Syringe In 1 Blister Pack / .5 Ml In 1 Syringe","636","RC","61314-318-01","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61314-326-05","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zarxio: 1 Blister Pack In 1 Carton (61314-326-01)  / 1 Syringe In 1 Blister Pack / .8 Ml In 1 Syringe","636","RC","61314-326-01","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zarxio: 1 Blister Pack In 1 Carton (61314-326-01)  / 1 Syringe In 1 Blister Pack / .8 Ml In 1 Syringe","636","RC","61314-326-01","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zarxio: 1 Blister Pack In 1 Carton (61314-326-01)  / 1 Syringe In 1 Blister Pack / .8 Ml In 1 Syringe","636","RC","61314-326-01","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zarxio: 1 Blister Pack In 1 Carton (61314-326-01)  / 1 Syringe In 1 Blister Pack / .8 Ml In 1 Syringe","636","RC","61314-326-01","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zarxio: 1 Blister Pack In 1 Carton (61314-326-01)  / 1 Syringe In 1 Blister Pack / .8 Ml In 1 Syringe","636","RC","61314-326-01","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61314-318-05","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61314-318-05","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61314-318-05","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61314-318-05","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61314-318-05","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bicillin L-A: 10 Syringe In 1 Package (60793-701-10)  / 2 Ml In 1 Syringe (60793-701-02)","636","RC","60793-701-10","NDC","","","facility","both","1","EA","","46.4","46.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bicillin L-A: 10 Syringe In 1 Package (60793-701-10)  / 2 Ml In 1 Syringe (60793-701-02)","636","RC","60793-701-10","NDC","","","facility","both","1","EA","","47.65","47.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60793-701-02","NDC","","","facility","both","1","EA","","46.54","46.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60793-701-02","NDC","","","facility","both","1","EA","","46.77","46.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60793-701-02","NDC","","","facility","both","1","EA","","47.12","47.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-885-11","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-854-11","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prednisone: 100 Blister Pack In 1 Carton (60687-854-01)  / 1 Tablet In 1 Blister Pack (60687-854-11)","636","RC","60687-854-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61755-050-00","NDC","","","facility","both","1","EA","","590.63","590.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01)  / 7 Ml In 1 Vial, Single-Use","636","RC","61755-008-01","NDC","","","facility","both","1","EA","","53.16","53.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01)  / 7 Ml In 1 Vial, Single-Use","636","RC","61755-008-01","NDC","","","facility","both","1","EA","","53.31","53.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","61958-2901-2","NDC","","","facility","both","1","EA","","1157.46","1157.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","61958-2901-2","NDC","","","facility","both","1","EA","","1148.44","1148.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","61958-2901-2","NDC","","","facility","both","1","EA","","1142.75","1142.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trogarzo: 2 Vial, Single-Use In 1 Carton (62064-122-02)  / 1.33 Ml In 1 Vial, Single-Use (62064-122-01)","636","RC","62064-122-02","NDC","","","facility","both","1","EA","","151.59","151.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trogarzo: 2 Vial, Single-Use In 1 Carton (62064-122-02)  / 1.33 Ml In 1 Vial, Single-Use (62064-122-01)","636","RC","62064-122-02","NDC","","","facility","both","1","EA","","152.1","152.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","62064-122-01","NDC","","","facility","both","1","EA","","135.53","135.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","62064-122-01","NDC","","","facility","both","1","EA","","153.7","153.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dihydroergotamine Mesylate: 10 AMPULE in 1 CARTON (61990-0411-2)  / 1 mL in 1 AMPULE (61990-0411-0) ","636","RC","61990-0411-2","NDC","","","facility","both","1","EA","","72.45","72.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunlenca: 1 Kit In 1 Carton (61958-3002-1)  *  1.5 Ml In 1 Vial (61958-3004-1)","636","RC","61958-3002-1","NDC","","","facility","both","1","EA","","29.67","29.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunlenca: 1 Kit In 1 Carton (61958-3002-1)  *  1.5 Ml In 1 Vial (61958-3004-1)","636","RC","61958-3002-1","NDC","","","facility","both","1","EA","","29.67","29.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","61958-2901-2","NDC","","","facility","both","1","EA","","9.9","9.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","61958-2901-2","NDC","","","facility","both","1","EA","","10.97","10.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","61958-2901-2","NDC","","","facility","both","1","EA","","11.57","11.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","61958-2901-2","NDC","","","facility","both","1","EA","","11.63","11.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","61958-2901-2","NDC","","","facility","both","1","EA","","1000.09","1000.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","61958-2901-2","NDC","","","facility","both","1","EA","","1101.76","1101.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Veklury: 1 Vial, Single-Dose In 1 Carton (61958-2901-2)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Dose","636","RC","61958-2901-2","NDC","","","facility","both","1","EA","","1112.74","1112.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01)  / 7 Ml In 1 Vial, Single-Use","636","RC","61755-008-01","NDC","","","facility","both","1","EA","","54.07","54.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01)  / 7 Ml In 1 Vial, Single-Use","636","RC","61755-008-01","NDC","","","facility","both","1","EA","","54.07","54.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01)  / 7 Ml In 1 Vial, Single-Use","636","RC","61755-008-01","NDC","","","facility","both","1","EA","","54.14","54.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-06)  / 1 Ml In 1 Vial, Single-Dose","636","RC","61703-309-06","NDC","","","facility","both","1","EA","","7.59","7.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-06)  / 1 Ml In 1 Vial, Single-Dose","636","RC","61703-309-06","NDC","","","facility","both","1","EA","","8.64","8.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61703-305-58","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 5 Vial, Single-Dose In 1 Carton (61703-305-38)  / 5 Ml In 1 Vial, Single-Dose (61703-305-58)","636","RC","61703-305-38","NDC","","","facility","both","1","EA","","3.03","3.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 5 Vial, Single-Dose In 1 Carton (61703-305-38)  / 5 Ml In 1 Vial, Single-Dose (61703-305-58)","636","RC","61703-305-38","NDC","","","facility","both","1","EA","","5.83","5.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","61553-822-41","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-16)  / 2 Ml In 1 Vial, Single-Dose","636","RC","61703-309-16","NDC","","","facility","both","1","EA","","8.66","8.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vincristine Sulfate: 1 Vial, Single-Dose In 1 Carton (61703-309-16)  / 2 Ml In 1 Vial, Single-Dose","636","RC","61703-309-16","NDC","","","facility","both","1","EA","","8.19","8.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eylea: 1 Vial, Single-Use In 1 Carton (61755-005-02)  / .05 Ml In 1 Vial, Single-Use","636","RC","61755-005-02","NDC","","","facility","both","1","EA","","1665","1665","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eylea: 1 Vial, Single-Use In 1 Carton (61755-005-02)  / .05 Ml In 1 Vial, Single-Use","636","RC","61755-005-02","NDC","","","facility","both","1","EA","","1665","1665","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eylea: 1 Vial, Single-Use In 1 Carton (61755-005-02)  / .05 Ml In 1 Vial, Single-Use","636","RC","61755-005-02","NDC","","","facility","both","1","EA","","1714.92","1714.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eylea: 1 Vial, Single-Use In 1 Carton (61755-005-02)  / .05 Ml In 1 Vial, Single-Use","636","RC","61755-005-02","NDC","","","facility","both","1","EA","","1727.36","1727.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial, Single-Dose In 1 Carton (61703-408-41)  / 40 Ml In 1 Vial, Single-Dose","636","RC","61703-408-41","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methotrexate: 1 Vial, Single-Dose In 1 Carton (61703-408-41)  / 40 Ml In 1 Vial, Single-Dose","636","RC","61703-408-41","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mitoxantrone: 1 Vial, Multi-Dose In 1 Carton (61703-343-18)  / 10 Ml In 1 Vial, Multi-Dose","636","RC","61703-343-18","NDC","","","facility","both","1","EA","","59.65","59.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paclitaxel: 1 Vial, Multi-Dose In 1 Carton (61703-342-50)  / 50 Ml In 1 Vial, Multi-Dose","636","RC","61703-342-50","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carboplatin: 1 Vial, Multi-Dose In 1 Carton (61703-339-50)  / 45 Ml In 1 Vial, Multi-Dose","636","RC","61703-339-50","NDC","","","facility","both","1","EA","","3.37","3.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carboplatin: 1 Vial, Multi-Dose In 1 Carton (61703-339-22)  / 15 Ml In 1 Vial, Multi-Dose","636","RC","61703-339-22","NDC","","","facility","both","1","EA","","5","5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pamidronate Disodium: 1 Vial, Single-Dose In 1 Carton (61703-324-18)  / 10 Ml In 1 Vial, Single-Dose","636","RC","61703-324-18","NDC","","","facility","both","1","EA","","23.04","23.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pamidronate Disodium: 1 Vial, Single-Dose In 1 Carton (61703-324-18)  / 10 Ml In 1 Vial, Single-Dose","636","RC","61703-324-18","NDC","","","facility","both","1","EA","","23.89","23.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial, Single-Dose In 1 Carton (61703-319-22)  / 20 Ml In 1 Vial, Single-Dose","636","RC","61703-319-22","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial, Single-Dose In 1 Carton (61703-319-22)  / 20 Ml In 1 Vial, Single-Dose","636","RC","61703-319-22","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytarabine: 1 Vial, Single-Dose In 1 Carton (61703-319-22)  / 20 Ml In 1 Vial, Single-Dose","636","RC","61703-319-22","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Libtayo: 1 Vial, Single-Use In 1 Carton (61755-008-01)  / 7 Ml In 1 Vial, Single-Use","636","RC","61755-008-01","NDC","","","facility","both","1","EA","","54.08","54.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-620-11","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-524-79","NDC","","","facility","both","1","EA","","12.15","12.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-729-11","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Pamoate: 50 Blister Pack In 1 Carton (60687-707-65)  / 1 Capsule In 1 Blister Pack (60687-707-11)","636","RC","60687-707-65","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-707-11","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-660-11","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promethazine Hydrochloride: 100 Blister Pack In 1 Carton (60687-660-01)  / 1 Tablet In 1 Blister Pack (60687-660-11)","636","RC","60687-660-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","60687-696-11","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","5846800902","NDC","","","facility","both","1","EA","","243.43","243.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","5846800903","NDC","","","facility","both","1","EA","","15.21","15.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","5846800903","NDC","","","facility","both","1","EA","","15.21","15.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","5192712020","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-17)  / 3 Ml In 1 Vial, Multi-Dose","636","RC","0002-8215-17","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin N: 1 Vial, Multi-Dose In 1 Carton (0002-8315-01)  / 10 Ml In 1 Vial, Multi-Dose","636","RC","0002-8315-01","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Forteo: 1 Syringe In 1 Carton (0002-8400-01)  / 2.24 Ml In 1 Syringe","636","RC","0002-8400-01","NDC","","","facility","both","1","EA","","126.01","126.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin R U-500: 1 Vial, Multi-Dose In 1 Carton (0002-8501-01)  / 20 Ml In 1 Vial, Multi-Dose","636","RC","0002-8501-01","NDC","","","facility","both","1","EA","","10.12","10.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kisunla: 1 Vial, Single-Dose In 1 Carton (0002-9401-01)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0002-9401-01","NDC","","","facility","both","1","EA","","7.24","7.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kenalog-10: 1 Vial, Multi-Dose In 1 Carton (0003-0494-20)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","0003-0494-20","NDC","","","facility","both","1","EA","","2.79","2.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nulojix: 1 Vial, Single-Use In 1 Carton (0003-0371-13)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0003-0371-13","NDC","","","facility","both","1","EA","","5.04","5.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nulojix: 1 Vial, Single-Use In 1 Carton (0003-0371-13)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0003-0371-13","NDC","","","facility","both","1","EA","","5.06","5.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-17)  / 3 Ml In 1 Vial, Multi-Dose","636","RC","0002-8215-17","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nulojix: 1 Vial, Single-Use In 1 Carton (0003-0371-13)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0003-0371-13","NDC","","","facility","both","1","EA","","5.07","5.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nulojix: 1 Vial, Single-Use In 1 Carton (0003-0371-13)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0003-0371-13","NDC","","","facility","both","1","EA","","5.08","5.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nulojix: 1 Vial, Single-Use In 1 Carton (0003-0371-13)  / 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-Use","636","RC","0003-0371-13","NDC","","","facility","both","1","EA","","5.08","5.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kenalog-40: 1 Vial, Multi-Dose In 1 Carton (0003-0293-20)  / 5 Ml In 1 Vial, Multi-Dose","636","RC","0003-0293-20","NDC","","","facility","both","1","EA","","3.94","3.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kenalog-40: 1 Vial, Single-Dose In 1 Carton (0003-0293-05)  / 1 Ml In 1 Vial, Single-Dose","636","RC","0003-0293-05","NDC","","","facility","both","1","EA","","3.88","3.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-8215-01)  / 10 Ml In 1 Vial, Multi-Dose","636","RC","0002-8215-01","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin R: 1 Vial, Multi-Dose In 1 Carton (0002-0213-01)  / 3 Ml In 1 Vial, Multi-Dose","636","RC","0002-0213-01","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Insulin Lispro: 1 Vial In 1 Carton (0002-7737-01)  / 10 Ml In 1 Vial","636","RC","0002-7737-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0002-7712-01","NDC","","","facility","both","1","EA","","2.47","2.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyramza: 1 Vial, Single-Dose In 1 Carton (0002-7678-01)  / 50 Ml In 1 Vial, Single-Dose","636","RC","0002-7678-01","NDC","","","facility","both","1","EA","","132.3","132.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyramza: 1 Vial, Single-Dose In 1 Carton (0002-7669-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0002-7669-01","NDC","","","facility","both","1","EA","","132.52","132.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyramza: 1 Vial, Single-Dose In 1 Carton (0002-7669-01)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0002-7669-01","NDC","","","facility","both","1","EA","","134.15","134.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zyprexa Intramuscular: 1 Vial In 1 Carton (0002-7597-01)  / 2 Ml In 1 Vial","636","RC","0002-7597-01","NDC","","","facility","both","1","EA","","4.17","4.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zyprexa Intramuscular: 1 Vial In 1 Carton (0002-7597-01)  / 2 Ml In 1 Vial","636","RC","0002-7597-01","NDC","","","facility","both","1","EA","","4.17","4.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zyprexa Intramuscular: 1 Vial In 1 Carton (0002-7597-01)  / 2 Ml In 1 Vial","636","RC","0002-7597-01","NDC","","","facility","both","1","EA","","4.17","4.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdualag: 1 Vial, Single-Dose In 1 Carton (0003-7125-11)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0003-7125-11","NDC","","","facility","both","1","EA","","212.88","212.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdualag: 1 Vial, Single-Dose In 1 Carton (0003-7125-11)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0003-7125-11","NDC","","","facility","both","1","EA","","236.22","236.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdualag: 1 Vial, Single-Dose In 1 Carton (0003-7125-11)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0003-7125-11","NDC","","","facility","both","1","EA","","236.6","236.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdualag: 1 Vial, Single-Dose In 1 Carton (0003-7125-11)  / 20 Ml In 1 Vial, Single-Dose","636","RC","0003-7125-11","NDC","","","facility","both","1","EA","","240.58","240.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo Qvantig: 1 Vial, Single-Dose In 1 Carton (0003-6120-01)  / 5 Ml In 1 Vial, Single-Dose","636","RC","0003-6120-01","NDC","","","facility","both","1","EA","","47.66","47.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0004-0298-30","NDC","","","facility","both","1","EA","","2.29","2.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0003-3774-12","NDC","","","facility","both","1","EA","","31.88","31.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0003-3774-12","NDC","","","facility","both","1","EA","","53.93","53.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0003-3774-12","NDC","","","facility","both","1","EA","","54.74","54.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0003-3774-12","NDC","","","facility","both","1","EA","","58.4","58.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11)  / 4 Ml In 1 Vial, Single-Dose","636","RC","0003-3772-11","NDC","","","facility","both","1","EA","","57.52","57.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11)  / 4 Ml In 1 Vial, Single-Dose","636","RC","0003-3772-11","NDC","","","facility","both","1","EA","","57.59","57.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11)  / 4 Ml In 1 Vial, Single-Dose","636","RC","0003-3772-11","NDC","","","facility","both","1","EA","","58.41","58.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3774-12)  / 10 Ml In 1 Vial, Single-Dose","636","RC","0003-3774-12","NDC","","","facility","both","1","EA","","52.11","52.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11)  / 4 Ml In 1 Vial, Single-Dose","636","RC","0003-3772-11","NDC","","","facility","both","1","EA","","58.56","58.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02)  / .5 Ml In 1 Syringe (0005-2000-01)","636","RC","0005-2000-02","NDC","","","facility","both","1","EA","","420.23","420.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0005-2000-01","NDC","","","facility","both","1","EA","","413.48","413.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","0005-1971-01","NDC","","","facility","both","1","EA","","355.99","355.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prevnar 20: 1 Syringe In 1 Carton (0005-2000-02)  / .5 Ml In 1 Syringe (0005-2000-01)","636","RC","0005-2000-02","NDC","","","facility","both","1","EA","","416.61","416.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11)  / 4 Ml In 1 Vial, Single-Dose","636","RC","0003-3772-11","NDC","","","facility","both","1","EA","","59.02","59.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13)  / 24 Ml In 1 Vial, Single-Dose","636","RC","0003-3734-13","NDC","","","facility","both","1","EA","","49.61","49.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11)  / 10 Ml In 1 Vial, Single-Use","636","RC","0003-2327-11","NDC","","","facility","both","1","EA","","325.48","325.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Orencia: 1 Vial, Single-Use In 1 Carton (0003-2187-13)  / 15 Ml In 1 Vial, Single-Use","636","RC","0003-2187-13","NDC","","","facility","both","1","EA","","102.34","102.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Orencia: 1 Vial, Single-Use In 1 Carton (0003-2187-13)  / 15 Ml In 1 Vial, Single-Use","636","RC","0003-2187-13","NDC","","","facility","both","1","EA","","105.71","105.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Orencia: 1 Vial, Single-Use In 1 Carton (0003-2187-13)  / 15 Ml In 1 Vial, Single-Use","636","RC","0003-2187-13","NDC","","","facility","both","1","EA","","106.16","106.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Orencia: 1 Vial, Single-Use In 1 Carton (0003-2187-13)  / 15 Ml In 1 Vial, Single-Use","636","RC","0003-2187-13","NDC","","","facility","both","1","EA","","106.91","106.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Orencia: 1 Vial, Single-Use In 1 Carton (0003-2187-13)  / 15 Ml In 1 Vial, Single-Use","636","RC","0003-2187-13","NDC","","","facility","both","1","EA","","107.13","107.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11)  / 10 Ml In 1 Vial, Single-Use","636","RC","0003-2327-11","NDC","","","facility","both","1","EA","","313.31","313.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3772-11)  / 4 Ml In 1 Vial, Single-Dose","636","RC","0003-3772-11","NDC","","","facility","both","1","EA","","59.57","59.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11)  / 10 Ml In 1 Vial, Single-Use","636","RC","0003-2327-11","NDC","","","facility","both","1","EA","","264.26","264.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13)  / 24 Ml In 1 Vial, Single-Dose","636","RC","0003-3734-13","NDC","","","facility","both","1","EA","","51.66","51.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13)  / 24 Ml In 1 Vial, Single-Dose","636","RC","0003-3734-13","NDC","","","facility","both","1","EA","","51.94","51.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13)  / 24 Ml In 1 Vial, Single-Dose","636","RC","0003-3734-13","NDC","","","facility","both","1","EA","","52.54","52.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opdivo: 1 Vial, Single-Dose In 1 Carton (0003-3734-13)  / 24 Ml In 1 Vial, Single-Dose","636","RC","0003-3734-13","NDC","","","facility","both","1","EA","","59.57","59.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azactam: 10 Vial, Single-Dose In 1 Carton (0003-2570-16)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","0003-2570-16","NDC","","","facility","both","1","EA","","4.93","4.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azactam: 10 Vial, Single-Dose In 1 Carton (0003-2570-16)  / 1 Injection, Powder, For Solution In 1 Vial, Single-Dose","636","RC","0003-2570-16","NDC","","","facility","both","1","EA","","4.93","4.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11)  / 10 Ml In 1 Vial, Single-Use","636","RC","0003-2327-11","NDC","","","facility","both","1","EA","","264.76","264.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22)  / 40 Ml In 1 Vial, Single-Use","636","RC","0003-2328-22","NDC","","","facility","both","1","EA","","201.95","201.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22)  / 40 Ml In 1 Vial, Single-Use","636","RC","0003-2328-22","NDC","","","facility","both","1","EA","","212.45","212.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22)  / 40 Ml In 1 Vial, Single-Use","636","RC","0003-2328-22","NDC","","","facility","both","1","EA","","212.69","212.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22)  / 40 Ml In 1 Vial, Single-Use","636","RC","0003-2328-22","NDC","","","facility","both","1","EA","","313.31","313.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22)  / 40 Ml In 1 Vial, Single-Use","636","RC","0003-2328-22","NDC","","","facility","both","1","EA","","325.97","325.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11)  / 10 Ml In 1 Vial, Single-Use","636","RC","0003-2327-11","NDC","","","facility","both","1","EA","","257.88","257.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2328-22)  / 40 Ml In 1 Vial, Single-Use","636","RC","0003-2328-22","NDC","","","facility","both","1","EA","","171.74","171.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","8290306547","NDC","","","facility","both","1","EA","","6.47","6.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Yervoy: 1 Vial, Single-Use In 1 Carton (0003-2327-11)  / 10 Ml In 1 Vial, Single-Use","636","RC","0003-2327-11","NDC","","","facility","both","1","EA","","280.57","280.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","8290306510","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","6425333335","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","6425333333","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","6332355701","NDC","","","facility","both","1","EA","","4.07","4.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","8290306424","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","8290306423","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","636","RC","8290306413","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isentress: 60 Tablet, Film Coated In 1 Bottle (0006-0227-61)","637","RC","0006-0227-61","NDC","","","facility","both","1","EA","","57.63","57.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-709-10)","637","RC","13811-709-10","NDC","","","facility","both","1","EA","","1.45","1.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Citalopram: 100 Tablet, Film Coated In 1 Bottle (13668-011-01)","637","RC","13668-011-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Mononitrate: 100 Tablet, Extended Release In 1 Bottle (13668-106-01)","637","RC","13668-106-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-708-10)","637","RC","13811-708-10","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-707-10)","637","RC","13811-707-10","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (13811-706-10)","637","RC","13811-706-10","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet In 1 Bottle (13668-720-90)","637","RC","13668-720-90","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sacubitril And Valsartan: 60 Tablet In 1 Bottle (13668-636-60)","637","RC","13668-636-60","NDC","","","facility","both","1","EA","","2.36","2.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sacubitril And Valsartan: 60 Tablet In 1 Bottle (13668-634-60)","637","RC","13668-634-60","NDC","","","facility","both","1","EA","","2.36","2.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tadalafil: 30 Tablet In 1 Bottle (13668-581-30)","637","RC","13668-581-30","NDC","","","facility","both","1","EA","","1.98","1.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (13668-221-30)","637","RC","13668-221-30","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (13668-216-30)","637","RC","13668-216-30","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Transderm Scop: 1 Patch In 1 Pouch (10019-553-90)  / 3 D In 1 Patch","637","RC","10019-553-90","NDC","","","facility","both","1","EA","","17.44","17.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"GRAFCO: 12 TUBE in 1 BOX (12165-100-03)  / 100 STICK in 1 TUBE","637","RC","12165-100-03","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Grafco Applicator 15 Cm: 100 Stick In 1 Tube (12165-100-01)","637","RC","12165-100-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Critic Aid Clear Af: 57 G In 1 Tube (11701-067-23)","637","RC","11701-067-23","NDC","","","facility","both","1","EA","","11.39","11.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pvp Iodine Prep Swabstick Ones And Threes: 25 Packet In 1 Box (10819-3885-2)  / 7 Ml In 1 Packet","637","RC","10819-3885-2","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 100 Capsule In 1 Bottle (10702-237-01)","637","RC","10702-237-01","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 100 Tablet In 1 Bottle, Plastic (10702-201-01)","637","RC","10702-201-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 500 Tablet In 1 Bottle (13107-084-05)","637","RC","13107-084-05","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 500 Tablet In 1 Bottle (13107-083-05)","637","RC","13107-083-05","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Tablet In 1 Bottle (13107-079-01)","637","RC","13107-079-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (13107-001-30)","637","RC","13107-001-30","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","12496-1208-1","NDC","","","facility","both","1","EA","","14.91","14.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenazopyridine Hydrochloride: 100 TABLET, FILM COATED in 1 BOTTLE (10135-620-01) ","637","RC","10135-620-01","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ferriprox: 500 Ml In 1 Bottle, Plastic (10122-101-50)","637","RC","10122-101-50","NDC","","","facility","both","1","EA","","627.84","627.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle (10135-676-01)","637","RC","10135-676-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Peg-3350, Sodium Chloride, Sodium Bicarbonate And Potassium Chloride: 4 L In 1 Bottle (10572-302-01)","637","RC","10572-302-01","NDC","","","facility","both","1","EA","","43.2","43.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin 81 mg Enteric Coated: 120 TABLET in 1 BOTTLE (10135-689-62) ","637","RC","10135-689-62","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle (10135-679-01)","637","RC","10135-679-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 100 Tablet In 1 Bottle (10702-170-01)","637","RC","10702-170-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isradipine: 100 Capsule In 1 Bottle (16252-540-01)","637","RC","16252-540-01","NDC","","","facility","both","1","EA","","1.53","1.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 500 Tablet In 1 Bottle, Plastic (16729-137-16)","637","RC","16729-137-16","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 500 Tablet In 1 Bottle, Plastic (16729-136-16)","637","RC","16729-136-16","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (16729-421-10)  / 30 G In 1 Tube","637","RC","16729-421-10","NDC","","","facility","both","1","EA","","103.9","103.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 100 Capsule, Extended Release In 1 Bottle (16729-331-01)","637","RC","16729-331-01","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ezetimibe: 30 Tablet In 1 Bottle (16714-813-01)","637","RC","16714-813-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"New Day: 1 Blister Pack In 1 Carton (16714-809-01)  / 1 Tablet In 1 Blister Pack","637","RC","16714-809-01","NDC","","","facility","both","1","EA","","19.4","19.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sumatriptan: 1 Blister Pack In 1 Carton (16714-798-01)  / 9 Tablet In 1 Blister Pack","637","RC","16714-798-01","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sumatriptan: 1 Blister Pack In 1 Carton (16714-797-01)  / 9 Tablet In 1 Blister Pack","637","RC","16714-797-01","NDC","","","facility","both","1","EA","","2.35","2.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sumatriptan: 1 Blister Pack In 1 Carton (16714-796-01)  / 9 Tablet In 1 Blister Pack","637","RC","16714-796-01","NDC","","","facility","both","1","EA","","1.48","1.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Terbinafine: 30 Tablet In 1 Bottle (16714-795-01)","637","RC","16714-795-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (16714-759-01)","637","RC","16714-759-01","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone: 60 Capsule In 1 Bottle (16714-835-01)","637","RC","16714-835-01","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 30 Tablet, Film Coated In 1 Bottle (16714-991-01)","637","RC","16714-991-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-990-01)","637","RC","16714-990-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-989-01)","637","RC","16714-989-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (16714-988-01)","637","RC","16714-988-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (16714-985-02)  / 80 G In 1 Tube","637","RC","16714-985-02","NDC","","","facility","both","1","EA","","8.07","8.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (16714-950-01)","637","RC","16714-950-01","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Permethrin: 1 Tube In 1 Container (16714-897-01)  / 60 G In 1 Tube","637","RC","16714-897-01","NDC","","","facility","both","1","EA","","26.9","26.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 100 Tablet In 1 Bottle (16714-887-01)","637","RC","16714-887-01","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 1 Tube In 1 Carton (16714-878-01)  / 35.44 G In 1 Tube","637","RC","16714-878-01","NDC","","","facility","both","1","EA","","13.53","13.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride: 30 Tablet, Extended Release In 1 Bottle (16729-443-10)","637","RC","16729-443-10","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 72 Cup, Unit-Dose In 1 Box, Unit-Dose (17856-1045-1)  / 5 Ml In 1 Cup, Unit-Dose (17856-1045-2)","637","RC","17856-1045-1","NDC","","","facility","both","1","EA","","7.64","7.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gavilax: 72 Pouch In 1 Case (17856-0312-6)  / 4.5 G In 1 Pouch","637","RC","17856-0312-6","NDC","","","facility","both","1","EA","","2.72","2.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gavilax: 50 Cup In 1 Case (17856-0312-5)  / 8.5 G In 1 Cup","637","RC","17856-0312-5","NDC","","","facility","both","1","EA","","25.25","25.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gavilax: 8.5 G In 1 Bag (17856-0312-2)","637","RC","17856-0312-2","NDC","","","facility","both","1","EA","","2.96","2.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine: 100 Capsule In 1 Bottle (23155-194-01)","637","RC","23155-194-01","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet In 1 Bottle (23155-026-01)","637","RC","23155-026-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mupirocin: 1 Tube In 1 Carton (21922-029-04)  / 15 G In 1 Tube","637","RC","21922-029-04","NDC","","","facility","both","1","EA","","41.5","41.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Permethrin: 1 Tube In 1 Carton (21922-021-07)  / 60 G In 1 Tube","637","RC","21922-021-07","NDC","","","facility","both","1","EA","","49.79","49.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (21922-017-05)  / 30 G In 1 Tube","637","RC","21922-017-05","NDC","","","facility","both","1","EA","","13.18","13.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (16714-758-01)","637","RC","16714-758-01","NDC","","","facility","both","1","EA","","3.18","3.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dermoplast Pain Relieving: 78 G In 1 Can (16864-680-01)","637","RC","16864-680-01","NDC","","","facility","both","1","EA","","10.45","10.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 90 Tablet In 1 Bottle (16729-449-15)","637","RC","16729-449-15","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 90 Tablet In 1 Bottle (16729-447-15)","637","RC","16729-447-15","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (16714-757-01)","637","RC","16714-757-01","NDC","","","facility","both","1","EA","","3.28","3.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (16714-143-01)","637","RC","16714-143-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (16714-142-01)","637","RC","16714-142-01","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (16714-141-01)","637","RC","16714-141-01","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxychloroquine Sulfate: 100 Tablet, Film Coated In 1 Bottle (16714-110-01)","637","RC","16714-110-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tizanidine: 150 Tablet In 1 Bottle (16714-172-01)","637","RC","16714-172-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 60 Tablet In 1 Bottle (16714-197-01)","637","RC","16714-197-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 60 Tablet In 1 Bottle (16714-196-01)","637","RC","16714-196-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guanfacine: 100 Tablet, Extended Release In 1 Bottle (16714-192-01)","637","RC","16714-192-01","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","16714-186-01","NDC","","","facility","both","1","EA","","14.8","14.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","16714-185-01","NDC","","","facility","both","1","EA","","5.48","5.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mupirocin: 1 Tube In 1 Carton (16714-055-01)  / 15 G In 1 Tube","637","RC","16714-055-01","NDC","","","facility","both","1","EA","","187.86","187.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Acetate: 200 Capsule In 1 Bottle, Plastic (16571-813-20)","637","RC","16571-813-20","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Tablet, Chewable In 1 Bottle (16571-786-01)","637","RC","16571-786-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levocarnitine: 9 Blister Pack In 1 Carton (16571-762-09)  / 10 Tablet In 1 Blister Pack","637","RC","16571-762-09","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamylon: 1 Tube In 1 Carton (16571-723-60)  / 56.7 G In 1 Tube","637","RC","16571-723-60","NDC","","","facility","both","1","EA","","120.23","120.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cetirizine Hydrochloride: 100 Tablet In 1 Bottle (16571-401-10)","637","RC","16571-401-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16571-113-01)","637","RC","16571-113-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 100 Tablet In 1 Bottle (16571-822-01)","637","RC","16571-822-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clopidogrel: 100 Tablet In 1 Box, Unit-Dose (16714-052-11)","637","RC","16714-052-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clopidogrel: 10 Tablet In 1 Blister Pack (16714-052-10)","637","RC","16714-052-10","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Capsule In 1 Bottle (16571-869-01)","637","RC","16571-869-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 500 Capsule In 1 Bottle (16714-662-02)","637","RC","16714-662-02","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 500 Capsule In 1 Bottle (16714-661-02)","637","RC","16714-661-02","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Capsule In 1 Bottle (16714-661-01)","637","RC","16714-661-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zolpidem Tartrate: 100 Tablet, Film Coated In 1 Bottle (16714-622-01)","637","RC","16714-622-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zolpidem Tartrate: 100 Tablet, Film Coated In 1 Bottle (16714-621-01)","637","RC","16714-621-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (16714-611-05)","637","RC","16714-611-05","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","16714-692-10","NDC","","","facility","both","1","EA","","2.04","2.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Capsule In 1 Bottle (16714-721-02)","637","RC","16714-721-02","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Capsule In 1 Bottle (16714-720-02)","637","RC","16714-720-02","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entecavir: 30 Tablet, Film Coated In 1 Bottle, Plastic (16714-718-01)","637","RC","16714-718-01","NDC","","","facility","both","1","EA","","3.12","3.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entecavir: 30 Tablet, Film Coated In 1 Bottle, Plastic (16714-717-01)","637","RC","16714-717-01","NDC","","","facility","both","1","EA","","2.87","2.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (16714-698-03)","637","RC","16714-698-03","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (16714-697-03)","637","RC","16714-697-03","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 1 Bottle In 1 Carton (16714-696-01)  / 35 Ml In 1 Bottle","637","RC","16714-696-01","NDC","","","facility","both","1","EA","","9.08","9.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 30 Tablet In 1 Bottle (16714-694-01)","637","RC","16714-694-01","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 100 Tablet In 1 Bottle (16714-693-02)","637","RC","16714-693-02","NDC","","","facility","both","1","EA","","1.73","1.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 30 Tablet In 1 Bottle (16714-693-01)","637","RC","16714-693-01","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-611-04)","637","RC","16714-611-04","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefadroxil: 100 Ml In 1 Bottle (16714-390-02)","637","RC","16714-390-02","NDC","","","facility","both","1","EA","","2.12","2.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefadroxil: 50 Capsule In 1 Bottle (16714-388-01)","637","RC","16714-388-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 473 Ml In 1 Bottle, Plastic (16714-358-01)","637","RC","16714-358-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 500 Capsule In 1 Bottle (16714-299-04)","637","RC","16714-299-04","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 200 Ml In 1 Bottle (16714-294-03)","637","RC","16714-294-03","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 50 Ml In 1 Bottle (16714-293-01)","637","RC","16714-293-01","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (16714-258-01)","637","RC","16714-258-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Capsule In 1 Bottle (16714-298-01)","637","RC","16714-298-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefdinir: 60 CAPSULE in 1 BOTTLE (16714-391-02) ","637","RC","16714-391-02","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefuroxime Axetil: 60 Tablet In 1 Bottle (16714-400-02)","637","RC","16714-400-02","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 100 Tablet In 1 Bottle (16714-577-01)","637","RC","16714-577-01","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin Palmitate Hydrochloride (Pediatric): 1 Bottle, Plastic In 1 Carton (16714-483-02)  / 100 Ml In 1 Bottle, Plastic","637","RC","16714-483-02","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 100 Tablet In 1 Bottle (16714-443-01)","637","RC","16714-443-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefpodoxime Proxetil: 1 Bottle In 1 Carton (16714-403-01)  / 50 Ml In 1 Bottle","637","RC","16714-403-01","NDC","","","facility","both","1","EA","","7.9","7.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefuroxime Axetil: 60 Tablet In 1 Bottle (16714-401-02)","637","RC","16714-401-02","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 1 Bottle, Plastic In 1 Carton (16714-601-02)  / 60 Ml In 1 Bottle, Plastic","637","RC","16714-601-02","NDC","","","facility","both","1","EA","","3.07","3.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Senna-Lax: 10 Blister Pack In 1 Box (0904-6522-61)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6522-61","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 30 Blister Pack In 1 Carton (0904-6553-04)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6553-04","NDC","","","facility","both","1","EA","","6.6","6.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Memantine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6505-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6505-61","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Memantine Hydrochloride: 50 Blister Pack In 1 Carton (0904-6505-06)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6505-06","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Blister Pack In 1 Carton (0904-6503-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-6503-61","NDC","","","facility","both","1","EA","","3.31","3.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 100 Blister Pack In 1 Carton (0904-6501-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6501-61","NDC","","","facility","both","1","EA","","2.7","2.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 100 Blister Pack In 1 Carton (0904-6500-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6500-61","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 100 Blister Pack In 1 Carton (0904-6476-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6476-61","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6557-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","637","RC","0904-6557-61","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tolterodine Tartrate: 30 Blister Pack In 1 Carton (0904-6593-04)  / 1 Capsule, Extended Release In 1 Blister Pack","637","RC","0904-6593-04","NDC","","","facility","both","1","EA","","9.22","9.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tolterodine Tartrate: 30 Blister Pack In 1 Carton (0904-6592-04)  / 1 Capsule, Extended Release In 1 Blister Pack","637","RC","0904-6592-04","NDC","","","facility","both","1","EA","","8.85","8.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 100 Blister Pack In 1 Carton (0904-6575-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6575-61","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride: 30 Blister Pack In 1 Carton (0904-6573-04)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","637","RC","0904-6573-04","NDC","","","facility","both","1","EA","","3.87","3.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 100 Blister Pack In 1 Carton (0904-6572-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6572-61","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 100 Blister Pack In 1 Carton (0904-6570-61)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-6570-61","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 50 Blister Pack In 1 Carton (0904-6570-06)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-6570-06","NDC","","","facility","both","1","EA","","3.39","3.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate Extended Release: 100 Blister Pack In 1 Carton (0904-6558-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","637","RC","0904-6558-61","NDC","","","facility","both","1","EA","","1.53","1.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 100 Blister Pack In 1 Carton (0904-6475-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6475-61","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 100 Blister Pack In 1 Carton (0904-6474-61)  / 1 Tablet, Delayed Release In 1 Blister Pack","637","RC","0904-6474-61","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisacodyl: 10 Blister Pack In 1 Box (0904-6407-61)  / 10 Tablet, Delayed Release In 1 Blister Pack","637","RC","0904-6407-61","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Blister Pack In 1 Carton (0904-6374-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6374-61","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Blister Pack In 1 Carton (0904-6373-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6373-61","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6371-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6371-61","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6370-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6370-61","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amlodipine Besylate: 100 Blister Pack In 1 Carton (0904-6369-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6369-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6363-61)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-6363-61","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Tablet In 1 Box, Unit-Dose (0904-6361-61)","637","RC","0904-6361-61","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Tablet In 1 Box, Unit-Dose (0904-6359-61)","637","RC","0904-6359-61","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Tablet In 1 Box, Unit-Dose (0904-6358-61)","637","RC","0904-6358-61","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 100 Blister Pack In 1 Carton (0904-6352-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6352-61","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Major Regular Strength Assorted Flavors: 150 Tablet, Chewable In 1 Bottle, Plastic (0904-6412-92)","637","RC","0904-6412-92","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tizanidine: 100 Blister Pack In 1 Carton (0904-6418-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6418-61","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clopidogrel: 20 Blister Pack In 1 Carton (0904-6467-10)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6467-10","NDC","","","facility","both","1","EA","","8.94","8.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clopidogrel: 30 Blister Pack In 1 Carton (0904-6467-07)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6467-07","NDC","","","facility","both","1","EA","","13.2","13.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Mononitrate: 100 Blister Pack In 1 Carton (0904-6450-61)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-6450-61","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Mononitrate: 100 Blister Pack In 1 Carton (0904-6449-61)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-6449-61","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6441-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6441-61","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Escitalopram: 100 Blister Pack In 1 Carton (0904-6427-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6427-61","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Escitalopram: 100 Blister Pack In 1 Carton (0904-6426-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6426-61","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6615-61)  / 1 Capsule, Delayed Release In 1 Blister Pack","637","RC","0904-6615-61","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6780-61)  / 1 Tablet, Coated In 1 Blister Pack","637","RC","0904-6780-61","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6778-61)  / 1 Tablet, Coated In 1 Blister Pack","637","RC","0904-6778-61","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6773-61)  / 10 Tablet In 1 Blister Pack","637","RC","0904-6773-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Loratadine Oral: 1 Bottle In 1 Carton (0904-6767-20)  / 120 Ml In 1 Bottle","637","RC","0904-6767-20","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"mintox: 355 mL in 1 BOTTLE (0904-6764-14) ","637","RC","0904-6764-14","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin Low Dose: 1000 Tablet, Delayed Release In 1 Bottle, Plastic (0904-6751-80)","637","RC","0904-6751-80","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 10 Blister Pack In 1 Box, Unit-Dose (0904-6730-61)  / 10 Tablet In 1 Blister Pack","637","RC","0904-6730-61","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 500 Tablet In 1 Bottle (0904-6720-40)","637","RC","0904-6720-40","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mucus Relief Er: 100 Blister Pack In 1 Carton (0904-6718-39)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-6718-39","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cetirizine: 100 Blister Pack In 1 Carton (0904-6717-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6717-61","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6781-61)  / 1 Tablet, Coated In 1 Blister Pack","637","RC","0904-6781-61","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Blister Pack In 1 Carton (0904-6823-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6823-61","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6818-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6818-61","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 50 Blister Pack In 1 Carton (0904-6818-06)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6818-06","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 50 Blister Pack In 1 Carton (0904-6817-06)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6817-06","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Montelukast Sodium: 100 Blister Pack In 1 Carton (0904-6808-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6808-61","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 100 Blister Pack In 1 Carton (0904-6782-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6782-61","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Blister Pack In 1 Carton (0904-6799-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6799-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Blister Pack In 1 Carton (0904-6798-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6798-61","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Blister Pack In 1 Carton (0904-6797-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6797-61","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin Low Dose Chewable Orange: 1000 Tablet, Chewable In 1 Package (0904-6794-80)","637","RC","0904-6794-80","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin Low Dose Chewable Orange: 300 Blister Pack In 1 Carton (0904-6794-30)  / 1 Tablet, Chewable In 1 Blister Pack","637","RC","0904-6794-30","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Modafinil: 30 Blister Pack In 1 Carton (0904-6791-04)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6791-04","NDC","","","facility","both","1","EA","","8.16","8.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cetirizine: 1 Bottle In 1 Carton (0904-6717-60)  / 100 Tablet, Film Coated In 1 Bottle","637","RC","0904-6717-60","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6640-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6640-61","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6639-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6639-61","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6638-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6638-61","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glipizide: 100 Blister Pack In 1 Carton (0904-6637-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6637-61","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride: 100 Blister Pack In 1 Carton (0904-6635-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6635-61","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyridostigmine Bromide: 100 Blister Pack In 1 Carton (0904-6622-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6622-61","NDC","","","facility","both","1","EA","","1.88","1.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Blister Pack In 1 Carton (0904-6620-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6620-61","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Blister Pack In 1 Carton (0904-6619-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6619-61","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ear Drops Major: 1 Bottle In 1 Carton (0904-6627-35)  / 15 Ml In 1 Bottle","637","RC","0904-6627-35","NDC","","","facility","both","1","EA","","2.52","2.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6642-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6642-61","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quetiapine: 100 Blister Pack In 1 Carton (0904-6643-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6643-61","NDC","","","facility","both","1","EA","","2.33","2.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 100 Blister Pack In 1 Carton (0904-6709-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6709-61","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevelamer Carbonate: 100 Blister Pack In 1 Carton (0904-6707-82)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6707-82","NDC","","","facility","both","1","EA","","5.91","5.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 50 Blister Pack In 1 Carton (0904-6705-06)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6705-06","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sildenafil: 50 Blister Pack In 1 Carton (0904-6671-06)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6671-06","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sildenafil: 30 Blister Pack In 1 Carton (0904-6671-04)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6671-04","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Blister Pack In 1 Carton (0904-6667-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-6667-61","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Blister Pack In 1 Carton (0904-6666-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-6666-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Blister Pack In 1 Carton (0904-6665-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-6665-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 100 Blister Pack In 1 Carton (0904-6663-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6663-61","NDC","","","facility","both","1","EA","","4.79","4.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Mapap: 4 Blister Pack In 1 Carton (0904-6645-24)  / 6 Tablet, Chewable In 1 Blister Pack","637","RC","0904-6645-24","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 100 Blister Pack In 1 Carton (0904-6351-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6351-61","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6324-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","637","RC","0904-6324-61","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bismatrol: 5 BLISTER PACK in 1 CARTON (0904-1315-46)  / 6 TABLET, CHEWABLE in 1 BLISTER PACK","637","RC","0904-1315-46","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"ROBAFEN COUGH FORMULA: 473 mL in 1 BOTTLE (0904-0061-16) ","637","RC","0904-0061-16","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oil: 473 Ml In 1 Bottle, Plastic (0869-0831-43)","637","RC","0869-0831-43","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0832-7123-89","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluvoxamine Maleate: 100 Tablet, Film Coated In 1 Bottle (0832-1672-11)","637","RC","0832-1672-11","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluvoxamine Maleate: 100 Tablet, Film Coated In 1 Bottle (0832-1671-11)","637","RC","0832-1671-11","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (0832-6056-12)","637","RC","0832-6056-12","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0832-1219-89","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calamine: 177 Ml In 1 Bottle, Plastic (0904-2533-21)","637","RC","0904-2533-21","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxazosin: 100 Blister Pack In 1 Carton (0904-5522-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-5522-61","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pentoxifylline: 100 Blister Pack In 1 Carton (0904-5448-61)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-5448-61","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Biscolax Laxative: 100 SUPPOSITORY in 1 CARTON (0904-5058-60) ","637","RC","0904-5058-60","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sudogest: 1 Bottle, Plastic In 1 Carton (0904-5053-59)  / 100 Tablet, Film Coated In 1 Bottle, Plastic","637","RC","0904-5053-59","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 TABLET in 1 BOX, UNIT-DOSE (0904-3990-61) ","637","RC","0904-3990-61","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0904-3865-75","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 100 Blister Pack In 1 Carton (0904-3854-61)  / 1 Tablet, Chewable In 1 Blister Pack","637","RC","0904-3854-61","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Earwax Removal Aid: 1 BOTTLE, DISPENSING in 1 CARTON (0904-3220-35)  / 15 mL in 1 BOTTLE, DISPENSING","637","RC","0904-3220-35","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 100 Blister Pack In 1 Carton (0904-2725-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-2725-61","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0832-0038-89","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calmoseptine: 113 G In 1 Tube (0799-0001-04)","637","RC","0799-0001-04","NDC","","","facility","both","1","EA","","8.75","8.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 Tablet In 1 Bottle (0781-8052-01)","637","RC","0781-8052-01","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0832-0512-89","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0832-1218-89","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0832-1216-89","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jantoven: 100 Blister Pack In 1 Carton (0832-1216-01)  / 1 Tablet In 1 Blister Pack (0832-1216-89)","637","RC","0832-1216-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0832-1214-89","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jantoven: 100 Tablet In 1 Bottle (0832-1214-00)","637","RC","0832-1214-00","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0832-1213-89","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0832-1212-89","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0832-1211-89","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxazosin: 100 Blister Pack In 1 Carton (0904-5523-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-5523-61","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxazosin: 100 Blister Pack In 1 Carton (0904-5524-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-5524-61","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 100 Blister Pack In 1 Carton (0904-6283-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6283-61","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone: 80 Blister Pack In 1 Carton (0904-6272-45)  / 1 Capsule In 1 Blister Pack","637","RC","0904-6272-45","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone: 80 Blister Pack In 1 Carton (0904-6271-45)  / 1 Capsule In 1 Blister Pack","637","RC","0904-6271-45","NDC","","","facility","both","1","EA","","2.89","2.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone: 80 Blister Pack In 1 Carton (0904-6269-45)  / 1 Capsule In 1 Blister Pack","637","RC","0904-6269-45","NDC","","","facility","both","1","EA","","2.96","2.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6290-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6290-61","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-6238-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6238-61","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa and Levodopa: 100 BLISTER PACK in 1 CARTON (0904-6237-61)  / 1 TABLET in 1 BLISTER PACK","637","RC","0904-6237-61","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 100 Blister Pack In 1 Carton (0904-6221-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-6221-61","NDC","","","facility","both","1","EA","","5.19","5.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 100 Blister Pack In 1 Carton (0904-6172-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6172-61","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Citalopram: 100 Blister Pack In 1 Carton (0904-6085-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6085-61","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"loperamide hydrochloride: 120 mL in 1 BOTTLE (0904-6256-20) ","637","RC","0904-6256-20","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6291-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6291-61","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6323-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","637","RC","0904-6323-61","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Blister Pack In 1 Carton (0904-6322-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","637","RC","0904-6322-61","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 50 Blister Pack In 1 Carton (0904-6322-06)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","637","RC","0904-6322-06","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sore Throat Cherry: 177 Ml In 1 Bottle, Spray (0904-6305-21)","637","RC","0904-6305-21","NDC","","","facility","both","1","EA","","3.19","3.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6303-61)","637","RC","0904-6303-61","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6302-61)","637","RC","0904-6302-61","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6301-61)","637","RC","0904-6301-61","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Box, Unit-Dose (0904-6300-61)","637","RC","0904-6300-61","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clopidogrel: 100 Blister Pack In 1 Carton (0904-6294-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6294-61","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atorvastatin Calcium: 30 Blister Pack In 1 Carton (0904-6293-04)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6293-04","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atorvastatin Calcium: 100 Blister Pack In 1 Carton (0904-6292-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6292-61","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Citalopram: 100 Blister Pack In 1 Carton (0904-6084-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6084-61","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zolpidem Tartrate: 100 Blister Pack In 1 Carton (0904-6082-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6082-61","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 100 Blister Pack In 1 Carton (0904-5789-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-5789-61","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Blister Pack In 1 Carton (0904-5785-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-5785-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Blister Pack In 1 Carton (0904-5784-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-5784-61","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicorelief: 50 BLISTER PACK in 1 CARTON (0904-5736-51)  / 1 GUM, CHEWING in 1 BLISTER PACK","637","RC","0904-5736-51","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Petroleum Skin Protectant: 368 G In 1 Jar (0904-5731-82)","637","RC","0904-5731-82","NDC","","","facility","both","1","EA","","5.3","5.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nasal: 30 mL in 1 BOTTLE, SPRAY (0904-5711-35) ","637","RC","0904-5711-35","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (0904-5677-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-5677-61","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 100 Blister Pack In 1 Box, Unit-Dose (0904-5676-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-5676-61","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Heartburn Relief Original Strength: 1 Bottle In 1 Carton (0904-5529-52)  / 60 Tablet, Film Coated In 1 Bottle","637","RC","0904-5529-52","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Mapap: 1 Bottle, Plastic In 1 Carton (0904-5791-46)  / 30 Tablet, Chewable In 1 Bottle, Plastic","637","RC","0904-5791-46","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 100 Blister Pack In 1 Carton (0904-6008-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6008-61","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 100 Blister Pack In 1 Carton (0904-6007-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6007-61","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin Hydrochloride: 100 Blister Pack In 1 Carton (0904-5959-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-5959-61","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol hydrochloride: 100 BLISTER PACK in 1 CARTON (0904-5929-61)  / 1 TABLET, FILM COATED in 1 BLISTER PACK","637","RC","0904-5929-61","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Digoxin: 100 Blister Pack In 1 Carton (0904-5922-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-5922-61","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Digoxin: 100 Blister Pack In 1 Carton (0904-5921-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-5921-61","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5892-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-5892-61","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pravastatin Sodium: 100 Blister Pack In 1 Box, Unit-Dose (0904-5891-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-5891-61","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 100 Blister Pack In 1 Carton (0904-5855-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-5855-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 100 Blister Pack In 1 Carton (0904-5854-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-5854-61","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 100 Blister Pack In 1 Carton (0904-5853-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-5853-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0904-6828-05","NDC","","","facility","both","1","EA","","3.95","3.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Finasteride: 50 Blister Pack In 1 Carton (0904-6830-06)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6830-06","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 100 Blister Pack In 1 Carton (0904-7367-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7367-61","NDC","","","facility","both","1","EA","","7.55","7.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Carton (0904-7365-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7365-61","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Carton (0904-7364-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7364-61","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Carton (0904-7363-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7363-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meclizine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7375-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7375-61","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Carton (0904-7362-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7362-61","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Blister Pack In 1 Carton (0904-7355-04)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7355-04","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 100 Blister Pack In 1 Carton (0904-7350-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7350-61","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 50 Blister Pack In 1 Carton (0904-7350-06)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7350-06","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Blister Pack In 1 Carton (0904-7346-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-7346-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Blister Pack In 1 Carton (0904-7345-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-7345-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Carton (0904-7361-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7361-61","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sucralfate: 10 Ml In 1 Cup, Unit-Dose (0904-7470-66)","637","RC","0904-7470-66","NDC","","","facility","both","1","EA","","9.15","9.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 50 Blister Pack In 1 Carton (0904-7468-06)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7468-06","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride Sr: 100 Blister Pack In 1 Carton (0904-7465-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","637","RC","0904-7465-61","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atovaquone: 5 Ml In 1 Cup, Unit-Dose (0904-7459-41)","637","RC","0904-7459-41","NDC","","","facility","both","1","EA","","37.17","37.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 100 Blister Pack In 1 Carton (0904-7458-61)  / 1 Tablet, Delayed Release In 1 Blister Pack","637","RC","0904-7458-61","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meclizine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7376-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7376-61","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7449-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7449-61","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7442-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7442-61","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Blister Pack In 1 Carton (0904-7411-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7411-61","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tamsulosin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7383-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-7383-61","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0904-7337-35","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 100 Blister Pack In 1 Carton (0904-7263-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7263-61","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 100 Blister Pack In 1 Carton (0904-7262-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7262-61","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sennosides: 10 Blister Pack In 1 Box, Unit-Dose (0904-7252-61)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7252-61","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sennosides: 100 Tablet, Film Coated In 1 Bottle (0904-7252-60)","637","RC","0904-7252-60","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7243-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7243-61","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 100 Blister Pack In 1 Carton (0904-7227-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7227-61","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folic Acid: 100 Blister Pack In 1 Carton (0904-7224-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7224-61","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (0904-7219-61)  / 1 Capsule, Extended Release In 1 Blister Pack","637","RC","0904-7219-61","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide: 60 Blister Pack In 1 Carton (0904-7244-68)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7244-68","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0904-7276-41","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0904-7325-62","NDC","","","facility","both","1","EA","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7308-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7308-61","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7307-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7307-61","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7306-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7306-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Blister Pack In 1 Carton (0904-7305-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7305-61","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 100 Blister Pack In 1 Carton (0904-7293-61)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-7293-61","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 100 Blister Pack In 1 Carton (0904-7292-61)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-7292-61","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 100 Blister Pack In 1 Carton (0904-7288-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7288-61","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0904-7278-41","NDC","","","facility","both","1","EA","","1.23","1.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 100 Blister Pack In 1 Carton (0904-7496-61)  / 1 Tablet, Coated In 1 Blister Pack","637","RC","0904-7496-61","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Blister Pack In 1 Carton (0904-7501-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7501-61","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 10 Blister Pack In 1 Carton (0904-7914-61)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7914-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 100 Blister Pack In 1 Carton (0904-7511-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7511-61","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cetirizine: 100 Blister Pack In 1 Carton (0904-7510-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7510-61","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin Low Dose Chewable Orange: 300 Blister Pack In 1 Carton (0904-7509-30)  / 1 Tablet, Chewable In 1 Blister Pack","637","RC","0904-7509-30","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride Xl: 100 Blister Pack In 1 Carton (0904-7505-61)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-7505-61","NDC","","","facility","both","1","EA","","2.13","2.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 100 Blister Pack In 1 Carton (0904-7728-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7728-61","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 30 Blister Pack In 1 Carton (0904-7016-04)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7016-04","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Blister Pack In 1 Carton (0904-7008-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7008-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Blister Pack In 1 Carton (0904-7007-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7007-61","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 100 Blister Pack In 1 Carton (0904-7001-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-7001-61","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 100 Blister Pack In 1 Carton (0904-7000-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-7000-61","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 30 Blister Pack In 1 Carton (0904-6991-04)  / 1 Capsule In 1 Blister Pack","637","RC","0904-6991-04","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pseudoephedrine Hcl: 10 Blister Pack In 1 Carton (0904-6990-61)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6990-61","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicyclomine Hydrochloride: 100 Blister Pack In 1 Carton (0904-6987-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-6987-61","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6966-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6966-61","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6956-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6956-61","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 100 Blister Pack In 1 Carton (0904-6991-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-6991-61","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prazosin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7020-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-7020-61","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 100 Blister Pack In 1 Carton (0904-7045-61)  / 1 Capsule, Delayed Release In 1 Blister Pack","637","RC","0904-7045-61","NDC","","","facility","both","1","EA","","1.23","1.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 100 Blister Pack In 1 Carton (0904-7044-61)  / 1 Capsule, Delayed Release In 1 Blister Pack","637","RC","0904-7044-61","NDC","","","facility","both","1","EA","","2.12","2.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 30 Blister Pack In 1 Carton (0904-7043-04)  / 1 Capsule, Delayed Release In 1 Blister Pack","637","RC","0904-7043-04","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amantadine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7042-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-7042-61","NDC","","","facility","both","1","EA","","1.81","1.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 100 Blister Pack In 1 Carton (0904-7041-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7041-61","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 100 Blister Pack In 1 Carton (0904-7016-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7016-61","NDC","","","facility","both","1","EA","","1.23","1.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naltrexone Hydrochloride: 30 Blister Pack In 1 Carton (0904-7036-04)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7036-04","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Major Oral Rinse: 15 Ml In 1 Cup, Unit-Dose (0904-7035-88)","637","RC","0904-7035-88","NDC","","","facility","both","1","EA","","1.6","1.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 100 Blister Pack In 1 Carton (0904-7027-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7027-61","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Major Bacitracin: 144 Packet In 1 Carton (0904-7023-67)  / .9 G In 1 Packet","637","RC","0904-7023-67","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prazosin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7021-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-7021-61","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6955-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6955-61","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorthalidone: 100 Blister Pack In 1 Carton (0904-6900-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6900-61","NDC","","","facility","both","1","EA","","2.44","2.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 30 Blister Pack In 1 Carton (0904-6890-04)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6890-04","NDC","","","facility","both","1","EA","","3.35","3.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 80 Blister Pack In 1 Carton (0904-6870-45)  / 1 Tablet, Delayed Release In 1 Blister Pack","637","RC","0904-6870-45","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6869-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6869-61","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Blister Pack In 1 Carton (0904-6868-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6868-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6860-61)  / 1 Tablet, Delayed Release In 1 Blister Pack","637","RC","0904-6860-61","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 100 Blister Pack In 1 Carton (0904-6852-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6852-61","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loperamide Hydrochloride: 120 Ml In 1 Bottle (0904-6836-20)","637","RC","0904-6836-20","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-6861-61)  / 1 Tablet, Delayed Release In 1 Blister Pack","637","RC","0904-6861-61","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pseudoephedrine Hydrochloride: 5 Blister Pack In 1 Box (0904-6907-06)  / 10 Tablet In 1 Blister Pack","637","RC","0904-6907-06","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6954-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6954-61","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6953-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6953-61","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6952-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6952-61","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6951-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6951-61","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (0904-6950-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-6950-61","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paliperidone: 100 Blister Pack In 1 Carton (0904-6935-61)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-6935-61","NDC","","","facility","both","1","EA","","17.04","17.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polyethylene Glycol 3350: 17 G In 1 Packet (0904-6931-86)","637","RC","0904-6931-86","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 100 Blister Pack In 1 Carton (0904-6927-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6927-61","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 100 Blister Pack In 1 Carton (0904-6926-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-6926-61","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxychloroquine Sulfate: 50 Blister Pack In 1 Carton (0904-7046-06)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7046-06","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin Hydrochloride: 100 Blister Pack In 1 Carton (0904-7162-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7162-61","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 100 Blister Pack In 1 Carton (0904-7156-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7156-61","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benzonatate: 100 Blister Pack In 1 Carton (0904-7153-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-7153-61","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin Monohydrate/ Macrocrystalline: 100 Blister Pack In 1 Carton (0904-7137-61)  / 1 Capsule In 1 Blister Pack","637","RC","0904-7137-61","NDC","","","facility","both","1","EA","","2.93","2.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Emtricitabine And Tenofovir Disoproxil Fumarate: 30 Blister Pack In 1 Carton (0904-7172-07)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7172-07","NDC","","","facility","both","1","EA","","2.33","2.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 100 Blister Pack In 1 Carton (0904-7177-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7177-61","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 100 Blister Pack In 1 Carton (0904-7216-61)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack","637","RC","0904-7216-61","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride Sr: 100 Blister Pack In 1 Carton (0904-7214-61)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-7214-61","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Major Bismuth Subsalicylate: 5 Blister Pack In 1 Box (0904-7205-46)  / 6 Tablet, Chewable In 1 Blister Pack","637","RC","0904-7205-46","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Blister Pack In 1 Carton (0904-7200-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7200-61","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 100 Blister Pack In 1 Carton (0904-7193-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7193-61","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atenolol: 100 Blister Pack In 1 Carton (0904-7187-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7187-61","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docusate Sodium - Stool Softener Laxative: 10 Blister Pack In 1 Carton (0904-7183-61)  / 10 Capsule, Liquid Filled In 1 Blister Pack","637","RC","0904-7183-61","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Blister Pack In 1 Carton (0904-7182-61)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-7182-61","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 80 Blister Pack In 1 Carton (0904-7182-45)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-7182-45","NDC","","","facility","both","1","EA","","3.25","3.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 100 Blister Pack In 1 Carton (0904-7179-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7179-61","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Blister Pack In 1 Carton (0904-7217-61)  / 1 Capsule, Extended Release In 1 Blister Pack","637","RC","0904-7217-61","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine: 50 Blister Pack In 1 Carton (0904-7082-06)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-7082-06","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine: 50 Blister Pack In 1 Carton (0904-7081-06)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-7081-06","NDC","","","facility","both","1","EA","","1.99","1.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7077-61)  / 1 Capsule, Extended Release In 1 Blister Pack","637","RC","0904-7077-61","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 Blister Pack In 1 Carton (0904-7076-61)  / 1 Capsule, Extended Release In 1 Blister Pack","637","RC","0904-7076-61","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nadolol: 30 Blister Pack In 1 Carton (0904-7071-07)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7071-07","NDC","","","facility","both","1","EA","","4.28","4.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nadolol: 30 Blister Pack In 1 Carton (0904-7070-07)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7070-07","NDC","","","facility","both","1","EA","","2.47","2.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 100 Blister Pack In 1 Carton (0904-7057-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7057-61","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losartan Potassium: 100 Blister Pack In 1 Carton (0904-7048-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7048-61","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxychloroquine Sulfate: 100 Blister Pack In 1 Carton (0904-7046-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7046-61","NDC","","","facility","both","1","EA","","1.58","1.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 100 Blister Pack In 1 Carton (0904-7083-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7083-61","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride Xl: 100 Blister Pack In 1 Carton (0904-7084-61)  / 1 Tablet, Extended Release In 1 Blister Pack","637","RC","0904-7084-61","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 100 Blister Pack In 1 Carton (0904-7126-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7126-61","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 100 Blister Pack In 1 Carton (0904-7125-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7125-61","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 100 Blister Pack In 1 Carton (0904-7124-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7124-61","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 100 Blister Pack In 1 Carton (0904-7123-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7123-61","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Blister Pack In 1 Carton (0904-7122-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7122-61","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Acetate: 50 Blister Pack In 1 Carton (0904-7119-06)  / 1 Capsule In 1 Blister Pack","637","RC","0904-7119-06","NDC","","","facility","both","1","EA","","1.69","1.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 100 Blister Pack In 1 Carton (0904-7109-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7109-61","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Blister Pack In 1 Carton (0904-7108-61)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0904-7108-61","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Captopril: 100 Blister Pack In 1 Carton (0904-7106-61)  / 1 Tablet In 1 Blister Pack","637","RC","0904-7106-61","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 454 G In 1 Jar (45802-055-05)","637","RC","45802-055-05","NDC","","","facility","both","1","EA","","36.78","36.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-054-36)  / 80 G In 1 Tube","637","RC","45802-054-36","NDC","","","facility","both","1","EA","","13.54","13.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 1 Tube In 1 Carton (45802-048-35)  / 15 G In 1 Tube","637","RC","45802-048-35","NDC","","","facility","both","1","EA","","12.29","12.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-055-36)  / 80 G In 1 Tube","637","RC","45802-055-36","NDC","","","facility","both","1","EA","","7.46","7.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enulose: 473 Ml In 1 Bottle (45963-438-64)","637","RC","45963-438-64","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen For Children: 12 Blister Pack In 1 Carton (45802-732-30)  / 1 Suppository In 1 Blister Pack","637","RC","45802-732-30","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","45802-732-00","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen Pain Reliever Fever Reducer: 12 Blister Pack In 1 Carton (45802-730-30)  / 1 Suppository In 1 Blister Pack","637","RC","45802-730-30","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Polystyrene Sulfonate: 10 Bottle, Unit-Dose In 1 Carton (46287-006-60)  / 60 Ml In 1 Bottle, Unit-Dose","637","RC","46287-006-60","NDC","","","facility","both","1","EA","","42.57","42.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bicalutamide: 30 Tablet, Film Coated In 1 Bottle (47335-485-83)","637","RC","47335-485-83","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ambrisentan: 30 Tablet, Film Coated In 1 Bottle (47335-237-83)","637","RC","47335-237-83","NDC","","","facility","both","1","EA","","72.37","72.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ambrisentan: 30 Tablet, Film Coated In 1 Bottle (47335-236-83)","637","RC","47335-236-83","NDC","","","facility","both","1","EA","","67.5","67.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sodium Polystyrene Sulfonate: 473 Ml In 1 Bottle (46287-006-01)","637","RC","46287-006-01","NDC","","","facility","both","1","EA","","9.61","9.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tadliq: 150 Ml In 1 Bottle (46287-045-15)","637","RC","46287-045-15","NDC","","","facility","both","1","EA","","108.75","108.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carospir: 118 Ml In 1 Bottle (46287-020-04)","637","RC","46287-020-04","NDC","","","facility","both","1","EA","","10.2","10.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen Pain Reliever Fever Reducer: 1 Suppository In 1 Blister Pack (45802-730-00)","637","RC","45802-730-00","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole Vaginal: 1 Tube In 1 Carton (45802-139-70)  / 70 G In 1 Tube","637","RC","45802-139-70","NDC","","","facility","both","1","EA","","62.03","62.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-065-35)  / 15 G In 1 Tube","637","RC","45802-065-35","NDC","","","facility","both","1","EA","","9.7","9.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-064-36)  / 80 G In 1 Tube","637","RC","45802-064-36","NDC","","","facility","both","1","EA","","10.52","10.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-064-35)  / 15 G In 1 Tube","637","RC","45802-064-35","NDC","","","facility","both","1","EA","","2.68","2.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Acetaminophen: 1 Bottle In 1 Carton (45802-201-26)  / 118 Ml In 1 Bottle","637","RC","45802-201-26","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-063-35)  / 15 G In 1 Tube","637","RC","45802-063-35","NDC","","","facility","both","1","EA","","5.97","5.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 1 Tube In 1 Carton (45802-059-35)  / 15 G In 1 Tube","637","RC","45802-059-35","NDC","","","facility","both","1","EA","","20.63","20.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gentamicin Sulfate: 1 Tube In 1 Carton (45802-056-35)  / 15 G In 1 Tube","637","RC","45802-056-35","NDC","","","facility","both","1","EA","","52.19","52.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-063-36)  / 80 G In 1 Tube","637","RC","45802-063-36","NDC","","","facility","both","1","EA","","13.54","13.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitroglycerin Lingual: 1 Bottle In 1 Carton (45802-210-01)  / 60 Spray In 1 Bottle","637","RC","45802-210-01","NDC","","","facility","both","1","EA","","286.19","286.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cetirizine Hydrochloride: 1 Bottle In 1 Carton (45802-626-26)  / 120 Ml In 1 Bottle","637","RC","45802-626-26","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketoconazole: 120 Ml In 1 Bottle (45802-465-64)","637","RC","45802-465-64","NDC","","","facility","both","1","EA","","28.73","28.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 1 Tube In 1 Carton (45802-438-03)  / 28 G In 1 Tube","637","RC","45802-438-03","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextromethorphan Polistirex Extended Release: 1 Bottle In 1 Carton (45802-433-21)  / 89 Ml In 1 Bottle","637","RC","45802-433-21","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Betamethasone Dipropionate: 1 Tube In 1 Carton (45802-376-35)  / 15 G In 1 Tube","637","RC","45802-376-35","NDC","","","facility","both","1","EA","","5","5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine Polacrilex: 3 Container In 1 Carton (45802-344-05)  / 24 Lozenge In 1 Container","637","RC","45802-344-05","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","45802-344-03","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 1 Tube In 1 Carton (45802-276-03)  / 28 G In 1 Tube","637","RC","45802-276-03","NDC","","","facility","both","1","EA","","2.78","2.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (45802-055-35)  / 15 G In 1 Tube","637","RC","45802-055-35","NDC","","","facility","both","1","EA","","5.43","5.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 100 Tablet In 1 Bottle (43547-898-10)","637","RC","43547-898-10","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 100 Tablet In 1 Bottle (43547-896-10)","637","RC","43547-896-10","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 100 Tablet In 1 Bottle (43547-689-10)","637","RC","43547-689-10","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 100 Tablet In 1 Bottle (43547-688-10)","637","RC","43547-688-10","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 100 Tablet In 1 Bottle (43547-548-10)","637","RC","43547-548-10","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin And Dexamethasone: 1 Bottle, Dropper In 1 Carton (43598-326-75)  / 7.5 Ml In 1 Bottle, Dropper","637","RC","43598-326-75","NDC","","","facility","both","1","EA","","22.47","22.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ssd Cream: 50 G In 1 Jar (43598-210-55)","637","RC","43598-210-55","NDC","","","facility","both","1","EA","","12.12","12.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","43598-160-31","NDC","","","facility","both","1","EA","","15.47","15.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ssd Cream: 25 G In 1 Tube (43598-210-25)","637","RC","43598-210-25","NDC","","","facility","both","1","EA","","10.69","10.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 100 Tablet In 1 Bottle (43547-546-10)","637","RC","43547-546-10","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"My Way: 1 TABLET in 1 CARTON (43386-620-30) ","637","RC","43386-620-30","NDC","","","facility","both","1","EA","","48.08","48.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gavilax: 510 G In 1 Bottle (43386-312-14)","637","RC","43386-312-14","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Misoprostol: 100 Tablet In 1 Bottle (43386-161-01)","637","RC","43386-161-01","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Misoprostol: 120 Tablet In 1 Bottle (43386-160-12)","637","RC","43386-160-12","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Misoprostol: 60 Tablet In 1 Bottle (43386-160-06)","637","RC","43386-160-06","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gavilyte-N: 438.4 G In 1 Bottle (43386-050-19)","637","RC","43386-050-19","NDC","","","facility","both","1","EA","","21.12","21.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fintepla: 1 Bottle, Plastic In 1 Carton (43376-322-30)  / 30 Ml In 1 Bottle, Plastic","637","RC","43376-322-30","NDC","","","facility","both","1","EA","","173.9","173.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (43547-269-10)","637","RC","43547-269-10","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 100 Tablet In 1 Bottle (43547-545-10)","637","RC","43547-545-10","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irbesartan: 90 Tablet In 1 Bottle (43547-376-09)","637","RC","43547-376-09","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Tablet In 1 Bottle (43547-352-10)","637","RC","43547-352-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Tablet In 1 Bottle (43547-351-10)","637","RC","43547-351-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Escitalopram: 100 Tablet, Film Coated In 1 Bottle (43547-282-10)","637","RC","43547-282-10","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (43975-350-03)","637","RC","43975-350-03","NDC","","","facility","both","1","EA","","3.6","3.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tolterodine Tartrate: 30 Capsule, Extended Release In 1 Bottle (43975-322-03)","637","RC","43975-322-03","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","43598-891-16","NDC","","","facility","both","1","EA","","10.45","10.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paliperidone: 30 Tablet, Extended Release In 1 Bottle (43975-351-03)","637","RC","43975-351-03","NDC","","","facility","both","1","EA","","2.83","2.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxepin Hydrochloride: 30 Tablet In 1 Bottle (44183-103-30)","637","RC","44183-103-30","NDC","","","facility","both","1","EA","","19.32","19.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","43598-448-71","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine Transdermal System Step 1: 28 Patch In 1 Carton (43598-448-28)  / 24 H In 1 Patch","637","RC","43598-448-28","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine Transdermal System Step 2: 14 Patch In 1 Carton (43598-447-74)  / 24 H In 1 Patch","637","RC","43598-447-74","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","43598-447-71","NDC","","","facility","both","1","EA","","2.51","2.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine Transdermal System Step 3: 14 Patch In 1 Carton (43598-446-74)  / 24 H In 1 Patch","637","RC","43598-446-74","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","43598-446-71","NDC","","","facility","both","1","EA","","2.54","2.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nicotine Polacrilex: 1 Bottle In 1 Carton (43598-486-24)  / 24 Lozenge In 1 Bottle","637","RC","43598-486-24","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","43598-697-11","NDC","","","facility","both","1","EA","","131.51","131.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","43598-582-01","NDC","","","facility","both","1","EA","","8.41","8.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","43598-580-01","NDC","","","facility","both","1","EA","","8.41","8.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tadalafil: 60 Tablet, Film Coated In 1 Bottle (43598-578-60)","637","RC","43598-578-60","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ranolazine: 60 Tablet, Film Coated, Extended Release In 1 Package (50228-423-60)","637","RC","50228-423-60","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 100 Tablet In 1 Bottle (50228-226-01)","637","RC","50228-226-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-195-60)","637","RC","50228-195-60","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (50228-192-60)","637","RC","50228-192-60","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (50228-184-01)","637","RC","50228-184-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","49884-465-64","NDC","","","facility","both","1","EA","","3.41","3.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","49884-308-52","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Varenicline: 56 Tablet, Film Coated In 1 Bottle (49884-156-76)","637","RC","49884-156-76","NDC","","","facility","both","1","EA","","1.27","1.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Capsule In 1 Bottle, Plastic (50228-181-01)","637","RC","50228-181-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 1000 Capsule In 1 Bottle, Plastic (50228-179-10)","637","RC","50228-179-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine: 100 Capsule In 1 Bottle (50228-113-01)","637","RC","50228-113-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Torsemide: 100 Tablet In 1 Bottle (50111-916-01)","637","RC","50111-916-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Tablet, Film Coated In 1 Bottle (50111-787-10)","637","RC","50111-787-10","NDC","","","facility","both","1","EA","","3.53","3.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Tablet In 1 Bottle (50111-560-01)","637","RC","50111-560-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Econtra One-Step: 3 Carton In 1 Package (50102-211-13)  / 1 Blister Pack In 1 Carton (50102-211-11)  / 1 Tablet In 1 Blister Pack (50102-211-01)","637","RC","50102-211-13","NDC","","","facility","both","1","EA","","10.79","10.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-088-11","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-087-11","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-062-11","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-057-11","NDC","","","facility","both","1","EA","","2.99","2.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-054-11","NDC","","","facility","both","1","EA","","3.55","3.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-037-11","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Varenicline: 56 Tablet, Film Coated In 1 Bottle (49884-155-76)","637","RC","49884-155-76","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","48433-219-05","NDC","","","facility","both","1","EA","","3.64","3.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mineral Oil: 30 Ml In 1 Cup, Unit-Dose (48433-202-30)","637","RC","48433-202-30","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Antacid: 100 Tablet, Chewable In 1 Box, Unit-Dose (48433-106-01)","637","RC","48433-106-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 90 Tablet In 1 Bottle (47781-659-90)","637","RC","47781-659-90","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 90 Tablet In 1 Bottle (47781-643-90)","637","RC","47781-643-90","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (47781-565-01)","637","RC","47781-565-01","NDC","","","facility","both","1","EA","","12.27","12.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (47781-564-01)","637","RC","47781-564-01","NDC","","","facility","both","1","EA","","11.71","11.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (47781-562-01)","637","RC","47781-562-01","NDC","","","facility","both","1","EA","","11.84","11.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, Amphetamine Sulfate Tablets,Cii: 100 Tablet In 1 Bottle (47781-176-01)","637","RC","47781-176-01","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyridostigmine Bromide: 30 Tablet, Extended Release In 1 Bottle (47781-335-30)","637","RC","47781-335-30","NDC","","","facility","both","1","EA","","9.57","9.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fentanyl System: 5 Pouch In 1 Carton (47781-428-47)  / 1 Patch In 1 Pouch (47781-428-11)","637","RC","47781-428-47","NDC","","","facility","both","1","EA","","27.76","27.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","47781-428-11","NDC","","","facility","both","1","EA","","28.01","28.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","47781-427-11","NDC","","","facility","both","1","EA","","26.05","26.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","47781-426-11","NDC","","","facility","both","1","EA","","11.71","11.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","47781-424-11","NDC","","","facility","both","1","EA","","8.67","8.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","47781-423-11","NDC","","","facility","both","1","EA","","9.45","9.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","47781-358-11","NDC","","","facility","both","1","EA","","8.17","8.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","47781-357-11","NDC","","","facility","both","1","EA","","3.75","3.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","47781-356-11","NDC","","","facility","both","1","EA","","5.29","5.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (49884-049-01)","637","RC","49884-049-01","NDC","","","facility","both","1","EA","","1.76","1.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 16 Ml In 1 Bottle (49884-042-33)","637","RC","49884-042-33","NDC","","","facility","both","1","EA","","10.07","10.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle (49884-009-01)","637","RC","49884-009-01","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triumeq: 30 Tablet, Film Coated In 1 Bottle (49702-231-13)","637","RC","49702-231-13","NDC","","","facility","both","1","EA","","214.87","214.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tivicay: 30 Tablet, Film Coated In 1 Bottle (49702-228-13)","637","RC","49702-228-13","NDC","","","facility","both","1","EA","","128.48","128.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Miconazole Nitrate Antifungal: 1 Tube In 1 Carton (49348-689-72)  / 30 G In 1 Tube","637","RC","49348-689-72","NDC","","","facility","both","1","EA","","3.51","3.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Nicotine: 50 Blister Pack In 1 Carton (49348-573-08)  / 1 Gum, Chewing In 1 Blister Pack","637","RC","49348-573-08","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Childrens Pain And Fever: 1 Bottle In 1 Carton (49348-119-34)  / 118 Ml In 1 Bottle","637","RC","49348-119-34","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sunmark Acid Reducer: 1 Bottle In 1 Carton (49348-128-13)  / 90 Tablet, Film Coated In 1 Bottle","637","RC","49348-128-13","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miconazole 7: 7 Suppository In 1 Applicator (49348-833-61)","637","RC","49348-833-61","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen Extra Strength: 500 Tablet, Film Coated In 1 Bottle, Plastic (49483-341-50)","637","RC","49483-341-50","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Senna Time: 1000 Tablet, Coated In 1 Bottle, Plastic (49483-080-10)","637","RC","49483-080-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levodopa: 25 G In 1 Bottle (49452-2680-2)","637","RC","49452-2680-2","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aminocaproic Acid: 236.5 Ml In 1 Bottle, Plastic (31722-035-23)","637","RC","31722-035-23","NDC","","","facility","both","1","EA","","12.99","12.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 1 Bottle In 1 Carton (31722-016-47)  / 473 Ml In 1 Bottle","637","RC","31722-016-47","NDC","","","facility","both","1","EA","","6.12","6.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Droxidopa: 90 Capsule In 1 Bottle (31722-015-90)","637","RC","31722-015-90","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Droxidopa: 90 Capsule In 1 Bottle (31722-010-90)","637","RC","31722-010-90","NDC","","","facility","both","1","EA","","3.3","3.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 60 Tablet In 1 Bottle, Plastic (29300-477-16)","637","RC","29300-477-16","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (29300-421-01)","637","RC","29300-421-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (29300-419-01)","637","RC","29300-419-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amiodarone Hydrochloride: 60 Tablet In 1 Bottle (29300-359-16)","637","RC","29300-359-16","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle, Plastic (29300-140-01)","637","RC","29300-140-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (31722-053-60)","637","RC","31722-053-60","NDC","","","facility","both","1","EA","","13.36","13.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (31722-230-01)","637","RC","31722-230-01","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (31722-229-01)","637","RC","31722-229-01","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-195-01)","637","RC","31722-195-01","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-188-01)","637","RC","31722-188-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-187-01)","637","RC","31722-187-01","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (31722-186-01)","637","RC","31722-186-01","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Citrate: 100 Tablet, Extended Release In 1 Bottle (31722-130-01)","637","RC","31722-130-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (31722-104-30)","637","RC","31722-104-30","NDC","","","facility","both","1","EA","","1.86","1.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 50 Ml In 1 Bottle (31722-063-31)","637","RC","31722-063-31","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (31722-054-60)","637","RC","31722-054-60","NDC","","","facility","both","1","EA","","8.43","8.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Pouch In 1 Carton (27241-139-09)  / 1 Bottle In 1 Pouch / 60 Ml In 1 Bottle","637","RC","27241-139-09","NDC","","","facility","both","1","EA","","4.8","4.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 30 Capsule, Delayed Release In 1 Bottle (27241-099-03)","637","RC","27241-099-03","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 90 Capsule, Delayed Release In 1 Bottle (27241-098-09)","637","RC","27241-098-09","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 30 Capsule, Delayed Release In 1 Bottle (27241-098-03)","637","RC","27241-098-03","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Voriconazole: 30 Tablet, Film Coated In 1 Bottle (27241-063-03)","637","RC","27241-063-03","NDC","","","facility","both","1","EA","","12.45","12.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entacapone: 100 Tablet In 1 Bottle (27241-049-10)","637","RC","27241-049-10","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 60 Capsule, Delayed Release In 1 Bottle (27241-097-06)","637","RC","27241-097-06","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 30 Ml In 1 Bottle, Unit-Dose (27808-002-01)","637","RC","27808-002-01","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Theophylline: 473 Ml In 1 Bottle (27808-033-01)","637","RC","27808-033-01","NDC","","","facility","both","1","EA","","4.31","4.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zaleplon: 100 Capsule In 1 Bottle, Plastic (29300-132-01)","637","RC","29300-132-01","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrochlorothiazide: 100 Capsule In 1 Bottle, Plastic (29300-130-01)","637","RC","29300-130-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisoprolol Fumarate: 30 Tablet In 1 Bottle, Plastic (29300-127-13)","637","RC","29300-127-13","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisoprolol Fumarate: 100 Tablet In 1 Bottle, Plastic (29300-126-01)","637","RC","29300-126-01","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 100 Capsule, Extended Release In 1 Bottle (29033-030-01)","637","RC","29033-030-01","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 120 Capsule, Extended Release In 1 Bottle (29033-020-12)","637","RC","29033-020-12","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 120 Capsule, Extended Release In 1 Bottle (29033-004-12)","637","RC","29033-004-12","NDC","","","facility","both","1","EA","","2.72","2.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline: 500 Capsule In 1 Bottle (27808-233-02)","637","RC","27808-233-02","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Febuxostat: 30 Tablet In 1 Bottle (27808-207-01)","637","RC","27808-207-01","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (29300-136-01)","637","RC","29300-136-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (23155-832-01)","637","RC","23155-832-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (23155-767-01)","637","RC","23155-767-01","NDC","","","facility","both","1","EA","","2.83","2.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitriol: 100 Capsule In 1 Bottle (23155-663-01)","637","RC","23155-663-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Tablet In 1 Bottle (23155-833-01)","637","RC","23155-833-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Muro 128: 1 Tube In 1 Carton (24208-385-55)  / 3.5 G In 1 Tube","637","RC","24208-385-55","NDC","","","facility","both","1","EA","","30.12","30.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 1 Bottle, Pump In 1 Carton (24208-342-05)  / 5 Ml In 1 Bottle, Pump","637","RC","24208-342-05","NDC","","","facility","both","1","EA","","237.59","237.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultramicrosize Griseofulvin: 100 Tablet In 1 Bottle, Plastic (23155-864-01)","637","RC","23155-864-01","NDC","","","facility","both","1","EA","","6.55","6.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultramicrosize Griseofulvin: 100 Tablet In 1 Bottle, Plastic (23155-863-01)","637","RC","23155-863-01","NDC","","","facility","both","1","EA","","5.3","5.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 50 Capsule In 1 Bottle (23155-858-25)","637","RC","23155-858-25","NDC","","","facility","both","1","EA","","4.29","4.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 100 Tablet In 1 Bottle (23155-606-01)","637","RC","23155-606-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 100 Tablet In 1 Bottle (23155-489-01)","637","RC","23155-489-01","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet In 1 Bottle (23155-486-01)","637","RC","23155-486-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 100 Tablet In 1 Bottle (23155-490-01)","637","RC","23155-490-01","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Acetate: 200 Capsule In 1 Bottle (23155-531-02)","637","RC","23155-531-02","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 100 Tablet In 1 Bottle (23155-500-01)","637","RC","23155-500-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexamethasone Sodium Phosphate: 1 Bottle, Dropper In 1 Carton (24208-720-02)  / 5 Ml In 1 Bottle, Dropper","637","RC","24208-720-02","NDC","","","facility","both","1","EA","","71.55","71.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine: 300 Tablet, Extended Release In 1 Bottle (24979-009-12)","637","RC","24979-009-12","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","42292-041-01","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","42292-039-01","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","42292-038-01","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 100 Capsule In 1 Bottle (42291-923-01)","637","RC","42291-923-01","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valsartan: 30 Tablet In 1 Bottle (42291-856-30)","637","RC","42291-856-30","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sucralfate: 420 Ml In 1 Bottle (42291-781-42)","637","RC","42291-781-42","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Riluzole: 60 Tablet, Film Coated In 1 Bottle (42291-775-60)","637","RC","42291-775-60","NDC","","","facility","both","1","EA","","16.26","16.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin Hydrochloride: 90 Tablet, Extended Release In 1 Bottle (42291-497-90)","637","RC","42291-497-90","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eplerenone: 90 Tablet, Coated In 1 Bottle (42291-454-90)","637","RC","42291-454-90","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 30 Tablet, Film Coated In 1 Bottle (42291-082-30)","637","RC","42291-082-30","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 100 Tablet In 1 Bottle (42571-315-01)","637","RC","42571-315-01","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dorzolamide Hydrochloride And Timolol Maleate Ophthalmic Solution: 1 Bottle In 1 Carton (42571-147-26)  / 10 Ml In 1 Bottle","637","RC","42571-147-26","NDC","","","facility","both","1","EA","","83","83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Np Thyroid 15: 100 Tablet In 1 Bottle (42192-327-01)","637","RC","42192-327-01","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (42291-076-30)  / 30 G In 1 Tube","637","RC","42291-076-30","NDC","","","facility","both","1","EA","","4.3","4.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (42291-068-30)","637","RC","42291-068-30","NDC","","","facility","both","1","EA","","2.3","2.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (42291-067-30)","637","RC","42291-067-30","NDC","","","facility","both","1","EA","","2.25","2.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (42291-066-30)","637","RC","42291-066-30","NDC","","","facility","both","1","EA","","2.28","2.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atomoxetine: 30 Capsule In 1 Bottle (42291-064-30)","637","RC","42291-064-30","NDC","","","facility","both","1","EA","","2.45","2.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 470 Ml In 1 Bottle (42192-608-16)","637","RC","42192-608-16","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 6 Ml In 1 Cup, Unit-Dose (42192-608-06)","637","RC","42192-608-06","NDC","","","facility","both","1","EA","","6.21","6.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hyoscyamine Sulfate Sl: 100 Tablet In 1 Bottle (42192-339-01)","637","RC","42192-339-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Np Thyroid 60: 100 Tablet In 1 Bottle (42192-330-01)","637","RC","42192-330-01","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 100 Tablet In 1 Bottle (42571-316-01)","637","RC","42571-316-01","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-302-01)","637","RC","42858-302-01","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-301-25)  / 25 Tablet In 1 Blister Pack","637","RC","42858-301-25","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle, Plastic (42858-301-01)","637","RC","42858-301-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dilaudid: 500 Tablet In 1 Bottle, Plastic (42858-234-50)","637","RC","42858-234-50","NDC","","","facility","both","1","EA","","6.55","6.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 4 Blister Pack In 1 Carton (42858-302-25)  / 25 Tablet In 1 Blister Pack","637","RC","42858-302-25","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle, Plastic (42858-161-01)","637","RC","42858-161-01","NDC","","","facility","both","1","EA","","15.33","15.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dilaudid: 100 Tablet In 1 Bottle, Plastic (42858-122-01)","637","RC","42858-122-01","NDC","","","facility","both","1","EA","","4.22","4.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-002-10)  / 10 Tablet In 1 Blister Pack","637","RC","42858-002-10","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 10 Blister Pack In 1 Carton (42858-001-10)  / 10 Tablet In 1 Blister Pack","637","RC","42858-001-10","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benzonatate: 100 Capsule In 1 Bottle (42806-714-01)","637","RC","42806-714-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, And Amphetamine Sulfate: 100 Tablet In 1 Bottle (42858-723-01)","637","RC","42858-723-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 30 Tablet, Film Coated, Extended Release In 1 Bottle (42858-703-03)","637","RC","42858-703-03","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ms Contin: 100 Tablet In 1 Bottle, Plastic (42858-631-01)","637","RC","42858-631-01","NDC","","","facility","both","1","EA","","14.98","14.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ms Contin: 100 Tablet In 1 Bottle, Plastic (42858-515-01)","637","RC","42858-515-01","NDC","","","facility","both","1","EA","","7.78","7.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entecavir: 30 Tablet In 1 Bottle, Plastic (42806-659-30)","637","RC","42806-659-30","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irbesartan: 90 Tablet, Film Coated In 1 Bottle (42658-122-04)","637","RC","42658-122-04","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 120 Tablet In 1 Bottle (42571-392-12)","637","RC","42571-392-12","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 100 Tablet In 1 Bottle (42806-358-01)","637","RC","42806-358-01","NDC","","","facility","both","1","EA","","1.98","1.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle, Plastic (42806-341-01)","637","RC","42806-341-01","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle, Plastic (42806-339-01)","637","RC","42806-339-01","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","42806-266-98","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isradipine: 100 Capsule In 1 Bottle (42806-263-01)","637","RC","42806-263-01","NDC","","","facility","both","1","EA","","16.26","16.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Estradiol: 100 Tablet In 1 Bottle (42806-088-01)","637","RC","42806-088-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Capsule In 1 Bottle (33342-157-11)","637","RC","33342-157-11","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tolterodine Tartrate: 60 Tablet, Film Coated In 1 Bottle (33342-097-09)","637","RC","33342-097-09","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rivastigmine Tartrate: 60 Capsule In 1 Bottle (33342-090-09)","637","RC","33342-090-09","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (31722-955-01)","637","RC","31722-955-01","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pioglitazone: 90 Tablet In 1 Bottle (33342-055-10)","637","RC","33342-055-10","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (31722-829-30)","637","RC","31722-829-30","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketoconazole: 100 Tablet In 1 Bottle (35573-433-02)","637","RC","35573-433-02","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","35573-428-51","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sacubitril And Valsartan: 180 Tablet In 1 Bottle (33342-570-57)","637","RC","33342-570-57","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-256-66)  / 10 Capsule In 1 Blister Pack","637","RC","33342-256-66","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 1 Tube In 1 Carton (33342-333-15)  / 15 G In 1 Tube","637","RC","33342-333-15","NDC","","","facility","both","1","EA","","4.08","4.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (33342-258-66)  / 10 Capsule In 1 Blister Pack","637","RC","33342-258-66","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 1 Tube In 1 Carton (33342-405-35)  / 35.44 G In 1 Tube","637","RC","33342-405-35","NDC","","","facility","both","1","EA","","16.59","16.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetrabenazine: 112 Tablet, Coated In 1 Bottle (31722-821-11)","637","RC","31722-821-11","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atovaquone: 1 Bottle In 1 Carton (31722-629-21)  / 210 Ml In 1 Bottle","637","RC","31722-629-21","NDC","","","facility","both","1","EA","","2.39","2.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Roflumilast: 30 Tablet In 1 Bottle (31722-623-30)","637","RC","31722-623-30","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 473 Ml In 1 Bottle (31722-574-47)","637","RC","31722-574-47","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 10 Capsule In 1 Carton (31722-632-31)","637","RC","31722-632-31","NDC","","","facility","both","1","EA","","4.32","4.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levocetirizine Dihydrochloride: 90 Tablet In 1 Bottle (31722-551-90)","637","RC","31722-551-90","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indomethacin: 12 Bottle In 1 Case (31722-542-01)  / 100 Capsule In 1 Bottle","637","RC","31722-542-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Torsemide: 100 Tablet In 1 Bottle (31722-532-01)","637","RC","31722-532-01","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Torsemide: 100 Tablet In 1 Bottle (31722-530-01)","637","RC","31722-530-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 100 Tablet In 1 Bottle (31722-778-01)","637","RC","31722-778-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 20 Tablet, Film Coated In 1 Bottle (31722-749-20)","637","RC","31722-749-20","NDC","","","facility","both","1","EA","","4.17","4.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irbesartan: 90 Tablet In 1 Bottle (31722-731-90)","637","RC","31722-731-90","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irbesartan: 90 Tablet In 1 Bottle (31722-729-90)","637","RC","31722-729-90","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Irbesartan: 30 Tablet In 1 Bottle (31722-729-30)","637","RC","31722-729-30","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Montelukast Sodium: 30 Tablet, Chewable In 1 Bottle (31722-728-30)","637","RC","31722-728-30","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Montelukast Sodium: 30 Tablet, Chewable In 1 Bottle (31722-727-30)","637","RC","31722-727-30","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir: 30 Tablet, Film Coated In 1 Bottle (31722-705-30)","637","RC","31722-705-30","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyproheptadine Hydrochloride: 473 Ml In 1 Bottle, Glass (39328-544-16)","637","RC","39328-544-16","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","39328-062-50","NDC","","","facility","both","1","EA","","23.84","23.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metamucil Therapy For Regularity: 5.8 G In 1 Packet (37000-024-10)","637","RC","37000-024-10","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metamucil Therapy For Regularity: 30 Packet In 1 Carton (37000-024-04)  / 5.8 G In 1 Packet","637","RC","37000-024-04","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Tablet, Coated In 1 Bottle (0143-9285-01)","637","RC","0143-9285-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate: 50 Capsule In 1 Bottle, Plastic (0143-9803-50)","637","RC","0143-9803-50","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Ml In 1 Bottle (0143-9889-01)","637","RC","0143-9889-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Ml In 1 Bottle (0143-9887-01)","637","RC","0143-9887-01","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-1775-05","NDC","","","facility","both","1","EA","","4.49","4.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mag-Al Plus: 10 Tray In 1 Case (0121-1761-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose","637","RC","0121-1761-30","NDC","","","facility","both","1","EA","","2.34","2.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-1744-05","NDC","","","facility","both","1","EA","","2.65","2.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 10 Tray In 1 Case (0121-1576-10)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose","637","RC","0121-1576-10","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guaifenesin: 10 Tray In 1 Case (0121-1488-00)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose (0121-1488-10)","637","RC","0121-1488-00","NDC","","","facility","both","1","EA","","2.67","2.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"POTASSIUM CHLORIDE: 10 TRAY in 1 CASE (0121-1465-15)  / 10 CUP, UNIT-DOSE in 1 TRAY / 15 mL in 1 CUP, UNIT-DOSE","637","RC","0121-1465-15","NDC","","","facility","both","1","EA","","13.37","13.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-1350-10","NDC","","","facility","both","1","EA","","3.89","3.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactulose: 4 Tray In 1 Case (0121-1154-40)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose (0121-1154-30)","637","RC","0121-1154-40","NDC","","","facility","both","1","EA","","2.9","2.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-1154-30","NDC","","","facility","both","1","EA","","2.2","2.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-1488-10","NDC","","","facility","both","1","EA","","2.67","2.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 473 Ml In 1 Bottle (0121-1045-16)","637","RC","0121-1045-16","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Childrens Acetaminophen: 10 Tray In 1 Case (0121-1781-00)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-1781-05)","637","RC","0121-1781-00","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-1781-05","NDC","","","facility","both","1","EA","","1.93","1.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-4721-05","NDC","","","facility","both","1","EA","","6.51","6.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-4675-05","NDC","","","facility","both","1","EA","","2.25","2.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-4577-15","NDC","","","facility","both","1","EA","","2.52","2.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-2823-21","NDC","","","facility","both","1","EA","","2.74","2.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-2232-15","NDC","","","facility","both","1","EA","","2.02","2.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dye Free Childrens Ibuprofen: 10 Cup, Unit-Dose In 1 Tray (0121-2044-10)  / 10 Ml In 1 Cup, Unit-Dose","637","RC","0121-2044-10","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-1896-30","NDC","","","facility","both","1","EA","","11.82","11.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-1870-10","NDC","","","facility","both","1","EA","","1.95","1.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-1828-10","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 473 Ml In 1 Bottle (0121-1034-16)","637","RC","0121-1034-16","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactulose: 473 Ml In 1 Bottle (0121-0873-16)","637","RC","0121-0873-16","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 473 Ml In 1 Bottle (0121-0868-16)","637","RC","0121-0868-16","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-0868-05","NDC","","","facility","both","1","EA","","2.21","2.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 10 Cup, Unit-Dose In 1 Tray (0121-0853-20)  / 20 Ml In 1 Cup, Unit-Dose","637","RC","0121-0853-20","NDC","","","facility","both","1","EA","","26.56","26.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 1 Bottle, Dropper In 1 Carton (0121-0770-01)  / 30 Ml In 1 Bottle, Dropper","637","RC","0121-0770-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Carbonate: 12 Bottle In 1 Case (0121-0766-16)  / 473 Ml In 1 Bottle","637","RC","0121-0766-16","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 473 Ml In 1 Bottle (0121-0678-16)","637","RC","0121-0678-16","NDC","","","facility","both","1","EA","","14.84","14.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 4 Tray In 1 Case (0121-0908-40)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-0908-05)","637","RC","0121-0908-40","NDC","","","facility","both","1","EA","","3.15","3.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-1016-05","NDC","","","facility","both","1","EA","","40.95","40.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-0978-10","NDC","","","facility","both","1","EA","","6.13","6.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-0974-10","NDC","","","facility","both","1","EA","","11.38","11.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-0970-01","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 473 Ml In 1 Bottle (0121-0948-16)","637","RC","0121-0948-16","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital Oral Solution: 473 Ml In 1 Bottle, Plastic (0121-0942-16)","637","RC","0121-0942-16","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-0914-05","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Carbonate: 4 Tray In 1 Case (0121-4766-05)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose","637","RC","0121-4766-05","NDC","","","facility","both","1","EA","","2.56","2.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle, Plastic (0143-1769-01)","637","RC","0143-1769-01","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pedia-Lax: 66 Ml In 1 Bottle, With Applicator (0132-0202-20)","637","RC","0132-0202-20","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fleet: 133 Ml In 1 Bottle, With Applicator (0132-0201-40)","637","RC","0132-0201-40","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fleet: 12 SUPPOSITORY in 1 JAR (0132-0079-12) ","637","RC","0132-0079-12","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-4950-15","NDC","","","facility","both","1","EA","","7.78","7.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-4827-05","NDC","","","facility","both","1","EA","","7.71","7.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-4799-05","NDC","","","facility","both","1","EA","","4.01","4.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 50 Tablet, Film Coated In 1 Bottle (0143-9929-50)","637","RC","0143-9929-50","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lokelma: 11 Packet In 1 Box (0310-1110-39)  / 10 G In 1 Packet (0310-1110-01)","637","RC","0310-1110-39","NDC","","","facility","both","1","EA","","15.73","15.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0310-1110-01","NDC","","","facility","both","1","EA","","14.87","14.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0310-1105-01","NDC","","","facility","both","1","EA","","14.62","14.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Koselugo: 60 Capsule In 1 Bottle (0310-0610-60)","637","RC","0310-0610-60","NDC","","","facility","both","1","EA","","173.98","173.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitro-Bid: 60 G In 1 Tube (0281-0326-60)","637","RC","0281-0326-60","NDC","","","facility","both","1","EA","","113.08","113.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitro-Bid: 30 G In 1 Tube (0281-0326-30)","637","RC","0281-0326-30","NDC","","","facility","both","1","EA","","56.54","56.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitro-Bid: 48 Packet In 1 Box (0281-0326-08)  / 1 G In 1 Packet","637","RC","0281-0326-08","NDC","","","facility","both","1","EA","","3.66","3.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clorpactin Wcs-90: 5 Vial In 1 Box (0327-0001-10)  / 2 G In 1 Vial","637","RC","0327-0001-10","NDC","","","facility","both","1","EA","","10.26","10.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valproic Acid: 473 Ml In 1 Bottle (0121-0675-85)","637","RC","0121-0675-85","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mepron: 42 Pouch In 1 Dose Pack (0173-0547-00)  / 5 Ml In 1 Pouch","637","RC","0173-0547-00","NDC","","","facility","both","1","EA","","54.48","54.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 100 Tablet, Film Coated In 1 Bottle (0172-5729-60)","637","RC","0172-5729-60","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 100 Tablet In 1 Bottle (0172-3925-60)","637","RC","0172-3925-60","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrochlorothiazide: 100 Tablet In 1 Bottle (0172-2089-60)","637","RC","0172-2089-60","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrochlorothiazide: 100 Tablet In 1 Bottle (0172-2083-60)","637","RC","0172-2083-60","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Efudex: 1 Tube In 1 Carton (0187-3204-47)  / 40 G In 1 Tube","637","RC","0187-3204-47","NDC","","","facility","both","1","EA","","99.58","99.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mestinon: 30 Tablet, Extended Release In 1 Bottle (0187-3013-30)","637","RC","0187-3013-30","NDC","","","facility","both","1","EA","","68.07","68.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pulmicort Flexhaler: 1 Inhaler In 1 Carton (0186-0916-12)  / 120 Aerosol, Powder In 1 Inhaler","637","RC","0186-0916-12","NDC","","","facility","both","1","EA","","440.37","440.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brilinta: 60 Tablet In 1 Bottle (0186-0776-60)","637","RC","0186-0776-60","NDC","","","facility","both","1","EA","","9.09","9.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brilinta: 10 Blister Pack In 1 Box, Unit-Dose (0186-0777-39)  / 10 Tablet In 1 Blister Pack","637","RC","0186-0777-39","NDC","","","facility","both","1","EA","","12.2","12.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolog: 1 Vial, Glass In 1 Carton (0169-7501-11)  / 10 Ml In 1 Vial, Glass","637","RC","0169-7501-11","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clindamycin Phosphate: 1 Bottle In 1 Carton (0168-0201-60)  / 60 Ml In 1 Bottle","637","RC","0168-0201-60","NDC","","","facility","both","1","EA","","55.62","55.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 80 G In 1 Tube (0168-0005-80)","637","RC","0168-0005-80","NDC","","","facility","both","1","EA","","10.37","10.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolin R: 1 Vial In 1 Carton (0169-1833-11)  / 10 Ml In 1 Vial","637","RC","0169-1833-11","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolog: 5 Syringe, Plastic In 1 Carton (0169-6339-10)  / 3 Ml In 1 Syringe, Plastic","637","RC","0169-6339-10","NDC","","","facility","both","1","EA","","26.98","26.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Novolin 70/30: 1 Vial In 1 Carton (0169-1837-11)  / 10 Ml In 1 Vial","637","RC","0169-1837-11","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Retin-A: 1 Tube In 1 Carton (0187-5160-20)  / 20 G In 1 Tube","637","RC","0187-5160-20","NDC","","","facility","both","1","EA","","24.92","24.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cuvposa: 1 Bottle In 1 Carton (0259-0501-16)  / 473 Ml In 1 Bottle","637","RC","0259-0501-16","NDC","","","facility","both","1","EA","","10.13","10.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (0254-3029-02)","637","RC","0254-3029-02","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lubiprostone: 60 Capsule, Gelatin Coated In 1 Bottle (0254-3028-02)","637","RC","0254-3028-02","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0254-3012-78","NDC","","","facility","both","1","EA","","195","195","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alvimopan: 6 Blister Pack In 1 Carton (0254-3012-55)  / 5 Capsule In 1 Blister Pack","637","RC","0254-3012-55","NDC","","","facility","both","1","EA","","195","195","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 1 Bottle, Glass In 1 Carton (0254-1016-36)  / 105 Ml In 1 Bottle, Glass","637","RC","0254-1016-36","NDC","","","facility","both","1","EA","","27.3","27.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0245-0144-89","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (0228-3062-11)","637","RC","0228-3062-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (0228-3059-11)","637","RC","0228-3059-11","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2892-03)","637","RC","0228-2892-03","NDC","","","facility","both","1","EA","","2.45","2.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine: 30 Capsule, Delayed Release Pellets In 1 Bottle (0228-2891-03)","637","RC","0228-2891-03","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 100 Tablet In 1 Bottle (0228-2127-10)","637","RC","0228-2127-10","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0223-1760-02","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0245-0147-89","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0245-5319-89","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Klor-Con M: 500 Tablet, Extended Release In 1 Bottle (0245-5319-15)","637","RC","0245-5319-15","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Klor-Con M: 100 Tablet, Extended Release In 1 Bottle (0245-5319-11)","637","RC","0245-5319-11","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0245-5317-89","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0245-5316-89","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Klor-Con: 100 Blister Pack In 1 Blister Pack (0245-5316-01)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (0245-5316-89)","637","RC","0245-5316-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0245-5315-89","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0245-0360-89","NDC","","","facility","both","1","EA","","2.02","2.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0245-0212-89","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Premarin: 100 Tablet, Film Coated In 1 Bottle (0046-1100-81)","637","RC","0046-1100-81","NDC","","","facility","both","1","EA","","11.74","11.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Proctofoam Hc: 1 Canister In 1 Carton (0037-6822-10)  / 10 G In 1 Canister","637","RC","0037-6822-10","NDC","","","facility","both","1","EA","","305.86","305.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Premarin Vaginal: 1 Tube, With Applicator In 1 Carton (0046-0872-21)  / 30 G In 1 Tube, With Applicator","637","RC","0046-0872-21","NDC","","","facility","both","1","EA","","762.3","762.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flecainide Acetate: 100 Tablet In 1 Bottle (0054-0011-25)","637","RC","0054-0011-25","NDC","","","facility","both","1","EA","","1.24","1.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flecainide Acetate: 100 Blister Pack In 1 Carton (0054-0011-20)  / 1 Tablet In 1 Blister Pack","637","RC","0054-0011-20","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flecainide Acetate: 100 Blister Pack In 1 Carton (0054-0010-20)  / 1 Tablet In 1 Blister Pack","637","RC","0054-0010-20","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitriol: 100 Capsule In 1 Bottle, Plastic (0054-0007-25)","637","RC","0054-0007-25","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diflucan: 1 Bottle In 1 Carton (0049-3450-19)  / 35 Ml In 1 Bottle","637","RC","0049-3450-19","NDC","","","facility","both","1","EA","","9.96","9.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-3016-13)","637","RC","0032-3016-13","NDC","","","facility","both","1","EA","","22.5","22.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Multaq: 60 Tablet, Film Coated In 1 Bottle (0024-4142-60)","637","RC","0024-4142-60","NDC","","","facility","both","1","EA","","21.88","21.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Restasis: 30 Vial, Single-Use In 1 Tray (0023-9163-30)  / .4 Ml In 1 Vial, Single-Use","637","RC","0023-9163-30","NDC","","","facility","both","1","EA","","2.24","2.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-2636-01)","637","RC","0032-2636-01","NDC","","","facility","both","1","EA","","14.82","14.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 250 Capsule, Delayed Release Pellets In 1 Bottle (0032-1224-07)","637","RC","0032-1224-07","NDC","","","facility","both","1","EA","","12.84","12.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-0047-70)","637","RC","0032-0047-70","NDC","","","facility","both","1","EA","","7.49","7.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 100 Capsule, Delayed Release Pellets In 1 Bottle (0032-0046-70)","637","RC","0032-0046-70","NDC","","","facility","both","1","EA","","3.75","3.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Creon: 70 Capsule, Delayed Release In 1 Bottle (0032-0045-70)","637","RC","0032-0045-70","NDC","","","facility","both","1","EA","","3.17","3.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celebrex: 100 Capsule In 1 Bottle (0025-1520-31)","637","RC","0025-1520-31","NDC","","","facility","both","1","EA","","16.61","16.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aldactone: 100 Tablet, Film Coated In 1 Bottle (0025-1001-31)","637","RC","0025-1001-31","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Citalopram: 1 Bottle, Plastic In 1 Carton (0054-0062-58)  / 240 Ml In 1 Bottle, Plastic","637","RC","0054-0062-58","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clotrimazole: 70 Lozenge In 1 Bottle, Plastic (0054-4146-22)","637","RC","0054-4146-22","NDC","","","facility","both","1","EA","","3.29","3.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 500 Ml In 1 Bottle, Plastic (0054-3727-63)","637","RC","0054-3727-63","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam Hydrochloride: 118 Ml In 1 Bottle, Glass (0054-3566-99)","637","RC","0054-3566-99","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 1 Bottle In 1 Carton (0054-3532-44)  / 30 Ml In 1 Bottle","637","RC","0054-3532-44","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Viscous: 1 Bottle In 1 Carton (0054-3500-49)  / 100 Ml In 1 Bottle","637","RC","0054-3500-49","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 120 Ml In 1 Bottle (0054-3294-50)","637","RC","0054-3294-50","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 60 Ml In 1 Bottle (0054-3294-46)","637","RC","0054-3294-46","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluticasone Propionate: 1 Bottle, Glass In 1 Carton (0054-3270-99)  / 120 Spray, Metered In 1 Bottle, Glass","637","RC","0054-3270-99","NDC","","","facility","both","1","EA","","14.12","14.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 500 Ml In 1 Bottle, Plastic (0054-3188-63)","637","RC","0054-3188-63","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 100 Tablet In 1 Bottle, Plastic (0054-4297-25)","637","RC","0054-4297-25","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 500 Ml In 1 Bottle (0054-0390-63)","637","RC","0054-0390-63","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 473 Ml In 1 Bottle (0054-0386-63)","637","RC","0054-0386-63","NDC","","","facility","both","1","EA","","1.6","1.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Codeine Sulfate: 10 Blister Pack In 1 Box (0054-0244-24)  / 10 Tablet In 1 Blister Pack","637","RC","0054-0244-24","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 500 Ml In 1 Bottle (0054-0237-63)","637","RC","0054-0237-63","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 100 Blister Pack In 1 Carton (0054-0236-24)  / 1 Tablet In 1 Blister Pack","637","RC","0054-0236-24","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 100 Tablet In 1 Bottle (0054-0235-25)","637","RC","0054-0235-25","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 100 Blister Pack In 1 Carton (0054-0235-24)  / 1 Tablet In 1 Blister Pack","637","RC","0054-0235-24","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Codeine Sulfate: 10 Blister Pack In 1 Box (0054-0243-24)  / 10 Tablet In 1 Blister Pack","637","RC","0054-0243-24","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1000 Ml In 1 Bottle (0054-0391-68)","637","RC","0054-0391-68","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitriol: 1 Bottle, Glass In 1 Carton (0054-3120-41)  / 15 Ml In 1 Bottle, Glass","637","RC","0054-3120-41","NDC","","","facility","both","1","EA","","10.7","10.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1 Blister Pack In 1 Carton (0054-0710-20)  / 100 Tablet In 1 Blister Pack","637","RC","0054-0710-20","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicyclomine Hydrochloride: 473 Ml In 1 Bottle (0054-0622-63)","637","RC","0054-0622-63","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferiprone: 100 Tablet, Coated In 1 Bottle (0054-0576-25)","637","RC","0054-0576-25","NDC","","","facility","both","1","EA","","102.04","102.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 120 Tablet, Film Coated In 1 Bottle (0054-0425-23)","637","RC","0054-0425-23","NDC","","","facility","both","1","EA","","1.98","1.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine: 90 Tablet, Film Coated, Extended Release In 1 Bottle (0054-0400-22)","637","RC","0054-0400-22","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prevymis: 30 Packet In 1 Carton (0006-5085-01)  / 48 Pellet In 1 Packet","637","RC","0006-5085-01","NDC","","","facility","both","1","EA","","123.48","123.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cortef: 50 Tablet In 1 Bottle (0009-0012-01)","637","RC","0009-0012-01","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0006-0277-01","NDC","","","facility","both","1","EA","","18.26","18.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pifeltro: 30 Tablet, Film Coated In 1 Bottle (0006-3069-01)","637","RC","0006-3069-01","NDC","","","facility","both","1","EA","","101.8","101.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0006-3076-01","NDC","","","facility","both","1","EA","","486.99","486.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Refresh Classic: 50 Vial, Single-Use In 1 Carton (0023-0506-50)  / .4 Ml In 1 Vial, Single-Use","637","RC","0023-0506-50","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Refresh Classic: 30 Vial, Single-Use In 1 Carton (0023-0506-01)  / .4 Ml In 1 Vial, Single-Use","637","RC","0023-0506-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Refresh Lacri-Lube: 1 Tube In 1 Carton (0023-0312-04)  / 3.5 G In 1 Tube","637","RC","0023-0312-04","NDC","","","facility","both","1","EA","","17.59","17.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Refresh Celluvisc: 30 Vial, Single-Use In 1 Carton (0023-4554-30)  / .4 Ml In 1 Vial, Single-Use","637","RC","0023-4554-30","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 10 Blister Pack In 1 Carton (0054-8297-25)  / 10 Tablet In 1 Blister Pack","637","RC","0054-8297-25","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zyvox: 150 Ml In 1 Bottle (0009-5136-04)","637","RC","0009-5136-04","NDC","","","facility","both","1","EA","","6.06","6.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0009-3169-01","NDC","","","facility","both","1","EA","","215.05","215.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 10 Blister Pack In 1 Carton (0054-8299-25)  / 10 Tablet In 1 Blister Pack","637","RC","0054-8299-25","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (0093-0135-01)","637","RC","0093-0135-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Tablet In 1 Bottle (0093-0053-01)","637","RC","0093-0053-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lantus: 1 Vial, Glass In 1 Carton (0088-2220-33)  / 10 Ml In 1 Vial, Glass","637","RC","0088-2220-33","NDC","","","facility","both","1","EA","","1.78","1.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lantus Solostar: 5 Syringe In 1 Carton (0088-2219-05)  / 3 Ml In 1 Syringe (0088-2219-01)","637","RC","0088-2219-05","NDC","","","facility","both","1","EA","","32.13","32.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0088-2219-01","NDC","","","facility","both","1","EA","","32.13","32.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loperamide Hydrochloride: 100 Capsule In 1 Bottle (0093-0311-01)","637","RC","0093-0311-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (0093-0319-01)","637","RC","0093-0319-01","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Warfarin Sodium: 100 Tablet In 1 Bottle (0093-1723-01)","637","RC","0093-1723-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Warfarin Sodium: 100 Tablet In 1 Bottle (0093-1720-01)","637","RC","0093-1720-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Neomycin Sulfate: 100 Tablet In 1 Bottle (0093-1177-01)","637","RC","0093-1177-01","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Tablet In 1 Bottle (0093-1003-01)","637","RC","0093-1003-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0813-01)","637","RC","0093-0813-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0812-01)","637","RC","0093-0812-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle (0093-0811-01)","637","RC","0093-0811-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 500 Capsule In 1 Bottle (0093-0810-05)","637","RC","0093-0810-05","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 500 Tablet In 1 Bottle (0093-0832-05)","637","RC","0093-0832-05","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0777-20)","637","RC","0078-0777-20","NDC","","","facility","both","1","EA","","19.04","19.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0696-20)","637","RC","0078-0696-20","NDC","","","facility","both","1","EA","","19.33","19.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Promacta: 30 Tablet, Film Coated In 1 Bottle (0078-0687-15)","637","RC","0078-0687-15","NDC","","","facility","both","1","EA","","1274.7","1274.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entresto: 180 Tablet, Film Coated In 1 Bottle (0078-0659-67)","637","RC","0078-0659-67","NDC","","","facility","both","1","EA","","19.47","19.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Entresto: 60 Tablet, Film Coated In 1 Bottle (0078-0659-20)","637","RC","0078-0659-20","NDC","","","facility","both","1","EA","","18.16","18.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Coartem: 24 Tablet In 1 Bottle (0078-0568-45)","637","RC","0078-0568-45","NDC","","","facility","both","1","EA","","9.33","9.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciloxan: 3.5 G In 1 Tube (0078-0841-01)","637","RC","0078-0841-01","NDC","","","facility","both","1","EA","","451.21","451.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyproheptadine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0115-1757-01)","637","RC","0115-1757-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ultramicrosize Griseofulvin: 100 Tablet, Coated In 1 Bottle, Plastic (0115-1725-01)","637","RC","0115-1725-01","NDC","","","facility","both","1","EA","","8.46","8.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule In 1 Bottle (0115-1487-01)","637","RC","0115-1487-01","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0093-9291-19","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0093-9290-19","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 100 Tablet In 1 Bottle (0093-9148-01)","637","RC","0093-9148-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle, Plastic (0115-9918-01)","637","RC","0115-9918-01","NDC","","","facility","both","1","EA","","3.75","3.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle, Plastic (0115-9919-01)","637","RC","0115-9919-01","NDC","","","facility","both","1","EA","","4.16","4.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 120 Ml In 1 Bottle, Dropper (0121-0653-04)","637","RC","0121-0653-04","NDC","","","facility","both","1","EA","","4.34","4.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amantadine Hydrochloride: 473 Ml In 1 Bottle (0121-0646-16)","637","RC","0121-0646-16","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amantadine Hydrochloride: 10 Tray In 1 Case (0121-0646-10)  / 10 Cup, Unit-Dose In 1 Tray / 10 Ml In 1 Cup, Unit-Dose","637","RC","0121-0646-10","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0121-0489-05","NDC","","","facility","both","1","EA","","6.91","6.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenhydramine Hydrochloride: 10 Tray In 1 Case (0121-0489-00)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (0121-0489-05)","637","RC","0121-0489-00","NDC","","","facility","both","1","EA","","6.92","6.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milk Of Magnesia: 10 Tray In 1 Case (0121-0431-30)  / 10 Cup, Unit-Dose In 1 Tray / 30 Ml In 1 Cup, Unit-Dose","637","RC","0121-0431-30","NDC","","","facility","both","1","EA","","2.24","2.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactulose: 30 Ml In 1 Cup, Unit-Dose (0116-4005-30)","637","RC","0116-4005-30","NDC","","","facility","both","1","EA","","1.82","1.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactulose: 15 Ml In 1 Cup, Unit-Dose (0116-4005-15)","637","RC","0116-4005-15","NDC","","","facility","both","1","EA","","1.73","1.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlorhexidine Gluconate: 473 Ml In 1 Bottle (0116-2001-16)","637","RC","0116-2001-16","NDC","","","facility","both","1","EA","","3.33","3.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lopressor: 100 TABLET in 1 BOTTLE (0078-0458-05) ","637","RC","0078-0458-05","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 30 Blister Pack In 1 Carton (0093-5245-65)  / 1 Tablet, Orally Disintegrating In 1 Blister Pack (0093-5245-19)","637","RC","0093-5245-65","NDC","","","facility","both","1","EA","","2.35","2.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0093-5245-19","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin V Potassium: 200 Ml In 1 Bottle (0093-4127-74)","637","RC","0093-4127-74","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefadroxil: 50 Tablet In 1 Bottle (0093-4059-53)","637","RC","0093-4059-53","NDC","","","facility","both","1","EA","","4.16","4.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicloxacillin Sodium: 100 Capsule In 1 Bottle (0093-3125-01)","637","RC","0093-3125-01","NDC","","","facility","both","1","EA","","2.27","2.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Capsule In 1 Bottle (0093-3107-01)","637","RC","0093-3107-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 100 Tablet In 1 Bottle (0093-2203-01)","637","RC","0093-2203-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin V Potassium: 100 Ml In 1 Bottle (0093-4127-73)","637","RC","0093-4127-73","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0093-5419-19","NDC","","","facility","both","1","EA","","10.86","10.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (0093-8739-01)","637","RC","0093-8739-01","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 75 Ml In 1 Bottle (0093-8675-78)","637","RC","0093-8675-78","NDC","","","facility","both","1","EA","","3.19","3.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Letrozole: 30 Tablet, Film Coated In 1 Bottle (0093-7620-56)","637","RC","0093-7620-56","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 180 Capsule, Delayed Release In 1 Bottle (0093-5907-86)","637","RC","0093-5907-86","NDC","","","facility","both","1","EA","","5.3","5.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xeljanz: 60 Tablet, Film Coated In 1 Bottle (0069-1001-01)","637","RC","0069-1001-01","NDC","","","facility","both","1","EA","","160.01","160.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Genteal Tears Night-Time: 1 Tube In 1 Carton (0065-0518-01)  / 3.5 G In 1 Tube","637","RC","0065-0518-01","NDC","","","facility","both","1","EA","","12.88","12.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium Carbonate: 10 Capsule, Gelatin Coated In 1 Blister Pack (0054-8527-25)","637","RC","0054-8527-25","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium Carbonate: 10 Capsule, Gelatin Coated In 1 Blister Pack (0054-8526-25)","637","RC","0054-8526-25","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leucovorin Calcium: 5 Blister Pack In 1 Carton (0054-8496-19)  / 10 Tablet In 1 Blister Pack","637","RC","0054-8496-19","NDC","","","facility","both","1","EA","","2.62","2.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Furosemide: 10 Blister Pack In 1 Carton (0054-8301-25)  / 10 Tablet In 1 Blister Pack","637","RC","0054-8301-25","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-4552-11)  / 10 Tablet In 1 Blister Pack","637","RC","0074-4552-11","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-7148-11)  / 10 Tablet In 1 Blister Pack","637","RC","0074-7148-11","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Synthroid: 10 Blister Pack In 1 Box, Unit-Dose (0074-6624-11)  / 10 Tablet In 1 Blister Pack","637","RC","0074-6624-11","NDC","","","facility","both","1","EA","","2.75","2.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Synthroid: 90 Tablet In 1 Bottle (0074-4552-90)","637","RC","0074-4552-90","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Focalin Xr: 100 Capsule, Extended Release In 1 Bottle (0078-0433-05)","637","RC","0078-0433-05","NDC","","","facility","both","1","EA","","8.21","8.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paxlovid: 10 Blister Pack In 1 Carton (0069-5321-30)  / 1 Kit In 1 Blister Pack (0069-5321-03)  *  2 Tablet, Film Coated In 1 Blister Pack (0069-2085-02)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-1735-11)","637","RC","0069-5321-30","NDC","","","facility","both","1","EA","","82.46","82.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0069-5321-03","NDC","","","facility","both","1","EA","","82.05","82.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paxlovid: 10 Blister Pack In 1 Carton (0069-5317-20)  / 1 Kit In 1 Blister Pack (0069-5317-02)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-2085-11)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-1735-11)","637","RC","0069-5317-20","NDC","","","facility","both","1","EA","","124.16","124.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0069-5317-02","NDC","","","facility","both","1","EA","","124.17","124.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paxlovid: 10 Blister Pack In 1 Carton (0069-5045-30)  / 1 Kit In 1 Blister Pack (0069-5045-06)  *  2 Tablet, Film Coated In 1 Blister Pack (0069-2085-02)  *  1 Tablet, Film Coated In 1 Blister Pack (0069-1345-11)","637","RC","0069-5045-30","NDC","","","facility","both","1","EA","","82.76","82.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0069-5045-06","NDC","","","facility","both","1","EA","","82.76","82.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rinvoq: 28 Tablet, Extended Release In 1 Bottle (0074-1043-28)","637","RC","0074-1043-28","NDC","","","facility","both","1","EA","","747.2","747.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrostat: 4 Bottle In 1 Carton (0071-0418-13)  / 25 Tablet In 1 Bottle","637","RC","0071-0418-13","NDC","","","facility","both","1","EA","","2.69","2.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrostat: 1 Bottle In 1 Carton (0071-0417-24)  / 100 Tablet In 1 Bottle","637","RC","0071-0417-24","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dilantin: 100 Blister Pack In 1 Carton (0071-0369-40)  / 1 Capsule In 1 Blister Pack","637","RC","0071-0369-40","NDC","","","facility","both","1","EA","","3.09","3.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (0527-4593-13)  / 10 Capsule In 1 Blister Pack","637","RC","0527-4593-13","NDC","","","facility","both","1","EA","","2.15","2.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 TABLET, EXTENDED RELEASE in 1 BOTTLE (0527-3312-37) ","637","RC","0527-3312-37","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride Extended-Release: 100 Capsule, Extended Release In 1 Bottle (0527-8111-37)","637","RC","0527-8111-37","NDC","","","facility","both","1","EA","","1.83","1.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 60 Tablet, Delayed Release In 1 Bottle (0527-2133-35)","637","RC","0527-2133-35","NDC","","","facility","both","1","EA","","6.81","6.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 1 Bottle, Plastic In 1 Carton (0527-1948-70)  / 480 Ml In 1 Bottle, Plastic","637","RC","0527-1948-70","NDC","","","facility","both","1","EA","","63.29","63.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0527-1790-01)","637","RC","0527-1790-01","NDC","","","facility","both","1","EA","","5","5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin Low Dose: 1 Bottle, Plastic In 1 Carton (0536-1234-41)  / 120 Tablet, Delayed Release In 1 Bottle, Plastic","637","RC","0536-1234-41","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Cherry Flavor: 177 Ml In 1 Bottle, Spray (0536-1228-58)","637","RC","0536-1228-58","NDC","","","facility","both","1","EA","","4.2","4.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dibucaine Topical Anesthetic 1% Hemorrhoidal: 1 Tube In 1 Box (0536-1211-95)  / 28 G In 1 Tube","637","RC","0536-1211-95","NDC","","","facility","both","1","EA","","5.95","5.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin: 1 Bottle, Plastic In 1 Carton (0536-1054-29)  / 100 Tablet, Film Coated In 1 Bottle, Plastic","637","RC","0536-1054-29","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Pain Relief Patches: 5 Patch In 1 Carton (0536-1202-15)  / 9 G In 1 Patch","637","RC","0536-1202-15","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Pain Relief Patches: 30 Patch In 1 Carton (0536-1202-07)  / 9 G In 1 Patch","637","RC","0536-1202-07","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Hemorrhoidal: 12 Blister Pack In 1 Carton (0536-1186-12)  / 1 Suppository In 1 Blister Pack","637","RC","0536-1186-12","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levonorgestrel: 1 Blister Pack In 1 Carton (0536-1142-63)  / 1 Tablet In 1 Blister Pack","637","RC","0536-1142-63","NDC","","","facility","both","1","EA","","9.15","9.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcium Carbonate 10 Gr (648 Mg) (Antacid): 1000 Tablet In 1 Bottle, Plastic (0536-1206-10)","637","RC","0536-1206-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Probenecid: 100 Tablet, Film Coated In 1 Bottle (0527-1367-01)","637","RC","0527-1367-01","NDC","","","facility","both","1","EA","","2.36","2.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"DIGOX: 100 TABLET in 1 BOTTLE (0527-1324-01) ","637","RC","0527-1324-01","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Primidone: 100 Tablet In 1 Bottle (0527-1301-01)","637","RC","0527-1301-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (0527-0760-37)","637","RC","0527-0760-37","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0521-2311-00","NDC","","","facility","both","1","EA","","3.18","3.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stomach Relief Regular Strength: 237 Ml In 1 Bottle, Plastic (0536-1286-36)","637","RC","0536-1286-36","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Proglycem: 1 Bottle, Dropper In 1 Box (0575-6200-30)  / 30 Ml In 1 Bottle, Dropper","637","RC","0575-6200-30","NDC","","","facility","both","1","EA","","19.18","19.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisacodyl: 50 Blister Pack In 1 Carton (0574-7050-50)  / 1 Suppository In 1 Blister Pack","637","RC","0574-7050-50","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisacodyl: 12 Blister Pack In 1 Carton (0574-7050-12)  / 1 Suppository In 1 Blister Pack","637","RC","0574-7050-12","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin: 12 Packet In 1 Carton (0574-7034-12)  / 1 Suppository In 1 Packet","637","RC","0574-7034-12","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 118 Ml In 1 Bottle (0574-1133-04)","637","RC","0574-1133-04","NDC","","","facility","both","1","EA","","11.58","11.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Actidose Aqua: 240 Ml In 1 Tube (0574-0521-76)","637","RC","0574-0521-76","NDC","","","facility","both","1","EA","","19.12","19.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amiloride Hydrochloride: 100 Tablet In 1 Bottle (0574-0292-01)","637","RC","0574-0292-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midazolam Hydrochloride: 1 Bottle, Glass In 1 Carton (0574-0150-04)  / 118 Ml In 1 Bottle, Glass","637","RC","0574-0150-04","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clotrimazole: 70 Lozenge In 1 Bottle, Plastic (0574-0107-70)","637","RC","0574-0107-70","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 500 TABLET in 1 BOTTLE, PLASTIC (0591-0240-05) ","637","RC","0591-0240-05","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride Sr: 60 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic (0591-3541-60)","637","RC","0591-3541-60","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 100 Tablet In 1 Bottle (0591-2998-01)","637","RC","0591-2998-01","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bosentan: 60 Tablet, Film Coated In 1 Bottle (0591-2512-60)","637","RC","0591-2512-60","NDC","","","facility","both","1","EA","","39.78","39.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamterene And Hydrochlorothiazide: 100 Tablet In 1 Bottle, Plastic (0591-0348-01)","637","RC","0591-0348-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicyclomine Hydrochloride: 100 Capsule In 1 Bottle, Plastic (0591-0794-01)","637","RC","0591-0794-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glipizide: 100 Tablet In 1 Bottle, Plastic (0591-0461-01)","637","RC","0591-0461-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glipizide: 100 Tablet In 1 Bottle, Plastic (0591-0460-01)","637","RC","0591-0460-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guanfacine: 100 Tablet In 1 Bottle, Plastic (0591-0444-01)","637","RC","0591-0444-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-0404-01)","637","RC","0591-0404-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clotrimazole: 140 Lozenge In 1 Bottle, Plastic (0574-0107-14)","637","RC","0574-0107-14","NDC","","","facility","both","1","EA","","1.26","1.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0536-3029-25","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Nicotine Polacrilex Gum, Original Flavor: 11 Blister Pack In 1 Carton (0536-3029-23)  / 10 Gum, Chewing In 1 Blister Pack","637","RC","0536-3029-23","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Capsaicin: 1 Tube In 1 Carton (0536-2525-25)  / 60 G In 1 Tube","637","RC","0536-2525-25","NDC","","","facility","both","1","EA","","9.29","9.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chest Congestion Relief: 473 Ml In 1 Bottle (0536-1314-85)","637","RC","0536-1314-85","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docusate Sodium Liquid: 473 Ml In 1 Bottle (0536-1304-85)","637","RC","0536-1304-85","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infants: 1 Bottle, Dropper In 1 Carton (0536-1303-75)  / 30 Ml In 1 Bottle, Dropper","637","RC","0536-1303-75","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rugby Polyvinyl Alcohol 1.4% Lubricating Eye Drops: 1 Bottle, Dropper In 1 Box (0536-1408-94)  / 15 Ml In 1 Bottle, Dropper","637","RC","0536-1408-94","NDC","","","facility","both","1","EA","","4.94","4.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bromocriptine Mesylate: 100 Tablet In 1 Bottle, Plastic (0574-0106-01)","637","RC","0574-0106-01","NDC","","","facility","both","1","EA","","3.07","3.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 100 Tablet In 1 Bottle (0555-0872-02)","637","RC","0555-0872-02","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medroxyprogesterone Acetate: 100 Tablet In 1 Bottle (0555-0779-02)","637","RC","0555-0779-02","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chlordiazepoxide Hydrochloride: 100 Capsule In 1 Bottle (0555-0159-02)","637","RC","0555-0159-02","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cresemba: 2 Blister Pack In 1 Carton (0469-0520-02)  / 7 Capsule In 1 Blister Pack","637","RC","0469-0520-02","NDC","","","facility","both","1","EA","","152.2","152.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fetzima: 30 Capsule, Extended Release In 1 Bottle, Plastic (0456-2280-30)","637","RC","0456-2280-30","NDC","","","facility","both","1","EA","","29.11","29.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fetzima: 30 Capsule, Extended Release In 1 Bottle, Plastic (0456-2240-30)","637","RC","0456-2240-30","NDC","","","facility","both","1","EA","","27.73","27.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linzess: 1 Bottle In 1 Carton (0456-1203-30)  / 30 Capsule, Gelatin Coated In 1 Bottle","637","RC","0456-1203-30","NDC","","","facility","both","1","EA","","30.91","30.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linzess: 1 Bottle In 1 Carton (0456-1202-30)  / 30 Capsule, Gelatin Coated In 1 Bottle","637","RC","0456-1202-30","NDC","","","facility","both","1","EA","","30.67","30.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linzess: 1 Bottle In 1 Carton (0456-1201-30)  / 30 Capsule, Gelatin Coated In 1 Bottle","637","RC","0456-1201-30","NDC","","","facility","both","1","EA","","31.41","31.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 1 Tube In 1 Carton (0472-0166-15)  / 15 G In 1 Tube","637","RC","0472-0166-15","NDC","","","facility","both","1","EA","","23.25","23.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myrbetriq: 1 Bottle In 1 Carton (0469-5020-99)  / 100 Ml In 1 Bottle","637","RC","0469-5020-99","NDC","","","facility","both","1","EA","","23.01","23.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Myrbetriq: 1 Bottle In 1 Carton (0469-2602-90)  / 90 Tablet, Film Coated, Extended Release In 1 Bottle","637","RC","0469-2602-90","NDC","","","facility","both","1","EA","","25.47","25.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xospata: 1 Bottle In 1 Carton (0469-1425-90)  / 90 Tablet In 1 Bottle","637","RC","0469-1425-90","NDC","","","facility","both","1","EA","","579.59","579.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Viibryd: 30 Tablet In 1 Bottle (0456-1140-30)","637","RC","0456-1140-30","NDC","","","facility","both","1","EA","","20.18","20.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Viibryd: 30 Tablet In 1 Bottle (0456-1110-30)","637","RC","0456-1110-30","NDC","","","facility","both","1","EA","","20.18","20.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dakins Full: 473 Ml In 1 Bottle (0436-0946-16)","637","RC","0436-0946-16","NDC","","","facility","both","1","EA","","25.55","25.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 1 TUBE in 1 CARTON (0472-0343-56)  / 28 g in 1 TUBE","637","RC","0472-0343-56","NDC","","","facility","both","1","EA","","15.56","15.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 1 TUBE in 1 CARTON (0472-0345-56)  / 28 g in 1 TUBE","637","RC","0472-0345-56","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miconazole 7: 7 SUPPOSITORY in 1 BOX (0472-1736-07) ","637","RC","0472-1736-07","NDC","","","facility","both","1","EA","","1.95","1.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valproic: 100 Capsule, Liquid Filled In 1 Bottle (0591-4012-01)","637","RC","0591-4012-01","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (0480-3568-01)","637","RC","0480-3568-01","NDC","","","facility","both","1","EA","","5.48","5.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (0480-3567-01)","637","RC","0480-3567-01","NDC","","","facility","both","1","EA","","5.48","5.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 100 Capsule In 1 Bottle (0480-3565-01)","637","RC","0480-3565-01","NDC","","","facility","both","1","EA","","6.29","6.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miconazole Nitrate: 3 Suppository In 1 Carton (0472-1738-03)","637","RC","0472-1738-03","NDC","","","facility","both","1","EA","","17.69","17.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"K-Phos No. 2: 100 Tablet, Coated In 1 Bottle (0486-1134-01)","637","RC","0486-1134-01","NDC","","","facility","both","1","EA","","1.69","1.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0591-4740-54","NDC","","","facility","both","1","EA","","73.77","73.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trihexyphenidyl Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0591-5335-01)","637","RC","0591-5335-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alprazolam: 100 Tablet In 1 Bottle (0781-1077-01)","637","RC","0781-1077-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alprazolam: 100 Tablet In 1 Bottle (0781-1061-01)","637","RC","0781-1061-01","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Griseofulvin: 118 Ml In 1 Bottle, Plastic (0713-0850-04)","637","RC","0713-0850-04","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mometasone Furoate: 1 Tube In 1 Carton (0713-0635-15)  / 15 G In 1 Tube","637","RC","0713-0635-15","NDC","","","facility","both","1","EA","","7.65","7.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alprazolam: 100 Tablet In 1 Bottle (0781-1079-01)","637","RC","0781-1079-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 40 Tablet, Multilayer, Extended Release In 1 Bottle (0781-1943-39)","637","RC","0781-1943-39","NDC","","","facility","both","1","EA","","8.82","8.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamterene And Hydrochlorothiazide: 100 Capsule In 1 Bottle (0781-2074-01)","637","RC","0781-2074-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (0781-5438-20)","637","RC","0781-5438-20","NDC","","","facility","both","1","EA","","7.35","7.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jardiance: 30 Blister Pack In 1 Carton (0597-0152-37)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0597-0152-37","NDC","","","facility","both","1","EA","","22.13","22.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jardiance: 30 Tablet, Film Coated In 1 Bottle (0597-0152-30)","637","RC","0597-0152-30","NDC","","","facility","both","1","EA","","16.74","16.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ofev: 1 Bottle In 1 Carton (0597-0145-60)  / 60 Capsule In 1 Bottle","637","RC","0597-0145-60","NDC","","","facility","both","1","EA","","405.5","405.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pradaxa: 10 Blister Pack In 1 Carton (0597-0108-60)  / 6 Capsule In 1 Blister Pack","637","RC","0597-0108-60","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Probenecid: 100 Tablet, Film Coated In 1 Bottle, Plastic (0591-5347-01)","637","RC","0591-5347-01","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Jardiance: 30 Blister Pack In 1 Carton (0597-0153-37)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","0597-0153-37","NDC","","","facility","both","1","EA","","22","22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 100 TABLET in 1 BOTTLE, PLASTIC (0603-4975-21) ","637","RC","0603-4975-21","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0603-1880-10","NDC","","","facility","both","1","EA","","4.44","4.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 473 Ml In 1 Bottle, Plastic (0603-1542-58)","637","RC","0603-1542-58","NDC","","","facility","both","1","EA","","22.8","22.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 473 mL in 1 BOTTLE, PLASTIC (0603-1508-58) ","637","RC","0603-1508-58","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pradaxa: 60 Blister Pack In 1 Carton (0597-0360-82)  / 1 Capsule In 1 Blister Pack","637","RC","0597-0360-82","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pradaxa: 60 Blister Pack In 1 Carton (0597-0355-56)  / 1 Capsule In 1 Blister Pack","637","RC","0597-0355-56","NDC","","","facility","both","1","EA","","5.22","5.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-8510-23)","637","RC","0406-8510-23","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8380-23)","637","RC","0406-8380-23","NDC","","","facility","both","1","EA","","2.79","2.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8330-23)","637","RC","0406-8330-23","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 1 Tablet, Extended Release In 1 Blister Pack (0406-8315-23)","637","RC","0406-8315-23","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-5771-23)","637","RC","0406-5771-23","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-5755-23)","637","RC","0406-5755-23","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3244-01)","637","RC","0406-3244-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 100 Tablet In 1 Bottle (0406-3243-01)","637","RC","0406-3243-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenoxylate Hydrochloride And Atropine Sulfate: 1000 Tablet In 1 Bottle (0406-1236-10)","637","RC","0406-1236-10","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Temazepam: 100 Capsule In 1 Bottle (0406-9961-01)","637","RC","0406-9961-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenoxylate Hydrochloride And Atropine Sulfate: 100 Tablet In 1 Bottle (0406-1236-01)","637","RC","0406-1236-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-9116-16","NDC","","","facility","both","1","EA","","1.27","1.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-9112-16","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-9125-16","NDC","","","facility","both","1","EA","","70.47","70.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-8768-16","NDC","","","facility","both","1","EA","","10.59","10.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-8767-16","NDC","","","facility","both","1","EA","","5.47","5.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-9104-16","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet In 1 Bottle (0406-1142-01)","637","RC","0406-1142-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 1 Tablet In 1 Blister Pack (0406-0552-23)","637","RC","0406-0552-23","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadose: 1000 Ml In 1 Bottle, Plastic (0406-0527-10)","637","RC","0406-0527-10","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (0406-0154-01)","637","RC","0406-0154-01","NDC","","","facility","both","1","EA","","5.63","5.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (0406-0136-01)","637","RC","0406-0136-01","NDC","","","facility","both","1","EA","","5.49","5.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (0406-0127-01)","637","RC","0406-0127-01","NDC","","","facility","both","1","EA","","5.29","5.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0395-1031-96","NDC","","","facility","both","1","EA","","57.62","57.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0395-1031-28","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0395-1031-16","NDC","","","facility","both","1","EA","","3.38","3.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benzoin Compound Tincture: 59 Ml In 1 Bottle, Plastic (0395-0243-92)","637","RC","0395-0243-92","NDC","","","facility","both","1","EA","","4.96","4.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-8766-16","NDC","","","facility","both","1","EA","","5.25","5.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-4644-16","NDC","","","facility","both","1","EA","","12.03","12.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (0378-1903-01)","637","RC","0378-1903-01","NDC","","","facility","both","1","EA","","5.42","5.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 90 Tablet In 1 Bottle, Plastic (0378-1815-77)","637","RC","0378-1815-77","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicyclomine Hydrochloride: 100 CAPSULE in 1 BOTTLE, PLASTIC (0378-1610-01) ","637","RC","0378-1610-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-0873-16","NDC","","","facility","both","1","EA","","49.58","49.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Citalopram: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-6232-01)","637","RC","0378-6232-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-7272-85","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-6550-85","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-6470-16","NDC","","","facility","both","1","EA","","30.51","30.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acamprosate Calcium: 180 Tablet, Delayed Release In 1 Bottle, Plastic (0378-6333-80)","637","RC","0378-6333-80","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Citalopram: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-6233-01)","637","RC","0378-6233-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-0872-16","NDC","","","facility","both","1","EA","","35.49","35.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0378-0871-16","NDC","","","facility","both","1","EA","","19.26","19.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle, Plastic (0378-0018-01)","637","RC","0378-0018-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (0781-5439-20)","637","RC","0781-5439-20","NDC","","","facility","both","1","EA","","8.53","8.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68382-256-01)","637","RC","68382-256-01","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxychloroquine Sulfate: 100 Tablet, Film Coated In 1 Bottle (68382-096-01)","637","RC","68382-096-01","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (68382-094-01)","637","RC","68382-094-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (68382-092-01)","637","RC","68382-092-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meloxicam: 100 Tablet In 1 Bottle (68382-051-01)","637","RC","68382-051-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meloxicam: 100 Tablet In 1 Bottle (68382-050-01)","637","RC","68382-050-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine: 100 Tablet In 1 Bottle (68382-020-01)","637","RC","68382-020-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Topiramate: 60 Capsule, Coated Pellets In 1 Bottle (68382-005-14)","637","RC","68382-005-14","NDC","","","facility","both","1","EA","","1.76","1.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 100 Tablet In 1 Bottle (68382-079-01)","637","RC","68382-079-01","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycodone Hydrochloride: 10 BLISTER PACK in 1 CARTON (68308-505-47)  / 10 TABLET in 1 BLISTER PACK","637","RC","68308-505-47","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Tablet In 1 Bottle (68382-806-01)","637","RC","68382-806-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Tablet In 1 Bottle (68382-805-01)","637","RC","68382-805-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxazosin: 100 Tablet In 1 Bottle (68382-786-01)","637","RC","68382-786-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ezetimibe: 90 Tablet In 1 Bottle (68382-773-16)","637","RC","68382-773-16","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68382-771-30","NDC","","","facility","both","1","EA","","5.15","5.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Liothyronine Sodium: 100 Tablet In 1 Bottle (68382-583-01)","637","RC","68382-583-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Citrate: 100 Tablet, Extended Release In 1 Bottle (68382-537-01)","637","RC","68382-537-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Citrate: 100 Tablet, Extended Release In 1 Bottle (68382-536-01)","637","RC","68382-536-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (68382-452-19)","637","RC","68382-452-19","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68382-772-30","NDC","","","facility","both","1","EA","","7.89","7.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68180-166-11","NDC","","","facility","both","1","EA","","4.16","4.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirabegron: 90 Tablet, Film Coated, Extended Release In 1 Bottle (68180-151-09)","637","RC","68180-151-09","NDC","","","facility","both","1","EA","","14.68","14.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 50 Ml In 1 Bottle (68180-150-01)","637","RC","68180-150-01","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cephalexin: 100 Capsule In 1 Bottle (68180-122-01)","637","RC","68180-122-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclosporine: 30 Vial, Single-Use In 1 Tray (68180-214-30)  / .4 Ml In 1 Vial, Single-Use","637","RC","68180-214-30","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naltrexone Hydrochloride: 3 Blister Pack In 1 Carton (68094-853-62)  / 10 Tablet, Film Coated In 1 Blister Pack (68094-853-59)","637","RC","68094-853-62","NDC","","","facility","both","1","EA","","3.79","3.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68094-764-59","NDC","","","facility","both","1","EA","","8.33","8.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Tablet In 1 Bottle (68180-981-01)","637","RC","68180-981-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisinopril: 100 Tablet In 1 Bottle (68180-980-01)","637","RC","68180-980-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Tablet In 1 Bottle (68180-975-01)","637","RC","68180-975-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefdinir: 60 Capsule In 1 Bottle (68180-711-60)","637","RC","68180-711-60","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Bottle, Glass In 1 Carton (68180-678-01)  / 60 Ml In 1 Bottle, Glass","637","RC","68180-678-01","NDC","","","facility","both","1","EA","","5.28","5.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (68180-677-11)  / 10 Capsule In 1 Blister Pack","637","RC","68180-677-11","NDC","","","facility","both","1","EA","","4.32","4.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline: 60 Ml In 1 Bottle (68180-657-01)","637","RC","68180-657-01","NDC","","","facility","both","1","EA","","4.79","4.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine Succinate: 30 Tablet, Film Coated, Extended Release In 1 Bottle (68180-604-06)","637","RC","68180-604-06","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cephalexin: 100 Ml In 1 Bottle (68180-441-01)","637","RC","68180-441-01","NDC","","","facility","both","1","EA","","2.15","2.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (68462-534-35)  / 30 G In 1 Tube","637","RC","68462-534-35","NDC","","","facility","both","1","EA","","132.47","132.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olmesartan Medoxomil: 30 Tablet, Film Coated In 1 Bottle (68462-437-30)","637","RC","68462-437-30","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68462-720-84","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 120 Tablet, Film Coated In 1 Bottle (68462-714-08)","637","RC","68462-714-08","NDC","","","facility","both","1","EA","","4.15","4.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 120 Tablet, Film Coated In 1 Bottle (68462-713-08)","637","RC","68462-713-08","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitroglycerin: 4 Bottle In 1 Carton (68462-639-45)  / 25 Tablet In 1 Bottle (68462-639-25)","637","RC","68462-639-45","NDC","","","facility","both","1","EA","","3.47","3.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68462-639-25","NDC","","","facility","both","1","EA","","3.31","3.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitroglycerin: 1 Bottle In 1 Carton (68462-638-01)  / 100 Tablet In 1 Bottle","637","RC","68462-638-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indomethacin: 100 Capsule In 1 Bottle (68462-406-01)","637","RC","68462-406-01","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamotrigine: 100 Tablet, Chewable In 1 Bottle (68462-229-01)","637","RC","68462-229-01","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium Carbonate: 100 Capsule In 1 Bottle (68462-222-01)","637","RC","68462-222-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle (68462-256-01)","637","RC","68462-256-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 100 Tablet, Film Coated In 1 Bottle (68462-138-01)","637","RC","68462-138-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zonisamide: 100 Capsule In 1 Bottle (68462-129-01)","637","RC","68462-129-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle (68462-258-01)","637","RC","68462-258-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68462-394-84","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (68462-338-01)","637","RC","68462-338-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle, Plastic (68462-337-01)","637","RC","68462-337-01","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-333-90)","637","RC","68462-333-90","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-332-90)","637","RC","68462-332-90","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-331-90)","637","RC","68462-331-90","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (68462-330-90)","637","RC","68462-330-90","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norethindrone Acetate: 50 Tablet In 1 Bottle (68462-304-50)","637","RC","68462-304-50","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (68462-292-01)","637","RC","68462-292-01","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 3 Tray In 1 Case (68094-750-62)  / 10 Cup, Unit-Dose In 1 Tray / 5 Ml In 1 Cup, Unit-Dose (68094-750-59)","637","RC","68094-750-62","NDC","","","facility","both","1","EA","","5.68","5.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68094-750-59","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-603-11","NDC","","","facility","both","1","EA","","3.84","3.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-598-11","NDC","","","facility","both","1","EA","","3.04","3.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-597-11","NDC","","","facility","both","1","EA","","1.88","1.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-592-11","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Mononitrate: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-591-01)  / 1 TABLET, EXTENDED RELEASE in 1 BLISTER PACK (68084-591-11) ","637","RC","68084-591-01","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-590-95","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-572-11","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-539-11","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-536-11","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-512-11","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simvastatin: 100 Blister Pack In 1 Box, Unit-Dose (68084-512-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-512-11)","637","RC","68084-512-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-698-11","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-697-11","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-655-11","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-654-11","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-645-11","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-640-11","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium Carbonate: 100 Blister Pack In 1 Box, Unit-Dose (68084-640-01)  / 1 Tablet, Extended Release In 1 Blister Pack (68084-640-11)","637","RC","68084-640-01","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-621-11","NDC","","","facility","both","1","EA","","14.53","14.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-511-11","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meclizine Hydrochloride: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-491-01)  / 1 TABLET in 1 BLISTER PACK (68084-491-11) ","637","RC","68084-491-01","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-354-11","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-347-11","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-346-11","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-345-11","NDC","","","facility","both","1","EA","","1.03","1.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-360-11","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-343-11","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-342-11","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-319-11","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-318-11","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-344-11","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-376-11","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 100 Blister Pack In 1 Box, Unit-Dose (68084-381-01)  / 1 Tablet In 1 Blister Pack (68084-381-11)","637","RC","68084-381-01","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-447-11","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-444-11","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-415-11","NDC","","","facility","both","1","EA","","2.4","2.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-388-11","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-381-11","NDC","","","facility","both","1","EA","","0.65","0.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-708-95","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68094-004-59","NDC","","","facility","both","1","EA","","3.54","3.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-997-11","NDC","","","facility","both","1","EA","","3.45","3.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-988-33","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-968-11","NDC","","","facility","both","1","EA","","1.19","1.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-964-95","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-882-11","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68094-030-59","NDC","","","facility","both","1","EA","","2.86","2.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68094-600-59","NDC","","","facility","both","1","EA","","1.24","1.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68094-503-59","NDC","","","facility","both","1","EA","","1.63","1.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68094-494-59","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 3 Tray In 1 Case (68094-330-62)  / 10 Cup, Unit-Dose In 1 Tray / 10.15 Ml In 1 Cup, Unit-Dose (68094-330-59)","637","RC","68094-330-62","NDC","","","facility","both","1","EA","","1.7","1.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68094-330-59","NDC","","","facility","both","1","EA","","1.76","1.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68094-231-59","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68094-043-59","NDC","","","facility","both","1","EA","","14.98","14.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68094-031-59","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-875-11","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-782-11","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-776-11","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-775-95","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-753-95","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-752-95","NDC","","","facility","both","1","EA","","23.68","23.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-805-11","NDC","","","facility","both","1","EA","","3.4","3.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-735-11","NDC","","","facility","both","1","EA","","3.35","3.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-722-11","NDC","","","facility","both","1","EA","","19.09","19.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-713-11","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-709-11","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-750-95","NDC","","","facility","both","1","EA","","1.37","1.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-808-11","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-862-11","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-859-11","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-856-11","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-854-11","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 30 Blister Pack In 1 Box, Unit-Dose (68084-823-21)  / 1 Tablet In 1 Blister Pack (68084-823-11)","637","RC","68084-823-21","NDC","","","facility","both","1","EA","","2.2","2.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-823-11","NDC","","","facility","both","1","EA","","2.17","2.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-813-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fycompa: 30 Tablet In 1 Bottle (69616-274-30)","637","RC","69616-274-30","NDC","","","facility","both","1","EA","","67.88","67.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fycompa: 30 Tablet In 1 Bottle (69616-272-30)","637","RC","69616-272-30","NDC","","","facility","both","1","EA","","34.36","34.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sotalol Hydrochloride: 100 Tablet In 1 Bottle (69584-842-10)","637","RC","69584-842-10","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Tablet In 1 Bottle (69584-093-10)","637","RC","69584-093-10","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 30 Tablet In 1 Bottle (69918-301-30)","637","RC","69918-301-30","NDC","","","facility","both","1","EA","","3.31","3.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fycompa: 340 Ml In 1 Bottle (69616-290-38)","637","RC","69616-290-38","NDC","","","facility","both","1","EA","","7.74","7.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propafenone Hydrochloride: 60 Capsule, Extended Release In 1 Bottle, Plastic (69680-130-60)","637","RC","69680-130-60","NDC","","","facility","both","1","EA","","1.36","1.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin 81 Mg: 120 Tablet, Coated In 1 Bottle, Plastic (69618-066-02)","637","RC","69618-066-02","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Senna: 100 Tablet In 1 Bottle (69618-064-01)","637","RC","69618-064-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infants Gas Relief Drops: 1 Bottle, Dropper In 1 Carton (69618-059-51)  / 30 Ml In 1 Bottle, Dropper","637","RC","69618-059-51","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (69452-390-98)","637","RC","69452-390-98","NDC","","","facility","both","1","EA","","2.67","2.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ropinirole: 100 Tablet, Film Coated In 1 Bottle, Plastic (69452-358-20)","637","RC","69452-358-20","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dofetilide: 60 Capsule In 1 Bottle (69452-132-17)","637","RC","69452-132-17","NDC","","","facility","both","1","EA","","1.27","1.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dofetilide: 60 Capsule In 1 Bottle (69452-131-17)","637","RC","69452-131-17","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 1 Bottle, Glass In 1 Carton (69452-125-50)  / 250 Ml In 1 Bottle, Glass","637","RC","69452-125-50","NDC","","","facility","both","1","EA","","3.9","3.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Coated In 1 Bottle (69367-388-01)","637","RC","69367-388-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dofetilide: 60 Capsule In 1 Bottle (69452-133-17)","637","RC","69452-133-17","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valproic Acid: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-150-20)","637","RC","69452-150-20","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atovaquone: 1 Bottle In 1 Carton (69452-252-87)  / 210 Ml In 1 Bottle","637","RC","69452-252-87","NDC","","","facility","both","1","EA","","39.27","39.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Progesterone: 100 Capsule In 1 Bottle (69452-234-20)","637","RC","69452-234-20","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rufinamide: 1 Bottle In 1 Carton (69452-223-84)  / 460 Ml In 1 Bottle","637","RC","69452-223-84","NDC","","","facility","both","1","EA","","32.46","32.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxylamine Succinate And Pyridoxine Hydrochloride: 100 Tablet, Delayed Release In 1 Bottle (69452-206-20)","637","RC","69452-206-20","NDC","","","facility","both","1","EA","","2.61","2.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","69452-156-74","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethosuximide: 100 Capsule, Liquid Filled In 1 Bottle, Plastic (69452-152-20)","637","RC","69452-152-20","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Brimonidine Tartrate: 1 Bottle In 1 Carton (70069-231-01)  / 5 Ml In 1 Bottle","637","RC","70069-231-01","NDC","","","facility","both","1","EA","","7.62","7.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle In 1 Carton (70069-051-01)  / 10 Ml In 1 Bottle","637","RC","70069-051-01","NDC","","","facility","both","1","EA","","25.79","25.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride Extended-Release: 100 Tablet, Extended Release In 1 Bottle (70010-135-01)","637","RC","70010-135-01","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin Hydrochloride: 100 Tablet In 1 Bottle (70010-063-01)","637","RC","70010-063-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (70010-034-01)","637","RC","70010-034-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (70010-032-01)","637","RC","70010-032-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (70010-030-01)","637","RC","70010-030-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Capsule, Extended Release In 1 Bottle (70010-004-01)","637","RC","70010-004-01","NDC","","","facility","both","1","EA","","1.77","1.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Capsule, Extended Release In 1 Bottle (70010-029-01)","637","RC","70010-029-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 500 Tablet In 1 Bottle (70010-161-05)","637","RC","70010-161-05","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 1000 Tablet In 1 Bottle (70010-161-10)","637","RC","70010-161-10","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylergonovine Maleate: 12 Tablet In 1 Bottle (70010-786-12)","637","RC","70010-786-12","NDC","","","facility","both","1","EA","","23.28","23.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metformin: 100 Tablet, Extended Release In 1 Bottle (70010-491-01)","637","RC","70010-491-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cetirizine Hydrochloride: 90 Tablet, Coated In 1 Bottle (70010-163-09)","637","RC","70010-163-09","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 100 Tablet In 1 Bottle (70010-162-01)","637","RC","70010-162-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-313-11","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","69339-153-01","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tacrolimus: 1 Tube In 1 Carton (68462-881-35)  / 30 G In 1 Tube","637","RC","68462-881-35","NDC","","","facility","both","1","EA","","61.46","61.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylergonovine Maleate: 12 Tablet In 1 Bottle (69238-1605-2)","637","RC","69238-1605-2","NDC","","","facility","both","1","EA","","21.91","21.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 100 Capsule In 1 Bottle (69238-1540-1)","637","RC","69238-1540-1","NDC","","","facility","both","1","EA","","1.75","1.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (69238-1532-5)  / 15 G In 1 Tube","637","RC","69238-1532-5","NDC","","","facility","both","1","EA","","5.97","5.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (69238-1532-3)  / 30 G In 1 Tube","637","RC","69238-1532-3","NDC","","","facility","both","1","EA","","11.58","11.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bumetanide: 100 Tablet In 1 Bottle (69238-1491-1)","637","RC","69238-1491-1","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 100 Tablet In 1 Bottle (69238-1306-1)","637","RC","69238-1306-1","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate: 500 Capsule In 1 Bottle (69238-1100-5)","637","RC","69238-1100-5","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dash Chlorhexidine Gluconate 0.12% Oral Rinse: 15 Ml In 1 Cup, Unit-Dose (69339-138-15)","637","RC","69339-138-15","NDC","","","facility","both","1","EA","","2.82","2.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenoxylate Hydrochloride And Atropine Sulfate: 100 Tablet In 1 Bottle (69315-910-01)","637","RC","69315-910-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 1000 Tablet In 1 Bottle (69315-905-10)","637","RC","69315-905-10","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 500 Tablet In 1 Bottle (69315-904-05)","637","RC","69315-904-05","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 473 Ml In 1 Bottle (69315-504-47)","637","RC","69315-504-47","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 15 G In 1 Bottle, Plastic (69315-306-15)","637","RC","69315-306-15","NDC","","","facility","both","1","EA","","13.65","13.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 100 Tablet In 1 Bottle (69238-2081-1)","637","RC","69238-2081-1","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amlodipine Besylate: 90 Tablet In 1 Bottle (69097-128-05)","637","RC","69097-128-05","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (69097-098-08)","637","RC","69097-098-08","NDC","","","facility","both","1","EA","","9","9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vigabatrin: 50 Packet In 1 Carton (69097-964-53)  / 10 Ml In 1 Packet","637","RC","69097-964-53","NDC","","","facility","both","1","EA","","29.85","29.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tenofovir Disoproxil Fumarate: 30 Tablet In 1 Bottle (69097-533-02)","637","RC","69097-533-02","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tadalafil: 60 Tablet, Film Coated In 1 Bottle (69097-526-03)","637","RC","69097-526-03","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 1 Bottle In 1 Carton (69230-326-60)  / 60 Tablet, Film Coated In 1 Bottle","637","RC","69230-326-60","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xifaxan: 60 Tablet In 1 Bottle (65649-303-02)","637","RC","65649-303-02","NDC","","","facility","both","1","EA","","95.81","95.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lansoprazole: 1 Kit In 1 Container (65628-080-10)  *  300 Ml In 1 Bottle, Plastic *  .9 G In 1 Bottle, Plastic","637","RC","65628-080-10","NDC","","","facility","both","1","EA","","3.99","3.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lansoprazole: 1 Kit In 1 Container (65628-080-03)  *  .27 G In 1 Bottle, Plastic *  90 Ml In 1 Bottle, Plastic","637","RC","65628-080-03","NDC","","","facility","both","1","EA","","4.49","4.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ad Prevent Original: 1 Tube In 1 Box (65197-401-01)  / 113 G In 1 Tube","637","RC","65197-401-01","NDC","","","facility","both","1","EA","","7.53","7.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 1 Bottle In 1 Carton (65162-893-74)  / 150 Ml In 1 Bottle","637","RC","65162-893-74","NDC","","","facility","both","1","EA","","27.36","27.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rivastigmine: 30 Patch In 1 Carton (65162-825-34)  / 24 H In 1 Patch","637","RC","65162-825-34","NDC","","","facility","both","1","EA","","7.06","7.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","65162-791-04","NDC","","","facility","both","1","EA","","4.07","4.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ad Treat Diaper Rash Cream With Dimethicone And Zinc Oxide: 1 Tube In 1 Box (65197-402-00)  / 113 G In 1 Tube","637","RC","65197-402-00","NDC","","","facility","both","1","EA","","7.53","7.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Budesonide: 100 Capsule, Delayed Release In 1 Bottle (65162-778-10)","637","RC","65162-778-10","NDC","","","facility","both","1","EA","","3.68","3.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xifaxan: 6 Blister Pack In 1 Carton (65649-303-03)  / 10 Tablet In 1 Blister Pack","637","RC","65649-303-03","NDC","","","facility","both","1","EA","","95.15","95.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diuril: 1 Bottle In 1 Carton (65649-311-12)  / 237 Ml In 1 Bottle","637","RC","65649-311-12","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 100 Tablet, Film Coated In 1 Bottle (65862-523-01)","637","RC","65862-523-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pioglitazone Hydrochloride: 30 Tablet In 1 Bottle (65862-513-30)","637","RC","65862-513-30","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 100 Tablet, Film Coated In 1 Bottle (65862-503-01)","637","RC","65862-503-01","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 20 Tablet, Film Coated In 1 Bottle (65862-502-20)","637","RC","65862-502-20","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 30 Capsule, Extended Release In 1 Bottle (65862-528-30)","637","RC","65862-528-30","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle (65862-420-01)","637","RC","65862-420-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 100 Tablet In 1 Bottle (65862-419-01)","637","RC","65862-419-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Escitalopram: 100 Tablet, Film Coated In 1 Bottle (65862-373-01)","637","RC","65862-373-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 473 Ml In 1 Bottle (65862-496-47)","637","RC","65862-496-47","NDC","","","facility","both","1","EA","","2.77","2.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prasugrel: 30 Tablet, Film Coated In 1 Bottle (65862-830-30)","637","RC","65862-830-30","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valganciclovir Hydrochloride: 60 Tablet In 1 Bottle (65862-753-60)","637","RC","65862-753-60","NDC","","","facility","both","1","EA","","5.28","5.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 150 Ml In 1 Bottle (65862-707-55)","637","RC","65862-707-55","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Venlafaxine Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (65862-697-90)","637","RC","65862-697-90","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 90 Tablet, Delayed Release In 1 Bottle (65862-559-90)","637","RC","65862-559-90","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 1 Blister Pack In 1 Carton (65862-641-69)  / 6 Tablet, Film Coated In 1 Blister Pack","637","RC","65862-641-69","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azithromycin: 3 Blister Pack In 1 Carton (65862-641-63)  / 6 Tablet, Film Coated In 1 Blister Pack","637","RC","65862-641-63","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","65862-626-03","NDC","","","facility","both","1","EA","","2.55","2.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Moxifloxacin Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (65862-603-30)","637","RC","65862-603-30","NDC","","","facility","both","1","EA","","3.89","3.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ritonavir: 30 Tablet, Film Coated In 1 Bottle (65862-687-30)","637","RC","65862-687-30","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 30 Tablet, Film Coated In 1 Bottle (65862-296-30)","637","RC","65862-296-30","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 5 Blister Pack In 1 Carton (65862-021-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack","637","RC","65862-021-06","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 500 Capsule In 1 Bottle (65862-017-05)","637","RC","65862-017-05","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Tartrate: 100 Tablet, Film Coated In 1 Bottle (65862-064-01)","637","RC","65862-064-01","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin: 100 Tablet, Film Coated In 1 Bottle (65862-015-01)","637","RC","65862-015-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 50 Tablet, Film Coated In 1 Bottle (65862-078-50)","637","RC","65862-078-50","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (65862-295-90)","637","RC","65862-295-90","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (65862-294-90)","637","RC","65862-294-90","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ribavirin: 84 Capsule In 1 Bottle (65862-290-84)","637","RC","65862-290-84","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 120 Tablet, Film Coated In 1 Bottle (65862-247-08)","637","RC","65862-247-08","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 120 Tablet, Film Coated In 1 Bottle (65862-246-08)","637","RC","65862-246-08","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clarithromycin: 60 Tablet, Film Coated In 1 Bottle (65862-225-60)","637","RC","65862-225-60","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefdinir: 1 Bottle In 1 Carton (65862-218-60)  / 60 Ml In 1 Bottle","637","RC","65862-218-60","NDC","","","facility","both","1","EA","","3.74","3.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losartan Potassium: 90 Tablet, Film Coated In 1 Bottle (65862-201-90)","637","RC","65862-201-90","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclobenzaprine Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (65862-191-05)","637","RC","65862-191-05","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefpodoxime Proxetil: 20 Tablet, Film Coated In 1 Bottle (65862-095-20)","637","RC","65862-095-20","NDC","","","facility","both","1","EA","","3.48","3.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Escitalopram Oxalate: 240 Ml In 1 Bottle (65162-705-88)","637","RC","65162-705-88","NDC","","","facility","both","1","EA","","5.31","5.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (64380-885-04)","637","RC","64380-885-04","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cinacalcet: 30 Tablet, Film Coated In 1 Bottle (64380-883-04)","637","RC","64380-883-04","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ethosuximide: 100 Capsule In 1 Bottle (64380-878-06)","637","RC","64380-878-06","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ursodiol: 100 Tablet In 1 Bottle (64380-918-06)","637","RC","64380-918-06","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 10 Capsule In 1 Blister Pack (64380-797-01)","637","RC","64380-797-01","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acarbose: 100 Tablet In 1 Bottle, Plastic (64380-759-06)","637","RC","64380-759-06","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vitamin D: 100 Capsule In 1 Bottle, Plastic (64380-737-06)","637","RC","64380-737-06","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 50 Tablet In 1 Bottle, Plastic (64380-970-25)","637","RC","64380-970-25","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamivudine: 60 Tablet, Film Coated In 1 Bottle (64380-710-03)","637","RC","64380-710-03","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranylcypromine Sulfate: 100 Tablet, Film Coated In 1 Bottle (64380-176-01)","637","RC","64380-176-01","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 90 Capsule In 1 Bottle (65162-025-09)","637","RC","65162-025-09","NDC","","","facility","both","1","EA","","4.52","4.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lisdexamfetamine Dimesylate: 90 Capsule In 1 Bottle (65162-024-09)","637","RC","65162-024-09","NDC","","","facility","both","1","EA","","4.34","4.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naproxen: 100 Tablet In 1 Bottle (65162-188-10)","637","RC","65162-188-10","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lactulose Solution: 473 Ml In 1 Bottle (64980-592-48)","637","RC","64980-592-48","NDC","","","facility","both","1","EA","","6.48","6.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naproxen: 100 Tablet In 1 Bottle (65162-189-10)","637","RC","65162-189-10","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lorazepam: 30 Ml In 1 Bottle, Dropper (65162-687-84)","637","RC","65162-687-84","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Felbamate: 237 Ml In 1 Bottle (65162-686-88)","637","RC","65162-686-88","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (65162-682-10)","637","RC","65162-682-10","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle (65162-681-10)","637","RC","65162-681-10","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 500 Tablet In 1 Bottle (65162-465-50)","637","RC","65162-465-50","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 100 Tablet In 1 Bottle (65162-465-10)","637","RC","65162-465-10","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 100 Tablet In 1 Bottle (65162-464-10)","637","RC","65162-464-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isradipine: 100 Capsule In 1 Bottle (64850-910-01)","637","RC","64850-910-01","NDC","","","facility","both","1","EA","","4.46","4.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate And Amphetamine Sulfate: 100 Tablet In 1 Bottle (64850-500-01)","637","RC","64850-500-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Livtencity: 1 Bottle In 1 Carton (64764-800-56)  / 56 Tablet, Coated In 1 Bottle","637","RC","64764-800-56","NDC","","","facility","both","1","EA","","400.18","400.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-750-30)","637","RC","64764-750-30","NDC","","","facility","both","1","EA","","28.45","28.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-730-30)","637","RC","64764-730-30","NDC","","","facility","both","1","EA","","28.45","28.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trintellix: 30 Tablet, Film Coated In 1 Bottle (64764-720-30)","637","RC","64764-720-30","NDC","","","facility","both","1","EA","","28.44","28.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","64764-544-30","NDC","","","facility","both","1","EA","","22.97","22.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Livtencity: 1 Bottle In 1 Carton (64764-800-28)  / 28 Tablet, Coated In 1 Bottle","637","RC","64764-800-28","NDC","","","facility","both","1","EA","","400.18","400.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-661-01)","637","RC","64896-661-01","NDC","","","facility","both","1","EA","","6.9","6.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyproheptadine Hydrochloride: 473 Ml In 1 Bottle (64980-504-48)","637","RC","64980-504-48","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Calcitriol: 1 Bottle, Glass In 1 Carton (64980-447-15)  / 15 Ml In 1 Bottle, Glass","637","RC","64980-447-15","NDC","","","facility","both","1","EA","","6.2","6.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyridostigmine Bromide: 30 Tablet In 1 Bottle (64980-220-03)","637","RC","64980-220-03","NDC","","","facility","both","1","EA","","11.02","11.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lithium Carbonate: 100 Tablet, Extended Release In 1 Bottle (64980-205-01)","637","RC","64980-205-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","64950-354-05","NDC","","","facility","both","1","EA","","9.8","9.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-664-01)","637","RC","64896-664-01","NDC","","","facility","both","1","EA","","8.67","8.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-663-01)","637","RC","64896-663-01","NDC","","","facility","both","1","EA","","6.9","6.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rytary: 100 Capsule, Extended Release In 1 Bottle (64896-662-01)","637","RC","64896-662-01","NDC","","","facility","both","1","EA","","6.9","6.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","65862-896-10","NDC","","","facility","both","1","EA","","9.25","9.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (67877-433-03)","637","RC","67877-433-03","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (67877-430-03)","637","RC","67877-430-03","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Linezolid: 1 Blister Pack In 1 Carton (67877-419-33)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","67877-419-33","NDC","","","facility","both","1","EA","","4.65","4.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 30 Tablet In 1 Bottle (67877-434-03)","637","RC","67877-434-03","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","67877-298-09","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Riluzole: 60 Tablet In 1 Bottle (67877-286-60)","637","RC","67877-286-60","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Triamcinolone Acetonide: 454 G In 1 Jar (67877-251-45)","637","RC","67877-251-45","NDC","","","facility","both","1","EA","","26.97","26.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 500 Capsule In 1 Bottle (67877-223-05)","637","RC","67877-223-05","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefuroxime Axetil: 60 Tablet, Film Coated In 1 Bottle (67877-216-60)","637","RC","67877-216-60","NDC","","","facility","both","1","EA","","2.28","2.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 473 Ml In 1 Bottle (67877-457-47)","637","RC","67877-457-47","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","67877-677-73","NDC","","","facility","both","1","EA","","109.09","109.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 1 Bottle In 1 Carton (67877-658-61)  / 120 Ml In 1 Bottle","637","RC","67877-658-61","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (67877-639-30)","637","RC","67877-639-30","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (67877-592-01)","637","RC","67877-592-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (67877-590-01)","637","RC","67877-590-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Colchicine: 100 Tablet In 1 Bottle (67877-589-01)","637","RC","67877-589-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefdinir: 60 Capsule In 1 Bottle (67877-543-60)","637","RC","67877-543-60","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 90 Capsule In 1 Bottle (67877-462-90)","637","RC","67877-462-90","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (67877-638-30)","637","RC","67877-638-30","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cefuroxime Axetil: 60 Tablet, Film Coated In 1 Bottle (67877-215-60)","637","RC","67877-215-60","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide Oral Solution: 200 Ml In 1 Bottle (67877-732-95)","637","RC","67877-732-95","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride: 30 Blister Pack In 1 Box, Unit-Dose (68084-252-21)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (68084-252-11)","637","RC","68084-252-21","NDC","","","facility","both","1","EA","","4.21","4.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-249-11","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-248-11","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-269-11","NDC","","","facility","both","1","EA","","2.5","2.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-214-11","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-205-11","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-204-11","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir Hydrochloride: 30 Blister Pack In 1 Box, Unit-Dose (68084-309-21)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-309-11)","637","RC","68084-309-21","NDC","","","facility","both","1","EA","","4.16","4.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-300-11","NDC","","","facility","both","1","EA","","2.71","2.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-299-11","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-291-11","NDC","","","facility","both","1","EA","","3.14","3.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-288-11","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-282-11","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-281-11","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-272-11","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 100 Blister Pack In 1 Box, Unit-Dose (68084-272-01)  / 1 Tablet, Film Coated In 1 Blister Pack (68084-272-11)","637","RC","68084-272-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-270-11","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-203-11","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-202-11","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-070-11","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-046-11","NDC","","","facility","both","1","EA","","1.04","1.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-045-11","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-041-11","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-189-11","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-157-11","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-120-11","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-119-11","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-109-11","NDC","","","facility","both","1","EA","","1.17","1.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-099-11","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-098-11","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","68084-097-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","66689-401-01","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Digoxin: 1 Bottle, Glass In 1 Carton (66689-327-02)  / 60 Ml In 1 Bottle, Glass","637","RC","66689-327-02","NDC","","","facility","both","1","EA","","1.05","1.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","66689-106-01","NDC","","","facility","both","1","EA","","1.95","1.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 1 Bottle, Plastic In 1 Carton (66689-058-04)  / 120 Ml In 1 Bottle, Plastic","637","RC","66689-058-04","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","66689-047-01","NDC","","","facility","both","1","EA","","7.54","7.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methadone Hydrochloride: 500 Ml In 1 Bottle (66689-711-16)","637","RC","66689-711-16","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cipro Hc: 1 Bottle In 1 Carton (66758-087-70)  / 10 Ml In 1 Bottle","637","RC","66758-087-70","NDC","","","facility","both","1","EA","","604.98","604.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciloxan: 3.5 G In 1 Tube (66758-071-38)","637","RC","66758-071-38","NDC","","","facility","both","1","EA","","441.79","441.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Uptravi: 1 Bottle In 1 Carton (66215-604-06)  / 60 Tablet, Coated In 1 Bottle","637","RC","66215-604-06","NDC","","","facility","both","1","EA","","669.1","669.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Uptravi: 1 Bottle In 1 Carton (66215-602-06)  / 60 Tablet, Coated In 1 Bottle","637","RC","66215-602-06","NDC","","","facility","both","1","EA","","557.58","557.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opsumit: 1 Bottle In 1 Carton (66215-501-30)  / 30 Tablet, Film Coated In 1 Bottle","637","RC","66215-501-30","NDC","","","facility","both","1","EA","","758.34","758.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dorzolamide Hydrochloride And Timolol Maleate: 1 Bottle, Dropper In 1 Carton (65862-946-01)  / 10 Ml In 1 Bottle, Dropper","637","RC","65862-946-01","NDC","","","facility","both","1","EA","","33.2","33.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","65862-930-08","NDC","","","facility","both","1","EA","","2.51","2.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Finasteride: 30 Tablet, Film Coated In 1 Bottle (65862-927-30)","637","RC","65862-927-30","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sevelamer Carbonate: 270 Tablet, Film Coated In 1 Bottle (65862-921-27)","637","RC","65862-921-27","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 60 Capsule In 1 Bottle (65862-907-60)","637","RC","65862-907-60","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","66658-234-01","NDC","","","facility","both","1","EA","","416.45","416.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","66553-008-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","66553-004-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","66553-002-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","66553-001-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sancuso: 168 H In 1 Pouch (66220-637-31)","637","RC","66220-637-31","NDC","","","facility","both","1","EA","","1099.14","1099.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dapagliflozin: 30 Tablet, Film Coated In 1 Bottle, Plastic (66993-457-30)","637","RC","66993-457-30","NDC","","","facility","both","1","EA","","20.94","20.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dapagliflozin: 30 Tablet, Film Coated In 1 Bottle, Plastic (66993-456-30)","637","RC","66993-456-30","NDC","","","facility","both","1","EA","","20.94","20.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Insulin Aspart: 5 Syringe, Plastic In 1 Carton (73070-103-15)  / 3 Ml In 1 Syringe, Plastic (73070-103-10)","637","RC","73070-103-15","NDC","","","facility","both","1","EA","","26.49","26.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","73070-103-10","NDC","","","facility","both","1","EA","","29.92","29.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Insulin Aspart: 1 Vial, Glass In 1 Carton (73070-100-11)  / 10 Ml In 1 Vial, Glass","637","RC","73070-100-11","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (73043-010-03)","637","RC","73043-010-03","NDC","","","facility","both","1","EA","","2.83","2.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclosporine: 3 Pouch In 1 Carton (73043-005-01)  / 10 Vial, Single-Use In 1 Pouch / .4 Ml In 1 Vial, Single-Use","637","RC","73043-005-01","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibsrela: 60 Tablet In 1 Bottle (73154-050-60)","637","RC","73154-050-60","NDC","","","facility","both","1","EA","","51.87","51.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle (72888-083-01)","637","RC","72888-083-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 100 Tablet In 1 Bottle (72888-082-01)","637","RC","72888-082-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 500 Tablet, Coated In 1 Bottle (72888-080-05)","637","RC","72888-080-05","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 1 Bottle In 1 Carton (72888-074-14)  / 250 Ml In 1 Bottle","637","RC","72888-074-14","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 50 Pouch In 1 Carton (72888-024-43)  / 1.58 G In 1 Pouch (72888-024-06)","637","RC","72888-024-43","NDC","","","facility","both","1","EA","","2.39","2.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 30 Pouch In 1 Carton (72888-024-07)  / 1.58 G In 1 Pouch (72888-024-06)","637","RC","72888-024-07","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","72888-024-06","NDC","","","facility","both","1","EA","","1.92","1.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 100 Tablet In 1 Bottle (72888-009-01)","637","RC","72888-009-01","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvedilol: 100 Tablet, Film Coated In 1 Bottle (72888-037-01)","637","RC","72888-037-01","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 100 Tablet In 1 Bottle (72888-113-01)","637","RC","72888-113-01","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 30 Tablet In 1 Bottle (72888-178-30)","637","RC","72888-178-30","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 500 Tablet In 1 Bottle (72888-153-05)","637","RC","72888-153-05","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine: 90 Tablet, Extended Release In 1 Package (72888-143-90)","637","RC","72888-143-90","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 100 Ml In 1 Bottle (72888-125-26)","637","RC","72888-125-26","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 500 Tablet, Extended Release In 1 Bottle, Plastic (72789-365-82)","637","RC","72789-365-82","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","73177-114-15","NDC","","","facility","both","1","EA","","432","432","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 100 Tablet In 1 Bottle (75834-221-01)","637","RC","75834-221-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nivagen Zinc Oxide: 56.7 G In 1 Tube (75834-170-02)","637","RC","75834-170-02","NDC","","","facility","both","1","EA","","8.48","8.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet In 1 Bottle (75834-159-01)","637","RC","75834-159-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet In 1 Bottle (75834-158-01)","637","RC","75834-158-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin: 30 Tablet, Film Coated In 1 Bottle (75834-242-30)","637","RC","75834-242-30","NDC","","","facility","both","1","EA","","6.47","6.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (75826-115-10)","637","RC","75826-115-10","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenazopyridine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (75826-114-10)","637","RC","75826-114-10","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diphenoxylate Hydrochloride And Atropine Sulfate: 1000 Tablet In 1 Bottle, Plastic (75826-107-00)","637","RC","75826-107-00","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Iodide: 30 Ml In 1 Bottle, With Applicator (75834-280-30)","637","RC","75834-280-30","NDC","","","facility","both","1","EA","","5.05","5.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ravicti: 1 Bottle In 1 Carton (75987-050-06)  / 25 Ml In 1 Bottle","637","RC","75987-050-06","NDC","","","facility","both","1","EA","","926.48","926.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle, Plastic (75907-069-01)","637","RC","75907-069-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Verapamil Hydrochloride: 100 Tablet In 1 Bottle (75834-320-01)","637","RC","75834-320-01","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Niva Thyroid: 100 Tablet In 1 Bottle (75834-311-01)","637","RC","75834-311-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Niva Thyroid: 100 Tablet In 1 Bottle (75834-310-01)","637","RC","75834-310-01","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin Ethylsuccinate: 100 Ml In 1 Bottle (75834-295-01)","637","RC","75834-295-01","NDC","","","facility","both","1","EA","","4.45","4.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nortriptyline Hydrochloride: 100 Capsule In 1 Bottle, Plastic (75907-071-01)","637","RC","75907-071-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemtesa: 30 Tablet, Film Coated In 1 Bottle (73336-075-30)","637","RC","73336-075-30","NDC","","","facility","both","1","EA","","24.95","24.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ella: 1 Blister Pack In 1 Carton (73302-456-01)  / 1 Tablet In 1 Blister Pack","637","RC","73302-456-01","NDC","","","facility","both","1","EA","","64.31","64.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Viokace: 1 Bottle In 1 Carton (73562-208-10)  / 100 Tablet In 1 Bottle","637","RC","73562-208-10","NDC","","","facility","both","1","EA","","14.56","14.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-116-01)","637","RC","73562-116-01","NDC","","","facility","both","1","EA","","17.84","17.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-114-01)","637","RC","73562-114-01","NDC","","","facility","both","1","EA","","28.44","28.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-112-01)","637","RC","73562-112-01","NDC","","","facility","both","1","EA","","14.41","14.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zenpep: 100 Capsule, Delayed Release In 1 Bottle (73562-110-01)","637","RC","73562-110-01","NDC","","","facility","both","1","EA","","7.35","7.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyproheptadine Hydrochloride: 100 Tablet In 1 Bottle, Plastic (72789-102-01)","637","RC","72789-102-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acyclovir: 100 Capsule In 1 Bottle (72578-002-01)","637","RC","72578-002-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Tablet, Extended Release In 1 Bottle (72516-032-01)","637","RC","72516-032-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","72485-507-01","NDC","","","facility","both","1","EA","","3","3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","72603-406-01","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 30 Tablet, Film Coated In 1 Bottle (72603-558-01)","637","RC","72603-558-01","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nurtec Odt: 1 Blister Pack In 1 Carton (72618-3000-2)  / 8 Tablet, Orally Disintegrating In 1 Blister Pack","637","RC","72618-3000-2","NDC","","","facility","both","1","EA","","213.47","213.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 100 Tablet, Extended Release In 1 Bottle (72603-338-01)","637","RC","72603-338-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 100 Tablet, Extended Release In 1 Bottle (72603-337-01)","637","RC","72603-337-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemfibrozil: 60 Tablet, Film Coated In 1 Bottle (72603-206-01)","637","RC","72603-206-01","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 30 Tablet, Film Coated In 1 Bottle (72603-156-01)","637","RC","72603-156-01","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate Cream Usp, 0.05% Clobetasol Propionate Cream Usp, 0.05%: 30 G In 1 Tube (72603-323-02)","637","RC","72603-323-02","NDC","","","facility","both","1","EA","","8.07","8.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclobenzaprine Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (72603-312-02)","637","RC","72603-312-02","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 100 Tablet, Film Coated In 1 Bottle (72603-272-01)","637","RC","72603-272-01","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 1 Bottle In 1 Carton (72603-240-01)  / 473 Ml In 1 Bottle","637","RC","72603-240-01","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","9999-1015-38","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","9999-1013-03","NDC","","","facility","both","1","EA","","44.72","44.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","9999-1009-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Natacyn: 1 Bottle, Glass In 1 Carton (82667-012-05)  / 15 Ml In 1 Bottle, Glass","637","RC","82667-012-05","NDC","","","facility","both","1","EA","","1704.6","1704.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cosopt: 1 Bottle, Dropper In 1 Carton (82584-605-10)  / 10 Ml In 1 Bottle, Dropper","637","RC","82584-605-10","NDC","","","facility","both","1","EA","","402.07","402.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluorescein Sodium And Benoxinate Hydrochloride: 1 Bottle, Glass In 1 Carton (82260-734-05)  / 5 Ml In 1 Bottle, Glass","637","RC","82260-734-05","NDC","","","facility","both","1","EA","","39.06","39.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sucralfate: 420 Ml In 1 Bottle (82182-106-14)","637","RC","82182-106-14","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pegasys: 1 Packet In 1 Box (82154-0451-4)  / 4 Syringe, Glass In 1 Packet / .5 Ml In 1 Syringe, Glass","637","RC","82154-0451-4","NDC","","","facility","both","1","EA","","1944.05","1944.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","82154-0451-1","NDC","","","facility","both","1","EA","","1944.05","1944.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","99999-4087-08","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lysodren: 1 Bottle In 1 Carton (76336-080-60)  / 100 Tablet In 1 Bottle","637","RC","76336-080-60","NDC","","","facility","both","1","EA","","29.19","29.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","77333-827-25","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","77333-812-25","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simethicone 80Mg: 100 Blister Pack In 1 Box (77333-812-10)  / 1 Tablet, Chewable In 1 Blister Pack (77333-812-25)","637","RC","77333-812-10","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","77333-049-25","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","77333-031-25","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nadolol: 100 Tablet In 1 Bottle (76385-134-01)","637","RC","76385-134-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nadolol: 100 Tablet In 1 Bottle (76385-133-01)","637","RC","76385-133-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 100 Tablet, Film Coated In 1 Bottle (76385-124-01)","637","RC","76385-124-01","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 100 Tablet, Film Coated In 1 Bottle (76385-123-01)","637","RC","76385-123-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 10 Capsule In 1 Blister Pack (76282-704-45)","637","RC","76282-704-45","NDC","","","facility","both","1","EA","","2.33","2.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","81033-512-15","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","81033-412-15","NDC","","","facility","both","1","EA","","3.77","3.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","81033-241-15","NDC","","","facility","both","1","EA","","1.32","1.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","81033-104-05","NDC","","","facility","both","1","EA","","31.23","31.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","81033-102-05","NDC","","","facility","both","1","EA","","2.11","2.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phytonadione: 1 Bottle In 1 Carton (70710-1014-1)  / 100 Tablet In 1 Bottle","637","RC","70710-1014-1","NDC","","","facility","both","1","EA","","32.69","32.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferasirox: 30 Tablet In 1 Bottle, Plastic (70700-271-30)","637","RC","70700-271-30","NDC","","","facility","both","1","EA","","3.2","3.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin: 30 Tablet, Film Coated In 1 Bottle (70710-1047-3)","637","RC","70710-1047-3","NDC","","","facility","both","1","EA","","7.94","7.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosfomycin Tromethamine: 1 Powder In 1 Packet (70700-268-99)","637","RC","70700-268-99","NDC","","","facility","both","1","EA","","133.3","133.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fosfomycin Tromethamine: 1 Dose Pack In 1 Carton (70700-268-94)  / 1 Powder In 1 Dose Pack","637","RC","70700-268-94","NDC","","","facility","both","1","EA","","133.31","133.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","70700-116-84","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Pain Reliever: 12 Blister Pack In 1 Carton (70677-1270-1)  / 1 Suppository In 1 Blister Pack","637","RC","70677-1270-1","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Deferasirox: 30 Tablet In 1 Bottle, Plastic (70700-270-30)","637","RC","70700-270-30","NDC","","","facility","both","1","EA","","1.6","1.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyproheptadine Hydrochloride: 100 Tablet In 1 Bottle (70710-1110-1)","637","RC","70710-1110-1","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Meclizine Hydrochloride: 100 Tablet In 1 Bottle (70710-1162-1)","637","RC","70710-1162-1","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirabegron: 90 Tablet, Extended Release In 1 Bottle (70710-1160-9)","637","RC","70710-1160-9","NDC","","","facility","both","1","EA","","17.09","17.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirabegron: 90 Tablet, Extended Release In 1 Bottle (70710-1159-9)","637","RC","70710-1159-9","NDC","","","facility","both","1","EA","","14.65","14.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 30 Tablet In 1 Bottle (70710-1140-3)","637","RC","70710-1140-3","NDC","","","facility","both","1","EA","","1.29","1.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Childrens Allergy Relief: 1 Bottle In 1 Carton (70677-1268-1)  / 118 Ml In 1 Bottle","637","RC","70677-1268-1","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Milk Of Magnesia: 355 Ml In 1 Bottle (70677-1073-1)","637","RC","70677-1073-1","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Regular Strength Stomach Relief 527: 236 Ml In 1 Bottle (70677-1191-1)","637","RC","70677-1191-1","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Earwax Removal Drops: 1 Bottle In 1 Box (70677-1154-1)  / 15 Ml In 1 Bottle","637","RC","70677-1154-1","NDC","","","facility","both","1","EA","","3.7","3.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stay Awake: 2 Blister Pack In 1 Carton (70677-1126-1)  / 8 Tablet In 1 Blister Pack","637","RC","70677-1126-1","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Magnesium Citrate: 296 Ml In 1 Bottle, Plastic (70677-1111-1)","637","RC","70677-1111-1","NDC","","","facility","both","1","EA","","2.45","2.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mineral Oil: 473 Ml In 1 Bottle, Plastic (70677-1110-1)","637","RC","70677-1110-1","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Anti-Diarrheal: 120 Ml In 1 Bottle (70677-1107-1)","637","RC","70677-1107-1","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Acid Reducer: 1 Bottle In 1 Carton (70677-1102-3)  / 90 Tablet, Film Coated In 1 Bottle","637","RC","70677-1102-3","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Ready To Use Mineral Oil Laxative: 1 Bottle In 1 Carton (70677-1090-1)  / 133 Ml In 1 Bottle","637","RC","70677-1090-1","NDC","","","facility","both","1","EA","","3.12","3.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Ready To Use Saline Laxative: 1 Bottle In 1 Carton (70677-1089-1)  / 133 Ml In 1 Bottle","637","RC","70677-1089-1","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Foster And Thrive Stomach Relief: 1 Bottle In 1 Carton (70677-1082-1)  / 40 Tablet In 1 Bottle","637","RC","70677-1082-1","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lansoprazole: 90 Capsule, Delayed Release In 1 Bottle (70756-807-90)","637","RC","70756-807-90","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin (Monohydrate/Macrocrystals): 100 Capsule In 1 Bottle (70756-404-11)","637","RC","70756-404-11","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amitriptyline Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (70756-201-11)","637","RC","70756-201-11","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 1 Tube In 1 Carton (70752-113-03)  / 35.44 G In 1 Tube","637","RC","70752-113-03","NDC","","","facility","both","1","EA","","16.96","16.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Posaconazole: 60 Tablet, Delayed Release In 1 Bottle (70748-258-07)","637","RC","70748-258-07","NDC","","","facility","both","1","EA","","9.96","9.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","70512-812-01","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin: 1 Bottle, Glass In 1 Carton (70069-829-01)  / 230 Ml In 1 Bottle, Glass","637","RC","70069-829-01","NDC","","","facility","both","1","EA","","49.19","49.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Esomeprazole Magnesium: 90 Capsule, Delayed Release In 1 Bottle (70069-815-90)","637","RC","70069-815-90","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valganciclovir Hydrochloride: 100 Ml In 1 Bottle (70069-810-01)","637","RC","70069-810-01","NDC","","","facility","both","1","EA","","20.78","20.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin: 1 Bottle, Glass In 1 Carton (70377-118-31)  / 230 Ml In 1 Bottle, Glass","637","RC","70377-118-31","NDC","","","facility","both","1","EA","","45.16","45.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 1 Bottle In 1 Carton (70377-117-11)  / 250 Ml In 1 Bottle","637","RC","70377-117-11","NDC","","","facility","both","1","EA","","3.14","3.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 50 Ml In 1 Bottle (70377-113-11)","637","RC","70377-113-11","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine: 90 Tablet, Extended Release In 1 Bottle, Plastic (70436-012-06)","637","RC","70436-012-06","NDC","","","facility","both","1","EA","","1.15","1.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxylamine Succinate And Pyridoxine Hydrochloride: 100 Tablet, Delayed Release In 1 Bottle (70505-100-10)","637","RC","70505-100-10","NDC","","","facility","both","1","EA","","4.92","4.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","70127-100-06","NDC","","","facility","both","1","EA","","53.11","53.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","70127-100-01","NDC","","","facility","both","1","EA","","86.44","86.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xcopri: 30 Tablet, Film Coated In 1 Bottle (71699-200-30)","637","RC","71699-200-30","NDC","","","facility","both","1","EA","","67.25","67.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xcopri: 30 Tablet, Film Coated In 1 Bottle (71699-050-30)","637","RC","71699-050-30","NDC","","","facility","both","1","EA","","64.84","64.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 1 Bottle In 1 Bottle (71656-061-16)  / 473 Ml In 1 Bottle","637","RC","71656-061-16","NDC","","","facility","both","1","EA","","2.26","2.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","71399-4456-1","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Natacyn: 1 Bottle, Glass In 1 Carton (71776-005-15)  / 15 Ml In 1 Bottle, Glass","637","RC","71776-005-15","NDC","","","facility","both","1","EA","","852.56","852.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride Extended-Release: 90 Tablet, Extended Release In 1 Bottle (72162-1786-9)","637","RC","72162-1786-9","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Caplyta: 30 Capsule In 1 Bottle (72060-142-40)","637","RC","72060-142-40","NDC","","","facility","both","1","EA","","94.61","94.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Opfolda: 4 Bottle, Plastic In 1 Bottle, Plastic (71904-300-01)  / 1 Capsule In 1 Bottle, Plastic","637","RC","71904-300-01","NDC","","","facility","both","1","EA","","60.34","60.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Asperflex 24Hrs: 1 Patch In 1 Package (71399-3884-1)","637","RC","71399-3884-1","NDC","","","facility","both","1","EA","","1.53","1.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 50 Tablet In 1 Bottle (71399-1025-6)","637","RC","71399-1025-6","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 100 Pouch In 1 Package (71399-1025-3)  / 1 Tablet In 1 Pouch","637","RC","71399-1025-3","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medpura Vitamin A And D Vitamin A And D: 113 G In 1 Tube (71399-0122-4)","637","RC","71399-0122-4","NDC","","","facility","both","1","EA","","5.9","5.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Medpura Vitamin A And D Vitamin A And D: 454 G In 1 Jar (71399-0122-1)","637","RC","71399-0122-1","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Capsule In 1 Bottle (72241-023-05)","637","RC","72241-023-05","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ticagrelor: 100 Tablet In 1 Bottle (72205-368-91)","637","RC","72205-368-91","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Albendazole: 2 Tablet In 1 Bottle (72205-051-08)","637","RC","72205-051-08","NDC","","","facility","both","1","EA","","39.36","39.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (72205-044-11)  / 10 Capsule In 1 Blister Pack","637","RC","72205-044-11","NDC","","","facility","both","1","EA","","3.02","3.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 1 Blister Pack In 1 Carton (72205-042-11)  / 10 Capsule In 1 Blister Pack","637","RC","72205-042-11","NDC","","","facility","both","1","EA","","2.74","2.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oseltamivir Phosphate: 60 Ml In 1 Bottle, Glass (72205-060-78)","637","RC","72205-060-78","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Atorvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (72205-024-90)","637","RC","72205-024-90","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 90 Tablet, Film Coated In 1 Bottle (72205-003-90)","637","RC","72205-003-90","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sacubitril And Valsartan: 60 Tablet, Film Coated In 1 Bottle (72205-282-60)","637","RC","72205-282-60","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sacubitril And Valsartan: 60 Tablet, Film Coated In 1 Bottle (72205-281-60)","637","RC","72205-281-60","NDC","","","facility","both","1","EA","","1.82","1.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sacubitril And Valsartan: 60 Tablet, Film Coated In 1 Bottle (72205-280-60)","637","RC","72205-280-60","NDC","","","facility","both","1","EA","","1.87","1.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vilazodone Hydrochloride: 30 Tablet In 1 Bottle (72205-262-30)","637","RC","72205-262-30","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vilazodone Hydrochloride: 30 Tablet In 1 Bottle (72205-260-30)","637","RC","72205-260-30","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Darunavir: 30 Tablet, Film Coated In 1 Bottle, Plastic (72205-185-30)","637","RC","72205-185-30","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Misoprostol: 100 Tablet In 1 Bottle (70954-444-20)","637","RC","70954-444-20","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicyclomine Hydrochloride: 473 Ml In 1 Bottle (70954-261-10)","637","RC","70954-261-10","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trihexyphenidyl Hydrochloride: 100 Tablet In 1 Bottle (70954-212-10)","637","RC","70954-212-10","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Naproxen Oral Suspension: 500 Ml In 1 Bottle (70954-151-10)","637","RC","70954-151-10","NDC","","","facility","both","1","EA","","5.11","5.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyridostigmine: 473 Ml In 1 Bottle (70954-148-10)","637","RC","70954-148-10","NDC","","","facility","both","1","EA","","70.21","70.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levocarnitine: 118 Ml In 1 Bottle (70954-140-10)","637","RC","70954-140-10","NDC","","","facility","both","1","EA","","2.51","2.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dapsone: 100 Tablet In 1 Bottle (70954-136-20)","637","RC","70954-136-20","NDC","","","facility","both","1","EA","","1.44","1.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dapsone: 100 Tablet In 1 Bottle (70954-135-20)","637","RC","70954-135-20","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bisoprolol Fumarate: 30 Tablet In 1 Bottle (70954-455-10)","637","RC","70954-455-10","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levofloxacin: 480 Ml In 1 Bottle (70954-852-30)","637","RC","70954-852-30","NDC","","","facility","both","1","EA","","15.53","15.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluoxetine Hydrochloride: 120 Ml In 1 Bottle, Plastic (70954-600-10)","637","RC","70954-600-10","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nitrofurantoin: 230 Ml In 1 Bottle (70954-496-10)","637","RC","70954-496-10","NDC","","","facility","both","1","EA","","99.04","99.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-089-11","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Delsym: 1 Bottle In 1 Carton (63824-175-65)  / 148 Ml In 1 Bottle","637","RC","63824-175-65","NDC","","","facility","both","1","EA","","1.12","1.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","55566-6500-1","NDC","","","facility","both","1","EA","","24.03","24.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Corlanor: 60 Tablet, Film Coated In 1 Bottle (55513-810-60)","637","RC","55513-810-60","NDC","","","facility","both","1","EA","","17.27","17.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pramipexole Dihydrochloride: 90 Tablet In 1 Bottle (57237-184-90)","637","RC","57237-184-90","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Moxifloxacin Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (57237-156-30)","637","RC","57237-156-30","NDC","","","facility","both","1","EA","","9.69","9.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valacyclovir Hydrochloride: 90 Tablet, Film Coated In 1 Bottle (57237-042-90)","637","RC","57237-042-90","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Penicillin V Potassium: 100 Tablet, Film Coated In 1 Bottle (57237-040-01)","637","RC","57237-040-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluconazole: 12 Blister Pack In 1 Carton (57237-005-11)  / 1 Tablet In 1 Blister Pack","637","RC","57237-005-11","NDC","","","facility","both","1","EA","","1.5","1.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Corlanor: 60 Tablet, Film Coated In 1 Bottle (55513-800-60)","637","RC","55513-800-60","NDC","","","facility","both","1","EA","","16.63","16.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amjevita: 1 Syringe In 1 Carton (55513-481-01)  / .8 Ml In 1 Syringe","637","RC","55513-481-01","NDC","","","facility","both","1","EA","","2406.14","2406.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sumatriptan: 5 Vial, Single-Dose In 1 Carton (55150-173-01)  / .5 Ml In 1 Vial, Single-Dose","637","RC","55150-173-01","NDC","","","facility","both","1","EA","","6.37","6.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","55111-671-06","NDC","","","facility","both","1","EA","","34.48","34.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diclegis: 100 Tablet, Delayed Release In 1 Bottle (55494-100-10)","637","RC","55494-100-10","NDC","","","facility","both","1","EA","","3.46","3.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Chemet: 100 Capsule In 1 Bottle (55292-201-11)","637","RC","55292-201-11","NDC","","","facility","both","1","EA","","39.67","39.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Tablet In 1 Bottle (57664-376-88)","637","RC","57664-376-88","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dexmethylphenidate Hydrochloride: 100 Tablet In 1 Bottle (57664-378-88)","637","RC","57664-378-88","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propafenone Hydrochloride: 60 Capsule, Extended Release In 1 Bottle (59651-277-60)","637","RC","59651-277-60","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 100 Tablet In 1 Bottle (59651-249-01)","637","RC","59651-249-01","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leflunomide: 30 Tablet, Film Coated In 1 Bottle (59651-348-30)","637","RC","59651-348-30","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Progesterone: 100 Capsule In 1 Bottle (59651-152-01)","637","RC","59651-152-01","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ibuprofen: 1 Bottle In 1 Carton (59651-032-47)  / 473 Ml In 1 Bottle","637","RC","59651-032-47","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle (59651-026-55)","637","RC","59651-026-55","NDC","","","facility","both","1","EA","","7.03","7.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Niacin: 90 Tablet, Extended Release In 1 Bottle (59651-018-90)","637","RC","59651-018-90","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylin: 500 Ml In 1 Bottle (59630-750-50)","637","RC","59630-750-50","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 100 Tablet, Film Coated In 1 Bottle (59651-499-01)","637","RC","59651-499-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Tablet In 1 Bottle (59651-456-01)","637","RC","59651-456-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 50 Tablet In 1 Bottle (59651-413-50)","637","RC","59651-413-50","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobazam: 1 Bottle In 1 Carton (59651-401-12)  / 120 Ml In 1 Bottle","637","RC","59651-401-12","NDC","","","facility","both","1","EA","","1.6","1.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbidopa And Levodopa: 100 Tablet In 1 Bottle (59651-457-01)","637","RC","59651-457-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rexulti: 1 Bottle In 1 Carton (59148-038-13)  / 30 Tablet In 1 Bottle","637","RC","59148-038-13","NDC","","","facility","both","1","EA","","83.85","83.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rexulti: 1 Bottle In 1 Carton (59148-037-13)  / 30 Tablet In 1 Bottle","637","RC","59148-037-13","NDC","","","facility","both","1","EA","","82.64","82.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycontin: 2 Blister Pack In 1 Carton (59011-440-20)  / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack","637","RC","59011-440-20","NDC","","","facility","both","1","EA","","27.21","27.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycontin: 2 Blister Pack In 1 Carton (59011-420-20)  / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack","637","RC","59011-420-20","NDC","","","facility","both","1","EA","","14.95","14.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","59385-022-01","NDC","","","facility","both","1","EA","","12.5","12.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vyvanse: 100 Capsule In 1 Bottle (59417-101-10)","637","RC","59417-101-10","NDC","","","facility","both","1","EA","","21.46","21.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","59385-024-01","NDC","","","facility","both","1","EA","","26.66","26.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dicloxacillin Sodium: 100 Capsule In 1 Bottle (59651-566-01)","637","RC","59651-566-01","NDC","","","facility","both","1","EA","","1.67","1.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 100 Tablet In 1 Bottle (59762-0075-1)","637","RC","59762-0075-1","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 100 Tablet In 1 Bottle (59762-0074-1)","637","RC","59762-0074-1","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone: 50 Tablet In 1 Bottle (59762-0073-1)","637","RC","59762-0073-1","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 180 Capsule, Delayed Release In 1 Bottle (59762-0117-1)","637","RC","59762-0117-1","NDC","","","facility","both","1","EA","","3.87","3.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valsartan: 90 Tablet In 1 Bottle (59746-362-90)","637","RC","59746-362-90","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valsartan: 90 Tablet In 1 Bottle (59746-361-90)","637","RC","59746-361-90","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfasalazine: 1 Bottle In 1 Carton (59762-5000-5)  / 100 Tablet In 1 Bottle","637","RC","59762-5000-5","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxycontin: 2 Blister Pack In 1 Carton (59011-410-20)  / 10 Tablet, Film Coated, Extended Release In 1 Blister Pack","637","RC","59011-410-20","NDC","","","facility","both","1","EA","","8.1","8.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 7 Blister Pack In 1 Carton (59746-020-22)  / 4 Tablet, Orally Disintegrating In 1 Blister Pack","637","RC","59746-020-22","NDC","","","facility","both","1","EA","","1.59","1.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ciprofloxacin: 50 Tablet, Film Coated In 1 Bottle (59651-873-50)","637","RC","59651-873-50","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loperamide Hydrochloride: 100 Capsule In 1 Bottle (59651-691-01)","637","RC","59651-691-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluphenazine Hydrochloride: 100 Tablet In 1 Bottle (59651-686-01)","637","RC","59651-686-01","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Edurant: 30 Tablet, Film Coated In 1 Bottle (59676-278-01)","637","RC","59676-278-01","NDC","","","facility","both","1","EA","","82.06","82.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 3 Blister Pack In 1 Carton (59746-010-32)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","637","RC","59746-010-32","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prezcobix: 30 Tablet, Film Coated In 1 Bottle (59676-575-30)","637","RC","59676-575-30","NDC","","","facility","both","1","EA","","136.48","136.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Risperidone: 7 Blister Pack In 1 Carton (59746-030-22)  / 4 Tablet, Orally Disintegrating In 1 Blister Pack","637","RC","59746-030-22","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stratuscare Adult Glycerin: 12 Suppository In 1 Jar (58980-410-12)","637","RC","58980-410-12","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Analgesic Balm: 1 Tube In 1 Box (57896-116-03)  / 85 G In 1 Tube","637","RC","57896-116-03","NDC","","","facility","both","1","EA","","5.21","5.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Regular Strength Pain Relief: 1000 Tablet In 1 Bottle (57896-104-10)","637","RC","57896-104-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Regular Strength Pain Relief: 1000 Tablet In 1 Bottle (57896-102-10)","637","RC","57896-102-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"100 TABLET in 1 BOTTLE (57896-201-01) ","637","RC","57896-201-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simethicone: 100 Tablet, Chewable In 1 Bottle (57896-791-01)","637","RC","57896-791-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Geri-Lanta Antacid Antigas: 355 Ml In 1 Bottle (57896-629-12)","637","RC","57896-629-12","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polyethylene Glycol 3350: 30 Packet In 1 Carton (57896-490-03)  / 17 G In 1 Packet (57896-490-01)","637","RC","57896-490-03","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","57896-490-01","NDC","","","facility","both","1","EA","","1.11","1.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polyethylene Glycol 3350: 238 G In 1 Bottle (57896-489-14)","637","RC","57896-489-14","NDC","","","facility","both","1","EA","","2.59","2.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Extra Strength Pain Relief: 1000 Tablet In 1 Bottle (57896-201-10)","637","RC","57896-201-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Geri-Kot: 100 Tablet In 1 Bottle (57896-454-01)","637","RC","57896-454-01","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Geri-Kot: 100 Tablet In 1 Bottle (57896-434-01)","637","RC","57896-434-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"DIOCTO: 473 mL in 1 BOTTLE, PLASTIC (57896-403-16) ","637","RC","57896-403-16","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Extra Strength Pain Relief: 1000 Tablet In 1 Bottle (57896-221-10)","637","RC","57896-221-10","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gericare Senna Syrup: 237 Ml In 1 Bottle (57896-472-08)","637","RC","57896-472-08","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Minocycline Hydrochloride: 50 Capsule In 1 Bottle (57664-853-85)","637","RC","57664-853-85","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mirtazapine: 30 Tablet In 1 Bottle (57664-510-83)","637","RC","57664-510-83","NDC","","","facility","both","1","EA","","3.5","3.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Infants Gas Relief: 1 Bottle In 1 Box (57896-798-01)  / 30 Ml In 1 Bottle","637","RC","57896-798-01","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Regular Strength Enteric Coated Aspirin: 100 Tablet, Coated In 1 Bottle (57896-921-01)","637","RC","57896-921-01","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olopatadine Hydrochloride: 1 Bottle, Plastic In 1 Carton (58602-006-40)  / 5 Ml In 1 Bottle, Plastic","637","RC","58602-006-40","NDC","","","facility","both","1","EA","","12.62","12.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diclofenac Sodium: 1 Tube In 1 Carton (58602-604-07)  / 100 G In 1 Tube","637","RC","58602-604-07","NDC","","","facility","both","1","EA","","13.09","13.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stratuscare Glycerin Laxative Pediatric: 25 Suppository In 1 Jar (58980-409-25)","637","RC","58980-409-25","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stratuscare Glycerin Laxative Pediatric: 12 Suppository In 1 Jar (58980-409-12)","637","RC","58980-409-12","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carafate: 420 Ml In 1 Bottle (58914-170-14)","637","RC","58914-170-14","NDC","","","facility","both","1","EA","","10.6","10.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Theratears: 7 Pouch In 1 Carton (58790-002-28)  / .6 Ml In 1 Pouch","637","RC","58790-002-28","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guaifenesin: 473 Ml In 1 Bottle (58657-509-16)","637","RC","58657-509-16","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen: 100 Tablet In 1 Bottle (58602-773-21)","637","RC","58602-773-21","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 1 Blister Pack In 1 Carton (58602-702-83)  / 10 Tablet In 1 Blister Pack","637","RC","58602-702-83","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Loratadine: 10 Blister Pack In 1 Carton (58602-702-04)  / 10 Tablet In 1 Blister Pack","637","RC","58602-702-04","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lyrica: 473 Ml In 1 Bottle (58151-244-35)","637","RC","58151-244-35","NDC","","","facility","both","1","EA","","11","11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Dilantin: 100 Capsule, Extended Release In 1 Bottle, Plastic (58151-118-01)","637","RC","58151-118-01","NDC","","","facility","both","1","EA","","2.48","2.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gleostine: 1 Bottle In 1 Carton (58181-3041-5)  / 5 Capsule, Gelatin Coated In 1 Bottle","637","RC","58181-3041-5","NDC","","","facility","both","1","EA","","791.63","791.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xarelto: 1 Bottle In 1 Carton (50458-575-01)  / 1 Granule, For Suspension In 1 Bottle","637","RC","50458-575-01","NDC","","","facility","both","1","EA","","20.02","20.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50458-578-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Briviact: 1 Bottle In 1 Carton (50474-870-15)  / 300 Ml In 1 Bottle","637","RC","50474-870-15","NDC","","","facility","both","1","EA","","92.37","92.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Briviact: 100 Blister Pack In 1 Carton (50474-570-09)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","50474-570-09","NDC","","","facility","both","1","EA","","40.57","40.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Briviact: 100 Blister Pack In 1 Carton (50474-470-09)  / 1 Tablet, Film Coated In 1 Blister Pack","637","RC","50474-470-09","NDC","","","facility","both","1","EA","","40.75","40.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Concerta: 100 Tablet, Extended Release In 1 Bottle (50458-586-01)","637","RC","50458-586-01","NDC","","","facility","both","1","EA","","22.64","22.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50458-580-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xarelto: 10 Blister Pack In 1 Carton (50458-579-10)  / 10 Tablet, Film Coated In 1 Blister Pack (50458-579-01)","637","RC","50458-579-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50458-579-01","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Xarelto: 10 Blister Pack In 1 Carton (50458-578-10)  / 10 Tablet, Film Coated In 1 Blister Pack (50458-578-01)","637","RC","50458-578-10","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50383-775-15","NDC","","","facility","both","1","EA","","1.49","1.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine Hydrochloride: 100 mL in 1 BOTTLE, PLASTIC (50383-775-04) ","637","RC","50383-775-04","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levocarnitine: 9 BLISTER PACK in 1 CARTON (50383-172-90)  / 10 TABLET in 1 BLISTER PACK","637","RC","50383-172-90","NDC","","","facility","both","1","EA","","1.47","1.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Urea: 28.35 G In 1 Tube (50268-872-28)","637","RC","50268-872-28","NDC","","","facility","both","1","EA","","45.68","45.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-816-11","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-797-11","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50419-775-01","NDC","","","facility","both","1","EA","","2.13","2.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cipro: 1 Kit In 1 Kit (50419-773-01)  *  100 Ml In 1 Bottle, Glass *  100 Ml In 1 Bottle, Glass","637","RC","50419-773-01","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adempas: 9 Tablet, Film Coated In 1 Bottle (50419-253-91)","637","RC","50419-253-91","NDC","","","facility","both","1","EA","","219.17","219.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-058-01","NDC","","","facility","both","1","EA","","2.42","2.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-051-01","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-023-01","NDC","","","facility","both","1","EA","","3.5","3.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Scopolamine: 24 Pouch In 1 Carton (50742-505-24)  / 1 Patch, Extended Release In 1 Pouch","637","RC","50742-505-24","NDC","","","facility","both","1","EA","","8.63","8.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (51079-074-20)  / 1 Tablet In 1 Blister Pack (51079-074-01)","637","RC","51079-074-20","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-141-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-103-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-088-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-074-01","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-086-01","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-083-01","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-076-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-075-01","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50742-505-01","NDC","","","facility","both","1","EA","","15.77","15.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tylenol Regular Strength: 10 Blister Pack In 1 Carton (50580-458-11)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","50580-458-11","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tylenol Extra Strength: 10 Blister Pack In 1 Carton (50580-457-11)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","50580-457-11","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"10 BLISTER PACK in 1 CARTON (50580-412-02)  / 10 TABLET, FILM COATED in 1 BLISTER PACK","637","RC","50580-412-02","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Collagenase Santyl: 1 Tube In 1 Carton (50484-010-30)  / 30 G In 1 Tube","637","RC","50484-010-30","NDC","","","facility","both","1","EA","","503.52","503.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Quinine Sulfate: 30 Capsule In 1 Bottle, Plastic (50742-238-30)","637","RC","50742-238-30","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buprenorphine And Naloxone: 30 Pouch In 1 Carton (50742-365-30)  / 1 Film In 1 Pouch (50742-365-01)","637","RC","50742-365-30","NDC","","","facility","both","1","EA","","8.69","8.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50742-365-01","NDC","","","facility","both","1","EA","","10.21","10.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50742-364-01","NDC","","","facility","both","1","EA","","2.92","2.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (50742-363-60)","637","RC","50742-363-60","NDC","","","facility","both","1","EA","","3.1","3.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ivabradine: 60 Tablet, Film Coated In 1 Bottle (50742-362-60)","637","RC","50742-362-60","NDC","","","facility","both","1","EA","","3.41","3.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Norethindrone Acetate: 50 Tablet In 1 Bottle (50742-267-50)","637","RC","50742-267-50","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine: 300 Tablet, Extended Release In 1 Bottle (50742-261-03)","637","RC","50742-261-03","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diltiazem Hydrochloride: 90 Capsule, Extended Release In 1 Bottle (50742-250-90)","637","RC","50742-250-90","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine: 60 Tablet, Extended Release In 1 Bottle (50742-247-60)","637","RC","50742-247-60","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mexiletine Hydrochloride: 100 Capsule In 1 Bottle (50742-239-01)","637","RC","50742-239-01","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-789-11","NDC","","","facility","both","1","EA","","2.67","2.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-361-11","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-339-11","NDC","","","facility","both","1","EA","","2.53","2.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Finasteride: 50 Blister Pack In 1 Box (50268-314-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-314-11)","637","RC","50268-314-15","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-314-11","NDC","","","facility","both","1","EA","","0.76","0.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-278-11","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-260-11","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-325-11","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-405-11","NDC","","","facility","both","1","EA","","2.7","2.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-411-11","NDC","","","facility","both","1","EA","","2.54","2.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-504-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-482-11","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-478-11","NDC","","","facility","both","1","EA","","2.56","2.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-476-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-440-11","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Indomethacin: 50 Blister Pack In 1 Box, Unit-Dose (50268-430-15)  / 1 Capsule In 1 Blister Pack (50268-430-11)","637","RC","50268-430-15","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-430-11","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrocortisone Acetate: 24 Suppository In 1 Carton (50268-411-24)","637","RC","50268-411-24","NDC","","","facility","both","1","EA","","1.9","1.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-441-11","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-224-11","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-223-11","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-167-11","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-152-11","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-143-11","NDC","","","facility","both","1","EA","","1.69","1.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-168-11","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-131-11","NDC","","","facility","both","1","EA","","1.28","1.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-107-11","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-105-11","NDC","","","facility","both","1","EA","","1.9","1.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-132-11","NDC","","","facility","both","1","EA","","2.24","2.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-169-11","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-222-11","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Capsaicin External Analgesic: 1 Tube In 1 Carton (50268-195-60)  / 60 G In 1 Tube","637","RC","50268-195-60","NDC","","","facility","both","1","EA","","5.73","5.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-192-11","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-190-11","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clopidogrel: 20 Blister Pack In 1 Box (50268-184-12)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-184-11)","637","RC","50268-184-12","NDC","","","facility","both","1","EA","","10.38","10.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-184-11","NDC","","","facility","both","1","EA","","10.31","10.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-177-11","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-176-11","NDC","","","facility","both","1","EA","","1.22","1.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-173-11","NDC","","","facility","both","1","EA","","0.77","0.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 50 Blister Pack In 1 Box (50268-169-15)  / 1 Capsule In 1 Blister Pack (50268-169-11)","637","RC","50268-169-15","NDC","","","facility","both","1","EA","","1.57","1.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losortan Potassium: 50 Blister Pack In 1 Box (50268-504-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-504-11)","637","RC","50268-504-15","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-710-11","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-709-11","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-686-11","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Polyvinyl Alcohol: 15 Ml In 1 Bottle (50268-678-15)","637","RC","50268-678-15","NDC","","","facility","both","1","EA","","8.17","8.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-665-11","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-664-11","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-663-11","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 50 Blister Pack In 1 Box (50268-662-15)  / 1 Tablet In 1 Blister Pack (50268-662-11)","637","RC","50268-662-15","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-680-11","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-711-11","NDC","","","facility","both","1","EA","","1.51","1.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-779-11","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-768-11","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-755-11","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-745-11","NDC","","","facility","both","1","EA","","6.66","6.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sulfamethoxazole And Trimethoprim: 50 Blister Pack In 1 Box, Unit-Dose (50268-728-15)  / 1 Tablet In 1 Blister Pack (50268-728-11)","637","RC","50268-728-15","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-728-11","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-725-11","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin: 50 Blister Pack In 1 Box (50268-711-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-711-11)","637","RC","50268-711-15","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-169-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-662-11","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-550-11","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 50 Blister Pack In 1 Box, Unit-Dose (50268-541-15)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (50268-541-11)","637","RC","50268-541-15","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-541-11","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-535-11","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-526-11","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-525-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-521-11","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-520-11","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losortan Potassium: 50 Blister Pack In 1 Box (50268-505-15)  / 1 Tablet, Film Coated In 1 Blister Pack (50268-505-11)","637","RC","50268-505-15","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-505-11","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-631-11","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nifedipine Er: 50 Blister Pack In 1 Box, Unit-Dose (50268-597-15)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (50268-597-11)","637","RC","50268-597-15","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-597-11","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-595-11","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-594-11","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-585-11","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","50268-562-11","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Succinate: 100 Blister Pack In 1 Carton (51079-169-20)  / 1 Tablet, Film Coated, Extended Release In 1 Blister Pack (51079-169-01)","637","RC","51079-169-20","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Theo-24: 100 Capsule, Extended Release In 1 Bottle (52244-100-10)","637","RC","52244-100-10","NDC","","","facility","both","1","EA","","6.43","6.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eplerenone: 30 Tablet, Film Coated In 1 Bottle (51991-877-33)","637","RC","51991-877-33","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Duloxetine Delayed-Release: 90 Capsule, Delayed Release Pellets In 1 Bottle (51991-746-90)","637","RC","51991-746-90","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lacosamide: 60 Tablet, Film Coated In 1 Bottle (51991-351-06)","637","RC","51991-351-06","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desvenlafaxine: 90 Tablet, Extended Release In 1 Bottle (51991-312-90)","637","RC","51991-312-90","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxcarbazepine: 100 Tablet, Film Coated In 1 Bottle (51991-293-01)","637","RC","51991-293-01","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 100 Tablet In 1 Bottle, Plastic (52817-260-10)","637","RC","52817-260-10","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eprontia: 473 Ml In 1 Bottle (52652-9001-1)","637","RC","52652-9001-1","NDC","","","facility","both","1","EA","","10.44","10.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Zonisade: 1 Bottle In 1 Carton (52652-8001-1)  / 150 Ml In 1 Bottle","637","RC","52652-8001-1","NDC","","","facility","both","1","EA","","35.61","35.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fleqsuvy: 1 Bottle In 1 Carton (52652-6001-2)  / 300 Ml In 1 Bottle","637","RC","52652-6001-2","NDC","","","facility","both","1","EA","","40.18","40.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","52268-011-01","NDC","","","facility","both","1","EA","","98.77","98.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fleqsuvy: 1 Bottle In 1 Carton (52652-6001-1)  / 120 Ml In 1 Bottle","637","RC","52652-6001-1","NDC","","","facility","both","1","EA","","31.8","31.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Epaned: 150 Ml In 1 Bottle (52652-4001-1)","637","RC","52652-4001-1","NDC","","","facility","both","1","EA","","6.91","6.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 1 Bottle In 1 Carton (52536-600-11)  / 120 Ml In 1 Bottle","637","RC","52536-600-11","NDC","","","facility","both","1","EA","","15.95","15.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"60 mL in 1 BOTTLE (52380-1905-2) ","637","RC","52380-1905-2","NDC","","","facility","both","1","EA","","1.42","1.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 1 Tube In 1 Carton (51672-4116-6)  / 45 G In 1 Tube","637","RC","51672-4116-6","NDC","","","facility","both","1","EA","","66.26","66.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenytoin Sodium: 100 Capsule, Extended Release In 1 Bottle (51672-4111-1)","637","RC","51672-4111-1","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenytoin: 237 Ml In 1 Bottle (51672-4069-1)","637","RC","51672-4069-1","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 450 Ml In 1 Bottle (51672-4047-9)","637","RC","51672-4047-9","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Warfarin Sodium: 100 Tablet In 1 Bottle (51672-4030-1)","637","RC","51672-4030-1","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 100 Tablet In 1 Bottle (51672-4023-1)","637","RC","51672-4023-1","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetazolamide: 100 Tablet In 1 Bottle (51672-4022-1)","637","RC","51672-4022-1","NDC","","","facility","both","1","EA","","0.31","0.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lidocaine: 1 Tube In 1 Carton (51672-3020-9)  / 35.44 G In 1 Tube","637","RC","51672-3020-9","NDC","","","facility","both","1","EA","","15.76","15.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate Oral Solution: 1 Bottle In 1 Carton (51672-5316-9)  / 500 Ml In 1 Bottle","637","RC","51672-5316-9","NDC","","","facility","both","1","EA","","6.63","6.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Enalapril Maleate: 100 Tablet In 1 Bottle (51672-4245-1)","637","RC","51672-4245-1","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 100 Tablet In 1 Bottle (52817-319-10)","637","RC","52817-319-10","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclobenzaprine Hydrochloride: 500 Tablet, Film Coated In 1 Bottle (52817-330-50)","637","RC","52817-330-50","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","54629-0772-41","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","54629-0095-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","54629-0050-24","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Haloperidol: 120 Ml In 1 Bottle, Dropper (54838-501-40)","637","RC","54838-501-40","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Tablet, Orally Disintegrating In 1 Blister Pack (55111-264-79)","637","RC","55111-264-79","NDC","","","facility","both","1","EA","","6.22","6.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Tablet, Orally Disintegrating In 1 Blister Pack (55111-263-79)","637","RC","55111-263-79","NDC","","","facility","both","1","EA","","3.92","3.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Tablet, Orally Disintegrating In 1 Blister Pack (55111-262-79)","637","RC","55111-262-79","NDC","","","facility","both","1","EA","","2.88","2.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tizanidine: 150 Tablet In 1 Bottle (55111-180-15)","637","RC","55111-180-15","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docusate Sodium Liquid: 473 Ml In 1 Bottle (54859-813-16)","637","RC","54859-813-16","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxepin Hydrochloride: 120 Ml In 1 Bottle, Plastic (54838-512-40)","637","RC","54838-512-40","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Oxybutynin Chloride: 473 Ml In 1 Bottle, Plastic (54838-510-80)","637","RC","54838-510-80","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 473 Ml In 1 Bottle, Plastic (54838-502-80)","637","RC","54838-502-80","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pentasa: 240 Capsule In 1 Bottle (54092-189-81)","637","RC","54092-189-81","NDC","","","facility","both","1","EA","","5.04","5.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Flecainide Acetate: 100 Tablet In 1 Bottle (53746-641-01)","637","RC","53746-641-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate: 50 Capsule In 1 Bottle, Plastic (53489-118-02)","637","RC","53489-118-02","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aminocaproic Acid: 236.5 Ml In 1 Bottle, Plastic (52817-815-08)","637","RC","52817-815-08","NDC","","","facility","both","1","EA","","16.75","16.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pentasa: 120 Capsule In 1 Bottle (54092-191-12)","637","RC","54092-191-12","NDC","","","facility","both","1","EA","","10.08","10.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adderall Xr: 100 Capsule, Extended Release In 1 Bottle (54092-381-01)","637","RC","54092-381-01","NDC","","","facility","both","1","EA","","11.83","11.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"SENNA: 236 mL in 1 BOTTLE (54162-007-08) ","637","RC","54162-007-08","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Intuniv: 100 Tablet, Extended Release In 1 Bottle (54092-513-02)","637","RC","54092-513-02","NDC","","","facility","both","1","EA","","16.12","16.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adderall Xr: 100 Capsule, Extended Release In 1 Bottle (54092-387-01)","637","RC","54092-387-01","NDC","","","facility","both","1","EA","","11.83","11.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Adderall Xr: 100 Capsule, Extended Release In 1 Bottle (54092-385-01)","637","RC","54092-385-01","NDC","","","facility","both","1","EA","","11.83","11.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-631-01","NDC","","","facility","both","1","EA","","2.63","2.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-630-01","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-608-01","NDC","","","facility","both","1","EA","","3.64","3.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-599-01","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-597-01","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-544-01","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-458-01","NDC","","","facility","both","1","EA","","0.9","0.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-453-01","NDC","","","facility","both","1","EA","","1.52","1.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-632-01","NDC","","","facility","both","1","EA","","4.77","4.77","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-767-01","NDC","","","facility","both","1","EA","","2.13","2.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-759-01","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-753-01","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-735-01","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-734-01","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-733-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-690-01","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-685-01","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-684-01","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-443-01","NDC","","","facility","both","1","EA","","1.1","1.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-285-01","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-284-01","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-255-01","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-246-01","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-211-01","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-210-01","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-206-01","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Allopurinol: 100 Blister Pack In 1 Carton (51079-205-20)  / 1 Tablet In 1 Blister Pack (51079-205-01)","637","RC","51079-205-20","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-205-01","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-209-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Diazepam: 100 Blister Pack In 1 Carton (51079-285-20)  / 1 Tablet In 1 Blister Pack (51079-285-01)","637","RC","51079-285-20","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-442-01","NDC","","","facility","both","1","EA","","0.94","0.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-441-01","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Carton (51079-440-20)  / 1 Tablet In 1 Blister Pack (51079-440-01)","637","RC","51079-440-20","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-440-01","NDC","","","facility","both","1","EA","","0.66","0.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-438-01","NDC","","","facility","both","1","EA","","1.29","1.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-437-01","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-436-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-375-01","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-348-01","NDC","","","facility","both","1","EA","","6.22","6.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-286-01","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-801-01","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trikafta: 4 Blister Pack In 1 Carton (51167-331-01)  / 1 Kit In 1 Blister Pack *  14 Tablet, Film Coated In 1 Blister Pack (51167-431-14)  *  7 Tablet, Film Coated In 1 Blister Pack (51167-531-07)","637","RC","51167-331-01","NDC","","","facility","both","1","EA","","537.16","537.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clobetasol Propionate: 1 Tube In 1 Carton (51672-1258-1)  / 15 G In 1 Tube","637","RC","51672-1258-1","NDC","","","facility","both","1","EA","","13.29","13.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluocinonide: 1 Tube In 1 Carton (51672-1264-1)  / 15 G In 1 Tube","637","RC","51672-1264-1","NDC","","","facility","both","1","EA","","21.9","21.9","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51672-2115-0","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51672-2114-0","NDC","","","facility","both","1","EA","","1.61","1.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Terbinafine Hydrochloride: 1 Tube In 1 Carton (51672-2080-1)  / 15 G In 1 Tube","637","RC","51672-2080-1","NDC","","","facility","both","1","EA","","8.46","8.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miconazole Nitrate: 1 Tube, With Applicator In 1 Carton (51672-2035-6)  / 45 G In 1 Tube, With Applicator","637","RC","51672-2035-6","NDC","","","facility","both","1","EA","","5.43","5.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Miconazole Nitrate: 1 Tube In 1 Carton (51672-2001-2)  / 30 G In 1 Tube","637","RC","51672-2001-2","NDC","","","facility","both","1","EA","","4.54","4.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mupirocin: 1 Tube In 1 Carton (51672-1370-1)  / 15 G In 1 Tube","637","RC","51672-1370-1","NDC","","","facility","both","1","EA","","124.5","124.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ketoconazole: 1 Tube In 1 Carton (51672-1298-1)  / 15 G In 1 Tube","637","RC","51672-1298-1","NDC","","","facility","both","1","EA","","30.11","30.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51672-2116-0","NDC","","","facility","both","1","EA","","1.81","1.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-922-01","NDC","","","facility","both","1","EA","","1.65","1.65","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-921-01","NDC","","","facility","both","1","EA","","0.63","0.63","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoprolol Tartrate: 100 Blister Pack In 1 Carton (51079-801-20)  / 1 Tablet, Film Coated In 1 Blister Pack (51079-801-01)","637","RC","51079-801-20","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-960-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Buspirone Hydrochloride: 100 Blister Pack In 1 Carton (51079-960-20)  / 1 Tablet In 1 Blister Pack (51079-960-01)","637","RC","51079-960-20","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-991-20)  / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-991-01) ","637","RC","51079-991-20","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 100 BLISTER PACK in 1 CARTON (51079-991-20)  / 1 TABLET, FILM COATED in 1 BLISTER PACK (51079-991-01) ","637","RC","51079-991-20","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-986-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-985-01","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-980-01","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","51079-978-01","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (60219-1522-1)","637","RC","60219-1522-1","NDC","","","facility","both","1","EA","","2.05","2.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyridoxine Hydrochloride: 25 Vial In 1 Tray (63323-180-01)  / 1 Ml In 1 Vial (63323-180-00)","637","RC","63323-180-01","NDC","","","facility","both","1","EA","","3.21","3.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tranexamic Acid: 30 Tablet In 1 Bottle (62559-265-30)","637","RC","62559-265-30","NDC","","","facility","both","1","EA","","4.43","4.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 1 Bottle In 1 Carton (62559-204-12)  / 120 Ml In 1 Bottle","637","RC","62559-204-12","NDC","","","facility","both","1","EA","","11.2","11.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 473 Ml In 1 Bottle, Plastic (62559-190-16)","637","RC","62559-190-16","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","62559-157-17","NDC","","","facility","both","1","EA","","1.76","1.76","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pancreaze: 1 Bottle, Glass In 1 Carton (62541-402-10)  / 100 Capsule, Delayed Release In 1 Bottle, Glass","637","RC","62541-402-10","NDC","","","facility","both","1","EA","","2.32","2.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guanfacine: 100 Tablet, Extended Release In 1 Bottle (62332-747-31)","637","RC","62332-747-31","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","62584-994-11","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","62584-984-11","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vancomycin Hydrochloride: 2 Blister Pack In 1 Carton (62559-390-20)  / 10 Capsule In 1 Blister Pack","637","RC","62559-390-20","NDC","","","facility","both","1","EA","","4.16","4.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","62584-733-11","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","62584-267-11","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Erythromycin Ethylsuccinate: 100 Ml In 1 Bottle (62559-630-01)","637","RC","62559-630-01","NDC","","","facility","both","1","EA","","4.56","4.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Mesalamine: 120 Capsule, Extended Release In 1 Bottle (62332-724-35)","637","RC","62332-724-35","NDC","","","facility","both","1","EA","","1.38","1.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Leflunomide: 30 Tablet In 1 Bottle (62332-062-30)","637","RC","62332-062-30","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (62175-310-37)","637","RC","62175-310-37","NDC","","","facility","both","1","EA","","5.48","5.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","62135-867-59","NDC","","","facility","both","1","EA","","129.21","129.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 473 Ml In 1 Bottle (62135-750-47)","637","RC","62135-750-47","NDC","","","facility","both","1","EA","","1.71","1.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Extended Release In 1 Bottle (62175-311-37)","637","RC","62175-311-37","NDC","","","facility","both","1","EA","","8.82","8.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (62332-498-30)","637","RC","62332-498-30","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lurasidone Hydrochloride: 30 Tablet, Film Coated In 1 Bottle (62332-497-30)","637","RC","62332-497-30","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 60 Blister Pack In 1 Carton (62332-365-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack","637","RC","62332-365-06","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 60 Blister Pack In 1 Carton (62332-364-06)  / 6 Tablet, Orally Disintegrating In 1 Blister Pack","637","RC","62332-364-06","NDC","","","facility","both","1","EA","","1.56","1.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"cephalexin: 100 CAPSULE in 1 BOTTLE (62756-294-88) ","637","RC","62756-294-88","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levonorgestral: 1 Tablet In 1 Blister Pack (62756-724-60)","637","RC","62756-724-60","NDC","","","facility","both","1","EA","","9.15","9.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-796-88)","637","RC","62756-796-88","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Banzel: 120 Tablet, Film Coated In 1 Bottle (62856-583-52)","637","RC","62856-583-52","NDC","","","facility","both","1","EA","","41.82","41.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Banzel: 120 Tablet, Film Coated In 1 Bottle (62856-582-52)","637","RC","62856-582-52","NDC","","","facility","both","1","EA","","21.91","21.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-798-88)","637","RC","62756-798-88","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 100 Tablet, Delayed Release In 1 Bottle (62756-797-88)","637","RC","62756-797-88","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Morphine Sulfate: 100 Tablet, Film Coated, Extended Release In 1 Bottle (63304-450-01)","637","RC","63304-450-01","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Potassium Chloride: 100 Tablet, Extended Release In 1 Bottle (63304-987-01)","637","RC","63304-987-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aptiom: 30 Tablet In 1 Bottle (63402-208-30)","637","RC","63402-208-30","NDC","","","facility","both","1","EA","","73.74","73.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aptiom: 30 Tablet In 1 Bottle (63402-204-30)","637","RC","63402-204-30","NDC","","","facility","both","1","EA","","74.33","74.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aptiom: 30 Tablet In 1 Bottle (63402-202-30)","637","RC","63402-202-30","NDC","","","facility","both","1","EA","","71.54","71.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone Hydrochloride: 4 Blister Pack In 1 Box, Unit-Dose (63739-005-32)  / 10 Capsule In 1 Blister Pack","637","RC","63739-005-32","NDC","","","facility","both","1","EA","","3.4","3.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aripiprazole: 10 Blister Pack In 1 Box, Unit-Dose (63739-074-10)  / 10 Tablet In 1 Blister Pack","637","RC","63739-074-10","NDC","","","facility","both","1","EA","","6.7","6.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Acetaminophen 325Mg Rs: 30 Blister Pack In 1 Box (63739-087-02)  / 10 Tablet In 1 Blister Pack","637","RC","63739-087-02","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losortan Potassium: 10 Blister Pack In 1 Box, Unit-Dose (63739-673-10)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","63739-673-10","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-671-10)  / 10 TABLET, COATED in 1 BLISTER PACK","637","RC","63739-671-10","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Famotidine: 10 Blister Pack In 1 Box, Unit-Dose (63739-645-10)  / 10 Tablet In 1 Blister Pack","637","RC","63739-645-10","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amlodipine Besylate: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-631-10)  / 10 TABLET in 1 BLISTER PACK","637","RC","63739-631-10","NDC","","","facility","both","1","EA","","0.46","0.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simvastatin: 10 Blister Pack In 1 Box, Unit-Dose (63739-573-10)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","63739-573-10","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Losartan Potassium: 10 Blister Pack In 1 Box, Unit-Dose (63739-686-10)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","63739-686-10","NDC","","","facility","both","1","EA","","0.86","0.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simvastatin: 10 Blister Pack In 1 Box, Unit-Dose (63739-571-10)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","63739-571-10","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tamsulosin Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-567-10)  / 10 Capsule In 1 Blister Pack","637","RC","63739-567-10","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 10 Blister Pack In 1 Box, Unit-Dose (63739-564-10)  / 10 Tablet, Delayed Release In 1 Blister Pack","637","RC","63739-564-10","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Simvastatin: 10 Blister Pack In 1 Box, Unit-Dose (63739-572-10)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","63739-572-10","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","63739-760-01","NDC","","","facility","both","1","EA","","2.08","2.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 10 Blister Pack In 1 Box, Unit-Dose (63739-992-10)  / 10 Tablet, Coated In 1 Blister Pack","637","RC","63739-992-10","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Ziprasidone Hydrochloride: 4 Blister Pack In 1 Box, Unit-Dose (63739-988-32)  / 10 Capsule In 1 Blister Pack","637","RC","63739-988-32","NDC","","","facility","both","1","EA","","3.5","3.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 10 Blister Pack In 1 Carton (63739-904-10)  / 10 Capsule In 1 Blister Pack","637","RC","63739-904-10","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 10 Blister Pack In 1 Carton (63739-903-10)  / 10 Capsule In 1 Blister Pack","637","RC","63739-903-10","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 10 Blister Pack In 1 Carton (63739-902-10)  / 10 Capsule In 1 Blister Pack","637","RC","63739-902-10","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Paroxetine: 10 Blister Pack In 1 Box, Unit-Dose (63739-888-10)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","63739-888-10","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 10 Blister Pack In 1 Box, Unit-Dose (63739-795-10)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","63739-795-10","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxychloroquine Sulfate: 10 Blister Pack In 1 Box, Unit-Dose (63739-777-10)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","63739-777-10","NDC","","","facility","both","1","EA","","5.01","5.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 10 Blister Pack In 1 Box, Unit-Dose (63739-560-10)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","63739-560-10","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gabapentin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-236-10)  / 10 CAPSULE in 1 BLISTER PACK","637","RC","63739-236-10","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Low Dose Aspirin: 30 Blister Pack In 1 Box (63739-212-02)  / 10 Tablet, Coated In 1 Blister Pack","637","RC","63739-212-02","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Phenobarbital: 10 Blister Pack In 1 Box (63739-192-10)  / 10 Tablet In 1 Blister Pack","637","RC","63739-192-10","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Nystatin: 5 Ml In 1 Cup, Unit-Dose (63739-160-70)","637","RC","63739-160-70","NDC","","","facility","both","1","EA","","1.55","1.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","63739-158-70","NDC","","","facility","both","1","EA","","3.4","3.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-145-10)  / 10 Tablet In 1 Blister Pack","637","RC","63739-145-10","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Bupropion Hydrochloride (Xl): 3 Blister Pack In 1 Box, Unit-Dose (63739-132-33)  / 10 Tablet, Extended Release In 1 Blister Pack","637","RC","63739-132-33","NDC","","","facility","both","1","EA","","3.05","3.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","63739-159-77","NDC","","","facility","both","1","EA","","1.49","1.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Capsule In 1 Carton (63739-297-10)","637","RC","63739-297-10","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Celecoxib: 100 Capsule In 1 Carton (63739-298-10)","637","RC","63739-298-10","NDC","","","facility","both","1","EA","","1.66","1.66","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 10 Blister Pack In 1 Box, Unit-Dose (63739-544-10)  / 10 Tablet In 1 Blister Pack","637","RC","63739-544-10","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levetiracetam: 2 TRAY in 1 CASE (63739-539-50)  / 20 CUP, UNIT-DOSE in 1 TRAY / 5 mL in 1 CUP, UNIT-DOSE","637","RC","63739-539-50","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydroxyzine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-483-10)  / 10 Tablet In 1 Blister Pack","637","RC","63739-483-10","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 10 Blister Pack In 1 Box, Unit-Dose (63739-480-10)  / 10 Tablet In 1 Blister Pack","637","RC","63739-480-10","NDC","","","facility","both","1","EA","","0.89","0.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baclofen: 10 Blister Pack In 1 Box, Unit-Dose (63739-479-10)  / 10 Tablet In 1 Blister Pack","637","RC","63739-479-10","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Aspirin Chewable: 30 Blister Pack In 1 Box (63739-434-02)  / 10 Tablet In 1 Blister Pack","637","RC","63739-434-02","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Isosorbide Dinitrate: 10 Blister Pack In 1 Box, Unit-Dose (63739-367-10)  / 10 Tablet In 1 Blister Pack","637","RC","63739-367-10","NDC","","","facility","both","1","EA","","1.33","1.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 10 Blister Pack In 1 Case (63739-328-10)  / 10 Tablet In 1 Blister Pack","637","RC","63739-328-10","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 10 Blister Pack In 1 Case (63739-327-10)  / 10 Tablet In 1 Blister Pack","637","RC","63739-327-10","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Spironolactone: 10 Blister Pack In 1 Box, Unit-Dose (63739-545-10)  / 10 Tablet In 1 Blister Pack","637","RC","63739-545-10","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methyldopa: 90 Tablet, Film Coated In 1 Bottle (62135-321-90)","637","RC","62135-321-90","NDC","","","facility","both","1","EA","","12.45","12.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-377-11","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alprazolam: 100 Blister Pack In 1 Box, Unit-Dose (60687-377-01)  / 1 Tablet In 1 Blister Pack (60687-377-11)","637","RC","60687-377-01","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-369-11","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-368-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-382-11","NDC","","","facility","both","1","EA","","1.29","1.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Benztropine Mesylate: 100 BLISTER PACK in 1 BOX, UNIT-DOSE (60687-356-01)  / 1 TABLET in 1 BLISTER PACK (60687-356-11) ","637","RC","60687-356-01","NDC","","","facility","both","1","EA","","0.82","0.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-351-11","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-345-11","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-340-11","NDC","","","facility","both","1","EA","","1.46","1.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-360-11","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-333-11","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-404-11","NDC","","","facility","both","1","EA","","1.02","1.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-402-11","NDC","","","facility","both","1","EA","","1.3","1.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-398-11","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-391-11","NDC","","","facility","both","1","EA","","1.29","1.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-390-11","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-388-11","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Alprazolam: 100 Blister Pack In 1 Box, Unit-Dose (60687-388-01)  / 1 Tablet In 1 Blister Pack (60687-388-11)","637","RC","60687-388-01","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-387-11","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-330-11","NDC","","","facility","both","1","EA","","9.22","9.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-256-11","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Box, Unit-Dose (60687-256-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-256-11)","637","RC","60687-256-01","NDC","","","facility","both","1","EA","","1.86","1.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-253-11","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-253-01)  / 1 Tablet In 1 Blister Pack (60687-253-11)","637","RC","60687-253-01","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-245-11","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Box, Unit-Dose (60687-245-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-245-11)","637","RC","60687-245-01","NDC","","","facility","both","1","EA","","1.86","1.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-242-11","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sertraline Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-242-01)  / 1 Tablet In 1 Blister Pack (60687-242-11)","637","RC","60687-242-01","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-283-11","NDC","","","facility","both","1","EA","","7.61","7.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-328-33","NDC","","","facility","both","1","EA","","6.2","6.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-319-11","NDC","","","facility","both","1","EA","","8.5","8.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-313-95","NDC","","","facility","both","1","EA","","5.94","5.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-312-11","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-309-11","NDC","","","facility","both","1","EA","","10.24","10.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-303-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-302-95","NDC","","","facility","both","1","EA","","2.97","2.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-293-11","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-292-11","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-409-95","NDC","","","facility","both","1","EA","","1.41","1.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-413-11","NDC","","","facility","both","1","EA","","1.85","1.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-487-11","NDC","","","facility","both","1","EA","","0.95","0.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-486-11","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-476-11","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-473-11","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 100 Blister Pack In 1 Box, Unit-Dose (60687-473-01)  / 1 Capsule In 1 Blister Pack (60687-473-11)","637","RC","60687-473-01","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-464-11","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-462-11","NDC","","","facility","both","1","EA","","6.7","6.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-475-11","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 100 Blister Pack In 1 Box, Unit-Dose (60687-495-01)  / 1 Capsule In 1 Blister Pack (60687-495-11)","637","RC","60687-495-01","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-495-11","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Box, Unit-Dose (60687-519-01)  / 1 Tablet In 1 Blister Pack (60687-519-11)","637","RC","60687-519-01","NDC","","","facility","both","1","EA","","0.84","0.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-518-11","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Doxycycline Hyclate: 50 Blister Pack In 1 Box, Unit-Dose (60687-513-65)  / 1 Capsule In 1 Blister Pack (60687-513-11)","637","RC","60687-513-65","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-513-11","NDC","","","facility","both","1","EA","","2.23","2.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-508-11","NDC","","","facility","both","1","EA","","0.79","0.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Box, Unit-Dose (60687-508-01)  / 1 Tablet In 1 Blister Pack (60687-508-11)","637","RC","60687-508-01","NDC","","","facility","both","1","EA","","0.8","0.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-507-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-506-11","NDC","","","facility","both","1","EA","","0.75","0.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pregabalin: 100 Blister Pack In 1 Box, Unit-Dose (60687-506-01)  / 1 Capsule In 1 Blister Pack (60687-506-11)","637","RC","60687-506-01","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-497-11","NDC","","","facility","both","1","EA","","0.72","0.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-496-11","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-461-11","NDC","","","facility","both","1","EA","","1.01","1.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-439-11","NDC","","","facility","both","1","EA","","0.58","0.58","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-437-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-436-11","NDC","","","facility","both","1","EA","","2.41","2.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-428-11","NDC","","","facility","both","1","EA","","1.13","1.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-423-11","NDC","","","facility","both","1","EA","","3.33","3.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-433-11","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-443-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Glycopyrrolate: 100 Blister Pack In 1 Box, Unit-Dose (60687-458-01)  / 1 Tablet In 1 Blister Pack (60687-458-11)","637","RC","60687-458-01","NDC","","","facility","both","1","EA","","1.74","1.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-457-11","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-454-11","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-453-11","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Box, Unit-Dose (60687-453-01)  / 1 Tablet In 1 Blister Pack (60687-453-11)","637","RC","60687-453-01","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-451-11","NDC","","","facility","both","1","EA","","4.91","4.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-450-11","NDC","","","facility","both","1","EA","","0.81","0.81","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Labetalol Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-450-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-450-11)","637","RC","60687-450-01","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-447-11","NDC","","","facility","both","1","EA","","2.72","2.72","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-446-11","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-444-11","NDC","","","facility","both","1","EA","","0.97","0.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-234-11","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rosuvastatin Calcium: 100 Blister Pack In 1 Box, Unit-Dose (60687-234-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-234-11)","637","RC","60687-234-01","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guanfacine Extended-Release: 100 Tablet, Extended Release In 1 Bottle (60505-3929-1)","637","RC","60505-3929-1","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Guanfacine Extended-Release: 100 Tablet, Extended Release In 1 Bottle (60505-3927-1)","637","RC","60505-3927-1","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3276-0)  / 10 Tablet, Orally Disintegrating In 1 Blister Pack","637","RC","60505-3276-0","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Lamivudine: 60 Tablet, Film Coated In 1 Bottle (60505-3251-6)","637","RC","60505-3251-6","NDC","","","facility","both","1","EA","","6.23","6.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3140-0)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","60505-3140-0","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3114-0)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","60505-3114-0","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3113-0)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","60505-3113-0","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Prasugrel: 30 Tablet, Film Coated In 1 Bottle (60505-4643-3)","637","RC","60505-4643-3","NDC","","","facility","both","1","EA","","1.08","1.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3111-0)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","60505-3111-0","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluvoxamine Maleate: 100 Tablet In 1 Bottle (60505-0164-1)","637","RC","60505-0164-1","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Amoxicillin And Clavulanate Potassium: 150 Ml In 1 Bottle, Plastic (60432-065-47)","637","RC","60432-065-47","NDC","","","facility","both","1","EA","","2.3","2.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Sf: 1 Tube In 1 Carton (60258-151-01)  / 56 G In 1 Tube","637","RC","60258-151-01","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Etravirine: 60 Tablet In 1 Bottle, Plastic (60219-1722-6)","637","RC","60219-1722-6","NDC","","","facility","both","1","EA","","22.46","22.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tetracycline Hydrochloride: 100 Capsule In 1 Bottle (60219-1523-1)","637","RC","60219-1523-1","NDC","","","facility","both","1","EA","","2.95","2.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluvoxamine Maleate: 100 Tablet In 1 Bottle (60505-0165-1)","637","RC","60505-0165-1","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Fluvoxamine Maleate: 100 Tablet In 1 Bottle (60505-0166-1)","637","RC","60505-0166-1","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Olanzapine: 10 Blister Pack In 1 Carton (60505-3110-0)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","60505-3110-0","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carbamazepine: 120 Capsule, Extended Release In 1 Bottle (60505-2806-7)","637","RC","60505-2806-7","NDC","","","facility","both","1","EA","","2.16","2.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Trazodone Hydrochloride: 100 Tablet In 1 Bottle (60505-2654-1)","637","RC","60505-2654-1","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Midodrine Hydrochloride: 100 Tablet In 1 Bottle (60505-1320-1)","637","RC","60505-1320-1","NDC","","","facility","both","1","EA","","0.87","0.87","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Azelastine Hydrochloride: 1 Bottle, Spray In 1 Carton (60505-0833-5)  / 200 Spray, Metered In 1 Bottle, Spray","637","RC","60505-0833-5","NDC","","","facility","both","1","EA","","25.82","25.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 1 Bottle, Spray In 1 Carton (60505-0815-0)  / 50 Spray In 1 Bottle, Spray","637","RC","60505-0815-0","NDC","","","facility","both","1","EA","","151.4","151.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Desmopressin Acetate: 100 Tablet In 1 Bottle (60505-0257-1)","637","RC","60505-0257-1","NDC","","","facility","both","1","EA","","1.07","1.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-184-11","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-179-11","NDC","","","facility","both","1","EA","","8.86","8.86","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-178-11","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-163-11","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-161-11","NDC","","","facility","both","1","EA","","1.06","1.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-155-11","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-152-11","NDC","","","facility","both","1","EA","","0.43","0.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-195-11","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-199-11","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-231-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-230-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-229-11","NDC","","","facility","both","1","EA","","0.91","0.91","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-224-11","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Gemfibrozil: 100 Blister Pack In 1 Box, Unit-Dose (60687-224-01)  / 1 Tablet In 1 Blister Pack (60687-224-11)","637","RC","60687-224-01","NDC","","","facility","both","1","EA","","0.35","0.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-211-11","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-210-11","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-206-11","NDC","","","facility","both","1","EA","","1.34","1.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cyclosporine: 60 Vial In 1 Tray (60505-6202-2)  / .4 Ml In 1 Vial","637","RC","60505-6202-2","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60505-7061-0","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60505-7062-0","NDC","","","facility","both","1","EA","","3.08","3.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-124-11","NDC","","","facility","both","1","EA","","0.38","0.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-113-11","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonidine Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-113-01)  / 1 Tablet In 1 Blister Pack (60687-113-11)","637","RC","60687-113-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-149-11","NDC","","","facility","both","1","EA","","20.75","20.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Divalproex Sodium: 10 Blister Pack In 1 Box, Unit-Dose (63739-995-10)  / 10 Capsule In 1 Blister Pack","637","RC","63739-995-10","NDC","","","facility","both","1","EA","","1.16","1.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Betaxolol Hydrochloride: 1 Bottle, Plastic In 1 Carton (61314-245-01)  / 5 Ml In 1 Bottle, Plastic","637","RC","61314-245-01","NDC","","","facility","both","1","EA","","84.62","84.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docosanol: 1 Tube In 1 Package (61269-981-35)  / 2 G In 1 Tube","637","RC","61269-981-35","NDC","","","facility","both","1","EA","","24.05","24.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pyridium: 100 Tablet, Film Coated In 1 Bottle (60846-501-01)","637","RC","60846-501-01","NDC","","","facility","both","1","EA","","7.39","7.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Docosanol: 2 G In 1 Tube (61269-881-35)","637","RC","61269-881-35","NDC","","","facility","both","1","EA","","17.73","17.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-836-11","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-833-11","NDC","","","facility","both","1","EA","","0.41","0.41","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-822-11","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydralazine Hydrochloride: 100 Blister Pack In 1 Carton (60687-822-01)  / 1 Tablet In 1 Blister Pack (60687-822-11)","637","RC","60687-822-01","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-815-11","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-810-11","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-807-11","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-795-11","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tramadol Hydrochloride: 100 Blister Pack In 1 Carton (60687-795-01)  / 1 Tablet, Coated In 1 Blister Pack (60687-795-11)","637","RC","60687-795-01","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-838-11","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cytomel: 100 Tablet In 1 Bottle (60793-115-01)","637","RC","60793-115-01","NDC","","","facility","both","1","EA","","0.64","0.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-858-11","NDC","","","facility","both","1","EA","","2.02","2.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-841-11","NDC","","","facility","both","1","EA","","2.59","2.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Biktarvy: 30 Tablet In 1 Bottle, Plastic (61958-2501-1)","637","RC","61958-2501-1","NDC","","","facility","both","1","EA","","230.82","230.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Vemlidy: 30 Tablet In 1 Bottle, Plastic (61958-2301-1)","637","RC","61958-2301-1","NDC","","","facility","both","1","EA","","84.46","84.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Descovy: 30 Tablet In 1 Blister Pack (61958-2002-2)","637","RC","61958-2002-2","NDC","","","facility","both","1","EA","","121.85","121.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Descovy: 30 Tablet In 1 Bottle, Plastic (61958-2002-1)","637","RC","61958-2002-1","NDC","","","facility","both","1","EA","","121.84","121.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","61874-130-11","NDC","","","facility","both","1","EA","","83.99","83.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","61874-115-11","NDC","","","facility","both","1","EA","","83.32","83.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Stribild: 30 Tablet, Film Coated In 1 Bottle, Plastic (61958-1201-1)","637","RC","61958-1201-1","NDC","","","facility","both","1","EA","","231.06","231.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methylphenidate Hydrochloride: 100 Tablet, Film Coated, Extended Release In 1 Bottle (62037-727-01)","637","RC","62037-727-01","NDC","","","facility","both","1","EA","","8.82","8.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-519-11","NDC","","","facility","both","1","EA","","0.83","0.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-595-11","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-593-11","NDC","","","facility","both","1","EA","","0.28","0.28","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrochlorothiazide: 100 Blister Pack In 1 Box, Unit-Dose (60687-593-01)  / 1 Tablet In 1 Blister Pack (60687-593-11)","637","RC","60687-593-01","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-591-11","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-590-11","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-590-01)  / 1 Tablet In 1 Blister Pack (60687-590-11)","637","RC","60687-590-01","NDC","","","facility","both","1","EA","","0.55","0.55","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-588-11","NDC","","","facility","both","1","EA","","0.53","0.53","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-587-11","NDC","","","facility","both","1","EA","","0.4","0.4","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-586-11","NDC","","","facility","both","1","EA","","2.78","2.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-585-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-584-11","NDC","","","facility","both","1","EA","","4.73","4.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-598-11","NDC","","","facility","both","1","EA","","0.61","0.61","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-623-11","NDC","","","facility","both","1","EA","","1.78","1.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valsartan: 100 Blister Pack In 1 Box, Unit-Dose (60687-623-01)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-623-11)","637","RC","60687-623-01","NDC","","","facility","both","1","EA","","1.78","1.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-620-11","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-618-11","NDC","","","facility","both","1","EA","","1.64","1.64","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Valsartan: 30 Blister Pack In 1 Box, Unit-Dose (60687-612-21)  / 1 Tablet, Film Coated In 1 Blister Pack (60687-612-11)","637","RC","60687-612-21","NDC","","","facility","both","1","EA","","0.7","0.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-612-11","NDC","","","facility","both","1","EA","","1.35","1.35","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-609-11","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Propranolol Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-609-01)  / 1 Tablet In 1 Blister Pack (60687-609-11)","637","RC","60687-609-01","NDC","","","facility","both","1","EA","","1.21","1.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-602-11","NDC","","","facility","both","1","EA","","0.26","0.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-580-11","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-550-11","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metronidazole: 100 Blister Pack In 1 Box, Unit-Dose (60687-550-01)  / 1 Tablet In 1 Blister Pack (60687-550-11)","637","RC","60687-550-01","NDC","","","facility","both","1","EA","","0.78","0.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-544-11","NDC","","","facility","both","1","EA","","0.73","0.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Clonazepam: 100 Blister Pack In 1 Box, Unit-Dose (60687-544-01)  / 1 Tablet In 1 Blister Pack (60687-544-11)","637","RC","60687-544-01","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-538-11","NDC","","","facility","both","1","EA","","3.32","3.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-534-40","NDC","","","facility","both","1","EA","","49.21","49.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-530-11","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Levothyroxine Sodium: 100 Blister Pack In 1 Box (60687-530-01)  / 1 Tablet In 1 Blister Pack (60687-530-11)","637","RC","60687-530-01","NDC","","","facility","both","1","EA","","0.88","0.88","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-540-11","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-552-11","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-555-11","NDC","","","facility","both","1","EA","","0.98","0.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-579-11","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydromorphone Hydrochloride: 100 Blister Pack In 1 Box, Unit-Dose (60687-579-01)  / 1 Tablet In 1 Blister Pack (60687-579-11)","637","RC","60687-579-01","NDC","","","facility","both","1","EA","","0.51","0.51","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-576-40","NDC","","","facility","both","1","EA","","8.15","8.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Rifampin: 30 Blister Pack In 1 Box, Unit-Dose (60687-575-21)  / 1 Capsule In 1 Blister Pack (60687-575-11)","637","RC","60687-575-21","NDC","","","facility","both","1","EA","","5.29","5.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-570-11","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-568-11","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Methocarbamol: 100 Blister Pack In 1 Box, Unit-Dose (60687-568-01)  / 1 Tablet In 1 Blister Pack (60687-568-11)","637","RC","60687-568-01","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-563-11","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-559-11","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-558-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-627-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-629-11","NDC","","","facility","both","1","EA","","5.48","5.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-730-11","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-728-11","NDC","","","facility","both","1","EA","","0.85","0.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-725-11","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-723-11","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-717-11","NDC","","","facility","both","1","EA","","0.67","0.67","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-711-11","NDC","","","facility","both","1","EA","","0.6","0.6","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-722-11","NDC","","","facility","both","1","EA","","0.99","0.99","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-733-11","NDC","","","facility","both","1","EA","","1.79","1.79","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-788-11","NDC","","","facility","both","1","EA","","1.25","1.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-783-11","NDC","","","facility","both","1","EA","","0.49","0.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-756-11","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-755-40","NDC","","","facility","both","1","EA","","4.5","4.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-746-11","NDC","","","facility","both","1","EA","","2.95","2.95","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-745-11","NDC","","","facility","both","1","EA","","1.49","1.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-742-11","NDC","","","facility","both","1","EA","","2.31","2.31","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-736-11","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Pantoprazole Sodium: 80 Blister Pack In 1 Carton (60687-736-09)  / 1 Tablet, Delayed Release In 1 Blister Pack (60687-736-11)","637","RC","60687-736-09","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-793-11","NDC","","","facility","both","1","EA","","3.13","3.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-704-11","NDC","","","facility","both","1","EA","","0.68","0.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-661-11","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-657-11","NDC","","","facility","both","1","EA","","0.45","0.45","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-656-11","NDC","","","facility","both","1","EA","","0.74","0.74","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-634-11","NDC","","","facility","both","1","EA","","1.97","1.97","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-633-11","NDC","","","facility","both","1","EA","","4.89","4.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-632-11","NDC","","","facility","both","1","EA","","1","1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-631-11","NDC","","","facility","both","1","EA","","0.93","0.93","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Metoclopramide: 100 Blister Pack In 1 Box, Unit-Dose (60687-631-01)  / 1 Tablet In 1 Blister Pack (60687-631-11)","637","RC","60687-631-01","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-664-11","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-693-11","NDC","","","facility","both","1","EA","","0.69","0.69","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-683-11","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Hydrochlorothiazide: 100 Blister Pack In 1 Carton (60687-683-01)  / 1 Capsule In 1 Blister Pack (60687-683-11)","637","RC","60687-683-01","NDC","","","facility","both","1","EA","","0.39","0.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-681-11","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Folic Acid: 100 Blister Pack In 1 Carton (60687-681-01)  / 1 Tablet In 1 Blister Pack (60687-681-11)","637","RC","60687-681-01","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-680-11","NDC","","","facility","both","1","EA","","1.09","1.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-676-11","NDC","","","facility","both","1","EA","","2","2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","60687-669-11","NDC","","","facility","both","1","EA","","0.62","0.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","3700074092","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","3877911865","NDC","","","facility","both","1","EA","","1.94","1.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","3877917798","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","3932801816","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","4009311213","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","4843310401","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","4746907405","NDC","","","facility","both","1","EA","","0.52","0.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","3660219209","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","3660207917","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","2055503300","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","2055502700","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","2055502500","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","2055500100","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1878777232","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","2055501900","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","2055503601","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","2055503901","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","3504600222","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","3172293847","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","3172293747","NDC","","","facility","both","1","EA","","0.42","0.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","3010304200","NDC","","","facility","both","1","EA","","0.71","0.71","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","3172213747","NDC","","","facility","both","1","EA","","4.42","4.42","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5789645101","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5789663412","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5789675201","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5789684401","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5789686406","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5789687503","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6025816001","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6025800615","NDC","","","facility","both","1","EA","","0.59","0.59","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5777100704","NDC","","","facility","both","1","EA","","0.5","0.5","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5865731216","NDC","","","facility","both","1","EA","","0.34","0.34","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5865731016","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5865717001","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5026886011","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5026852411","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5026837511","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5026885211","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5026818311","NDC","","","facility","both","1","EA","","4.49","4.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5618412041","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5485951608","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5483801150","NDC","","","facility","both","1","EA","","0.14","0.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5483800650","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5319136201","NDC","","","facility","both","1","EA","","0.33","0.33","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","5280048826","NDC","","","facility","both","1","EA","","4.47","4.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6299127531","NDC","","","facility","both","1","EA","","3.78","3.78","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1785600102","NDC","","","facility","both","1","EA","","2.7","2.7","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1657187290","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","536134380","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","536344308","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","536440601","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","573051330","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","592800100","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","574031216","NDC","","","facility","both","1","EA","","0.56","0.56","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","574031116","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","395266216","NDC","","","facility","both","1","EA","","0.13","0.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","574030416","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","574030316","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","574030216","NDC","","","facility","both","1","EA","","0.44","0.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","573475652","NDC","","","facility","both","1","EA","","0.19","0.19","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","395266128","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","121059515","NDC","","","facility","both","1","EA","","7.75","7.75","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","87086644","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","87040501","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","45018404","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","87040203","NDC","","","facility","both","1","EA","","0.3","0.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","121067616","NDC","","","facility","both","1","EA","","1.18","1.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","395266116","NDC","","","facility","both","1","EA","","0.17","0.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","395009016","NDC","","","facility","both","1","EA","","0.16","0.16","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","121059530","NDC","","","facility","both","1","EA","","3.3","3.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","121119030","NDC","","","facility","both","1","EA","","8.3","8.3","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","592800308","NDC","","","facility","both","1","EA","","1.98","1.98","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","761012012","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1000670038","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1013574901","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1093904633","NDC","","","facility","both","1","EA","","1.8","1.8","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1093915933","NDC","","","facility","both","1","EA","","1.14","1.14","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1093965744","NDC","","","facility","both","1","EA","","4.02","4.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1093969133","NDC","","","facility","both","1","EA","","0.36","0.36","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1650055434","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1152372688","NDC","","","facility","both","1","EA","","2.03","2.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1093995607","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1093995585","NDC","","","facility","both","1","EA","","2.38","2.38","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1093976744","NDC","","","facility","both","1","EA","","1.68","1.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1093995959","NDC","","","facility","both","1","EA","","1.39","1.39","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","1000670028","NDC","","","facility","both","1","EA","","0.1","0.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","904421551","NDC","","","facility","both","1","EA","","0.09","0.09","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","904208560","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","904052361","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","802392716","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","904053061","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","904522452","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","904546072","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","904759161","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","904740361","NDC","","","facility","both","1","EA","","0.24","0.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","904719106","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","904598463","NDC","","","facility","both","1","EA","","7.92","7.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6332325402","NDC","","","facility","both","1","EA","","30.57","30.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0002-8803-01","NDC","","","facility","both","1","EA","","23.37","23.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0002-8805-01","NDC","","","facility","both","1","EA","","23.37","23.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Humulin N: 5 Syringe In 1 Carton (0002-8805-59)  / 3 Ml In 1 Syringe (0002-8805-01)","637","RC","0002-8805-59","NDC","","","facility","both","1","EA","","23.37","23.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","97344038787","NDC","","","facility","both","1","EA","","0.01","0.01","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","9866900201","NDC","","","facility","both","1","EA","","7.94","7.94","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","8770140065","NDC","","","facility","both","1","EA","","2.89","2.89","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eliquis: 10 Blister Pack In 1 Carton (0003-0893-31)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","0003-0893-31","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tamiflu: 1 Blister Pack In 1 Carton (0004-0801-85)  / 10 Capsule In 1 Blister Pack","637","RC","0004-0801-85","NDC","","","facility","both","1","EA","","23.2","23.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0006-0112-01","NDC","","","facility","both","1","EA","","18.26","18.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0005-4344-15","NDC","","","facility","both","1","EA","","1.84","1.84","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Tamiflu: 1 Blister Pack In 1 Carton (0004-0802-85)  / 10 Capsule In 1 Blister Pack","637","RC","0004-0802-85","NDC","","","facility","both","1","EA","","23.13","23.13","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Baraclude: 1 Bottle In 1 Carton (0003-1614-12)  / 210 Ml In 1 Bottle","637","RC","0003-1614-12","NDC","","","facility","both","1","EA","","30.37","30.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Cobenfy: 60 Capsule, Coated Pellets In 1 Bottle (0003-1100-60)","637","RC","0003-1100-60","NDC","","","facility","both","1","EA","","51.17","51.17","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eliquis: 10 Blister Pack In 1 Carton (0003-0894-31)  / 10 Tablet, Film Coated In 1 Blister Pack","637","RC","0003-0894-31","NDC","","","facility","both","1","EA","","2.47","2.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Eliquis: 60 Tablet, Film Coated In 1 Bottle, Plastic (0003-0894-21)","637","RC","0003-0894-21","NDC","","","facility","both","1","EA","","2.49","2.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7135101099","NDC","","","facility","both","1","EA","","0.54","0.54","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7135101001","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7139974015","NDC","","","facility","both","1","EA","","0.15","0.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6954323460","NDC","","","facility","both","1","EA","","0.07","0.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6936728302","NDC","","","facility","both","1","EA","","0.04","0.04","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6961801854","NDC","","","facility","both","1","EA","","0.18","0.18","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7139974805","NDC","","","facility","both","1","EA","","0.23","0.23","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7430000071","NDC","","","facility","both","1","EA","","7.73","7.73","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7214063608","NDC","","","facility","both","1","EA","","19.25","19.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7214003147","NDC","","","facility","both","1","EA","","26.24","26.24","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7214000022","NDC","","","facility","both","1","EA","","9.15","9.15","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7214000021","NDC","","","facility","both","1","EA","","21.02","21.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7214045231","NDC","","","facility","both","1","EA","","8.82","8.82","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7431200640","NDC","","","facility","both","1","EA","","0.11","0.11","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6845510890","NDC","","","facility","both","1","EA","","0.08","0.08","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6845510849","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6498010401","NDC","","","facility","both","1","EA","","0.57","0.57","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6498033901","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6373612002","NDC","","","facility","both","1","EA","","13.07","13.07","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6332325410","NDC","","","facility","both","1","EA","","34.85","34.85","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6845510826","NDC","","","facility","both","1","EA","","2.22","2.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6817600015","NDC","","","facility","both","1","EA","","0.92","0.92","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6498033990","NDC","","","facility","both","1","EA","","0.12","0.12","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6817600011","NDC","","","facility","both","1","EA","","0.96","0.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6817600010","NDC","","","facility","both","1","EA","","1.62","1.62","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6809422401","NDC","","","facility","both","1","EA","","1.96","1.96","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","6761811128","NDC","","","facility","both","1","EA","","0.47","0.47","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","0006-0221-01","NDC","","","facility","both","1","EA","","18.26","18.26","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","8068102500","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","8068104100","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","8068107100","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","8068109800","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","8068111600","NDC","","","facility","both","1","EA","","0.03","0.03","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7985450032","NDC","","","facility","both","1","EA","","0.06","0.06","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","8068116900","NDC","","","facility","both","1","EA","","0.02","0.02","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","8068115500","NDC","","","facility","both","1","EA","","3.46","3.46","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","8068114000","NDC","","","facility","both","1","EA","","0.05","0.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","8068117200","NDC","","","facility","both","1","EA","","0.48","0.48","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7733352025","NDC","","","facility","both","1","EA","","0.37","0.37","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7733393725","NDC","","","facility","both","1","EA","","0.21","0.21","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7733311025","NDC","","","facility","both","1","EA","","0.29","0.29","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7583402001","NDC","","","facility","both","1","EA","","0.27","0.27","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7733393810","NDC","","","facility","both","1","EA","","0.2","0.2","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7733398325","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7733394825","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7733394810","NDC","","","facility","both","1","EA","","0.32","0.32","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7733394025","NDC","","","facility","both","1","EA","","0.25","0.25","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","637","RC","7733393825","NDC","","","facility","both","1","EA","","0.22","0.22","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Kymriah: 1 Injection, Suspension In 1 Bag (0078-0846-19)","891","RC","0078-0846-19","NDC","","","facility","both","1","EA","","646485.83","646485.83","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Breyanzi: 1 Kit In 1 Carton (73153-900-01)  *  5 Ml In 1 Vial, Single-Dose (73153-902-04)  *  5 Ml In 1 Vial, Single-Dose (73153-901-08)","891","RC","73153-900-01","NDC","","","facility","both","1","EA","","517729.43","517729.43","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Breyanzi: 1 Kit In 1 Carton (73153-900-01)  *  5 Ml In 1 Vial, Single-Dose (73153-902-04)  *  5 Ml In 1 Vial, Single-Dose (73153-901-08)","891","RC","73153-900-01","NDC","","","facility","both","1","EA","","584485.44","584485.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Breyanzi: 1 Kit In 1 Carton (73153-900-01)  *  5 Ml In 1 Vial, Single-Dose (73153-902-04)  *  5 Ml In 1 Vial, Single-Dose (73153-901-08)","891","RC","73153-900-01","NDC","","","facility","both","1","EA","","584485.44","584485.44","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","891","RC","71287-220-01","NDC","","","facility","both","1","EA","","508200","508200","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","891","RC","71287-219-01","NDC","","","facility","both","1","EA","","508200","508200","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","891","RC","71287-219-01","NDC","","","facility","both","1","EA","","508200","508200","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","891","RC","71287-119-01","NDC","","","facility","both","1","EA","","553938","553938","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"NDC Description Not Available","891","RC","71287-119-01","NDC","","","facility","both","1","EA","","876222.1","876222.1","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Abecma: 1 Suspension In 1 Bag (59572-515-01)","891","RC","59572-515-01","NDC","","","facility","both","1","EA","","581143.68","581143.68","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvykti: 1 Injection, Suspension In 1 Bag (57894-111-02)","891","RC","57894-111-02","NDC","","","facility","both","1","EA","","526845","526845","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvykti: 1 Injection, Suspension In 1 Bag (57894-111-02)","891","RC","57894-111-02","NDC","","","facility","both","1","EA","","610841.49","610841.49","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvykti: 1 Injection, Suspension In 1 Bag (57894-111-01)","891","RC","57894-111-01","NDC","","","facility","both","1","EA","","526845","526845","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvykti: 1 Injection, Suspension In 1 Bag (57894-111-01)","891","RC","57894-111-01","NDC","","","facility","both","1","EA","","555365.52","555365.52","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvykti: 1 Injection, Suspension In 1 Bag (57894-111-01)","891","RC","57894-111-01","NDC","","","facility","both","1","EA","","574261.05","574261.05","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"
"Carvykti: 1 Injection, Suspension In 1 Bag (57894-111-01)","891","RC","57894-111-01","NDC","","","facility","both","1","EA","","606777","606777","","","","","","","","","","","","","Gross Charge Type: Pharmacy | NDC EA = 1 EA"